Effectiveness of an out-of-pocket cost removal intervention on health check attendance in Japan

Abstract Background: Annual health checks are important for identifying individuals at high risk for cardiometabolic diseases. In Japan, there is a nationwide program focused on providing specific health checks to screen for such high-risk individuals aged 40–74 years. However, there are socioeconomic disparities in health check attendance rates, and an intervention to lower financial barriers could be useful for increasing health check utilization. Thus, this study aimed to evaluate the effectiveness of an out-of-pocket (OOP) cost removal intervention on health check attendance in Japan.Methods: Data were obtained on beneficiaries of the National Health Insurance system of Yokohama City, Kanagawa Prefecture, Japan. In 2018, Yokohama started an intervention to remove OOP costs for specific health checks for all National Health Insurance beneficiaries. We analyzed data from 2015−2018 (131,295 people aged 40–74 years; 377,660 observations). Specific health check utilization in each year was set as the outcome variable.Results: A generalized estimating equation showed that people were more likely to receive specific health checks in 2018 (after the OOP cost removal intervention started) than in 2017 (immediately before the intervention; odds ratio [95% confidence interval] = 1.167 [1.149–1.185]), after adjusting for age, gender, tax exemption (a proxy variable for annual income), and residential area. Contrastingly, the likelihood of receiving specific health checks in 2015 and 2016 was almost the same as that in 2017 (1.025 [1.008–1.042] in 2015, and 0.959 [0.945–0.974] in 2016). Subgroup analyses revealed that the effectiveness of the OOP cost removal intervention was greater among the older age group and those who did not receive a tax exemption (i.e., those with relatively higher income). Conclusions: The present study showed that the OOP cost removal intervention could promote specific health check utilization. This indicates that financial incentives could motivate people’s behavior regarding health check attendance. However, as the effectiveness differed by age and income level, policymakers should consider the possibility that removing OOP costs widens the disparities in health check access.