Impacts of health checkup programs standardization on working-age self-employed and unemployed: Insights from Japan’s local government response to national policy
研究日本特定健康检查和健康指导政策实施后，地方政府人均健康检查支出增加对自雇者和失业者健康结果与行为的影响，发现政策降低了多病共患比例，但对失业者和租房者效果不显著。
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.