Impacts of health checkup programs standardization on working-age self-employed and unemployed: Insights from Japan’s local government response to national policy

Masato Oikawa, Takamasa Otake, Toshihide Awatani, Haruko Noguchi and Akira Kawamura

Journal of Health Economics, 2025, vol. 103, issue C

Abstract: This study analyzes the effects of the expansion of municipal per capita expenses on health checkup programs, following the introduction of the Specific Health Checkups and Specific Health Guidance (SHC-SHG), on the health outcomes and behaviors of self-employed and unemployed populations, which have been largely overlooked by previous research. To address this, we applied a dosing difference-in-differences (DID) estimation method, exploiting variation in treatment intensity across municipalities. The DID estimation reveals that the SHC-SHG introduction led to a reduction in the proportion of people diagnosed with lifestyle-related diseases in the municipalities that required significant increases in per-capita health checkup program expenses to comply with the new program, with a more pronounced impact on those with multiple diagnoses compared to those with a single diagnosis. A subgroup analysis indicates that health improvements following the SHC-SHG introduction were observed among self-employed workers and homeowners, whereas such improvements were not evident among the unemployed and renters. Moreover, we identify significant behavioral changes among the population in the high-expansion municipalities following the policy introduction. A back-of-the-envelope calculation demonstrates the municipal response to the SHC-SHG introduction is cost-effective.

Keywords: Health checkup; Lifestyle-related diseases; Health outcomes; Health behaviors; Cost-effectiveness (search for similar items in EconPapers)
JEL-codes: I10 I12 I18 K32 (search for similar items in EconPapers)
Date: 2025
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Persistent link: https://EconPapers.repec.org/RePEc:eee:jhecon:v:103:y:2025:i:c:s0167629625000815

DOI: 10.1016/j.jhealeco.2025.103046

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