Financial hardship due to out-of-pocket spending on health care: an exploratory study using the Japan Household Panel Survey

As population ageing continues in Japan, concerns are growing that the burden of out-of-pocket spending on health care will cause people financial hardship or force them to forgo necessary care. This study will use Japanese data to compare different measures of financial protection in health care, including those used for global monitoring of SDG indicator 3.8.2 [1], and assess their sensitivity to differences in health spending by age. Using these indicators, the study will also explore the levels and trends of financial hardship in health care among households with older persons in Japan and examine the potential impact of relevant policy changes. The results will have implications for both global and domestic monitoring of financial protection in health in the context of population ageing.

[1] SDG indicator 3.8.2 on catastrophic out-of-pocket health spending is defined as the “Proportion of the population with household expenditures on health greater than 10% of total household expenditure or income.” It is also calculated using 25% as the threshold.

• Describe the levels and trends of financial hardship due to out-of-pocket health spending using the Japan Household Panel Survey data.
• Analyze the association of household age structure with financial hardship and compare the sensitivity of different indicators to these age-related inequalities.
• Assess the potential impact of the change introduced in 2018 to the copayment thresholds for the high-cost medical expense benefit in Japan on households with older persons.

• All available data from the Japan Household Panel Survey from 2004 to 2022 (19 waves) will be analyzed.
• Prevalence of financial hardship in healthcare due to out-of-pocket payments will be calculated based on the current SDG indicator 3.8.2 used by WHO/World Bank and its variants including the proposed revised indicator for SDG 3.8.2.
• Indicators will be disaggregated into categories of household age composition to assess associations between financial hardship due to out-of-pocket health spending with age.
• Persistence of financial hardship due to out-of-pocket health spending among households with older persons will be analyzed by calculating transitional probabilities, means and counts over time.
• The change in prevalence of financial hardship before and after the policy revision in 2018 will be examined using different indicators and compared by household age composition and income level.

Kamimura K, Rosenberg M. “Persistent financial hardship among households with older persons in Japan”, International Health Economics Association 2025 Congress, Bali, Indonesia, 19 July 2025.

Forthcoming