Anticipation and Adaptation: Cost-Sharing Responses and Mortality Among the Oldest-Old

Rong Fu (), Masato Oikawa (), Akira Kawamura () and Haruko Noguchi ()
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Rong Fu: Faculty of Commerce, Waseda University, and Waseda Institute of Social & Human Capital Studies (WISH)
Masato Oikawa: Faculty of Education and Integrated Arts and Sciences, Waseda University, and WISH
Akira Kawamura: Faculty of Human Sciences, Waseda University, and WISH
Haruko Noguchi: Faculty of Political Science and Economics, Waseda University, and WISH

No 2610, Working Papers from Waseda University, Faculty of Political Science and Economics

Abstract: We study a Japanese reform that doubled coinsurance rates for higher-income enrollees aged 75+, using administrative data linking insurance claims to tax records for nearly the entire oldest-old population over 26 months. Patients exhibit a last-minute anticipatory surge, then persistently reduce utilization by cutting visit frequency rather than treatment intensity. Responses follow a gradient of service discretionarity, and a binding expenditure cap shields the most medically intensive patients from the reform’s financial impact. Despite utilization reductions, we find no detectable adverse effect on 15-month mortality. Cost-sharing increases, paired with effective safety nets, can restrain utilization without detectable mortality consequences.

Keywords: cost-sharing; healthcare utilization; oldest-old; value-based insurance design (search for similar items in EconPapers)
JEL-codes: H51 I11 I13 J14 (search for similar items in EconPapers)
Pages: 62 pages
Date: 2026-07
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