Changes in Health-related Quality of Life Among Impoverished Persons in the Free/Low-Cost Medical Care Program in Japan: Evidence From a Prospective Cohort Study

Background: The Free/Low-Cost Medical Care Program (FLCMC) can subsidize the payment (exempt/lower) in designated institutions in Japan. Given that poverty is a multidimensional concept including social isolation, the FLCMC applicants may need social support over and above financial aid to improve their quality of life. However, there was no data to discuss what services should be provided and to whom. Hence, we aimed to describe the changes in health-related quality of life scores among users of the FLCMC, with respect to their socioeconomic backgrounds. Methods: This cohort study included patients who newly used FLCMC from July 2018 to April 2019. We used patients’ social work records, obtained at baseline, and self-report questionnaires on the Medical Outcomes Study 8 Items Short Form Health Survey (SF-8), measured both at baseline and 6 months after the application. We used the change in physical and mental health component summary scores (PCS-8 and MCS-8, respectively) as outcome variables. Results: Multiple linear regression analyses, adjusting for age, sex, healthcare institute, and baseline PCS-8 and MCS-8, showed that lower income was associated with an increase in PCS-8 (coef. −0.09; 95% CI, −0.15 to, −0.03) and MCS-8 (coef. −0.04; 95% CI, −0.11, to 0.03). Living alone (versus living with someone) was potentially associated with a decrease in both PCS-8 (coef. −1.58; 95% CI, −7.26 to 4.09) and MCS-8 (coef. −3.62; 95% CI, −9.19 to 1.95). Conclusion: Among patients using FLCMC, those who live alone may need additional support. Further study testing the generalizability of the findings is required.