菅 万理

Abstract This study examines the impacts of demand-side (the improved employment protection law) and supply-side (pension reform) government interventions on older male workers’ employment outcomes in Japan. To identify the effects of interventions implemented concurrently, we employ a difference-in-difference-in-differences (DDD) approach with variation in the bindingness of the revision of employment protection law as our specification strategy. Our results show that the revised employment protection law had a significant positive impact on employment. However, the results of the event study’s DDD model show that the treatment effects do not last over time.

© 2019, Springer Nature Switzerland AG. Purpose: It is well-known that people psychologically adapt to health shocks over time and social participation (SP) has a favourable impact on health. Combining these two understandings, the current study addresses how psychological adaptation to major health shocks was affected by SP experience one year prior to the initial diagnosis. Methods: Data were collected from a twelve-wave nationwide panel survey conducted from 2005 to 2016, starting with 34,240 individuals aged 50–59 years. Individuals who were initially diagnosed with cancer, stroke, heart disease or diabetes at any time between the second and twelfth waves and kept diagnosed as such were focused on. Random-effects models were estimated to examine how baseline SP prior to the diagnosis affected the pace of change in psychological distress, which was measured using Kessler 6 (K6) scores (range 0–24; M 3.3 SD 4.2), following immediate responses to the initial diagnosis. Results: Baseline SP enabled or accelerated psychological adaptation to major health shocks. It is noted that the pace of decline of the K6 score per year after the immediate responses was 0.20 for cancer and 0.09 for diabetes (both p < 0.001) among men with baseline SP, in contrast with non-significant and limited changes among those without it. While the results for women were more mixed than those for men, the former results confirmed favourable impacts of baseline SP on psychological adaptation to health shocks in general. Conclusions: The results highlight a favourable impact of SP on psychological adaptation to health shocks.

© 2019 The Author(s). Background: It is well known that there are educational inequalities in incidences of non-communicable diseases (NCDs). Unlike most preceding studies, this study examined this issue using a hazards model analysis, with specific reference to the potential mediating effects of socioeconomic status (SES), other than educational level, and health behaviour as well as gender differences. Methods: Data were obtained from a 12-wave longitudinal nationwide survey conducted from 2005 to 2016 with middle-aged individuals in Japan. Participants included 31,210 individuals (15,127 men and 16,083 women) who were aged 50-59 years at wave 1. Incidences of six NCDs (diabetes, heart disease, stroke, hypertension, hyperlipidaemia, and cancer), initially diagnosed between waves 2 and 12, were considered. Cox proportional hazards models were estimated to examine their associations with educational level, adjusted for baseline SES and health behaviour. Educational inequalities were measured by the relative indices of inequality (RII). Results: Lower educational level was associated with higher incidences of diabetes and stroke among both men and women, and with hypertension only among women. After controlling for baseline SES, health behaviour, and regional areas, the RII ranged from 1.37 (95% confidence interval [CI]: 1.02-1.85) for stroke among men to 2.65 (95% CI, 2.09-3.36) for diabetes among women. Small to moderate parts (0.0-32.7%) of the RII were explained by baseline SES and health behaviour. A negative association with education was observed for diabetes and hypertension among women. Conclusions: Results underscored the importance of educational level as a predictor of the incidences of selected NCDs, especially among women, with limited mediating effects of other SES and health behaviour.

© 2018 Elsevier Inc. Social participation (SP) is known to have a favorable impact on the health of older adults by reducing the risk of functional disability, psychological distress, cognitive impairment, and mortality. However, the preventive impact of SP on non-communicable diseases (NCDs) among middle-aged adults is largely understudied. Using the dataset from a population-based, 10-wave longitudinal survey that started with Japanese adults aged 50–59 years in 2005 (16,290 men and 17,248 women), we estimated Cox proportional hazards models to estimate the preventive impact of SP adjusted for baseline covariates. After controlling for baseline covariates, baseline participation in at least one of six types of SP prevented diabetes both for men (hazard rate [HR] = 0.86; 95% confidence interval [CI] = 0.77, 0.95) and women (HR = 0.75; 95% CI = 0.66, 0.85) and stroke both for men (HR = 0.83; 95% CI = 0.70, 0.99) and women (HR = 0.78; 95% CI = 0.64, 0.97). SP also had a preventive impact on hypertension only for women (HR = 0.91; 95% CI = 0.84, 0.99). SP did not prevent heart disease, hyperlipidemia, or cancer for either gender. We also found that SP tended to have a stronger preventive effect when it was conducted with other persons than done alone, highlighting personal interactions as a key aspect of SP for later health outcomes. Overall, the results showed that SP can prevent the onset of selected NCDs, suggesting that policy measures to encourage SP may be favorable for the health of middle-aged adults.

© 2018 The Author(s). Background: Many studies have separately addressed the associations of informal caregiving with coresidence, a caregiver's work status, and health conditions, but not jointly. We examined how their parents' need for care affects middle-aged women's lifestyle and psychological distress, considering the potential simultaneity of decisions on caregiving and living adjustments. Methods: We used 22,305 observations of 7037 female participants (aged 54-67 years) from a nationwide longitudinal survey in Japan conducted during 2009 and 2013. We considered the occurrence of parents' need for care (OPNC) as an external event and estimated regression models to explain how it affected the probabilities of the participants becoming caregivers, coresiding with parents, and working outside the home. We further conducted the mediation analysis to examine how the impact of OPNC on participants' psychological distress measured by Kessler 6 (K6) scores was mediated by caregiving and living adjustments. Results: OPNC made 30.9% and 30.3% of middle-aged women begin informal caregiving for parents and parents-in-law, respectively, whereas the impact on residential arrangement with parents or work status was non-significant or rather limited. OPNC raised middle-aged women' K6 scores (range: 0-24) by 0.368 (SE: 0.061) and 0.465 (SE: 0.073) for parents and parents-in-law, respectively, and informal caregiving mediated those impacts by 37.7% (95% CI: 15.6-68.2%) and 44.0% (95% CI: 22.2-75.4%), respectively. By contrast, the mediating effect of residential arrangement with parents or work status was non-significant. Conclusions: Results underscore the fact that OPNC tends to promote middle-aged women to begin informal caregiving and worsen their psychological distress.

© 2017 Elsevier Inc. Retirement is a major life-course transition that is closely related to changes in health. This study examined the dynamic impact of retirement on health and health behaviors, distinguishing an immediate change in the level of health at retirement and a change in the rate of change after retirement. We used panel data from 9283 individuals (4441 men and 4842 women) who had retired during a nationwide ten-year panel survey in Japan conducted in 2005–2014. We focused on three health behaviors (current smoking, heavy alcohol drinking, and leisure-time physical activity) and two health indicators (self-rated health and psychological distress). We estimated regression models that controlled for both time-invariant individual attributes and the endogeneity of retirement, using panel data collected during the five years before and after retirement. Results generally confirmed that the transition was accompanied by favorable changes in health and health behaviors with some gender differences. Among men, retirement immediately promoted leisure-time physical activity and reduced poor self-rated health and psychological distress. Retirement also accelerated smoking cessation and leisure-time physical activity and decelerated reporting poor health. Among women, retirement immediately promoted leisure-time physical activity and reduced psychological distress, while it did not affect the rate of change in any health variable after retirement. The current study underscores the need for more in-depth knowledge of the dynamic impact of retirement on health. This will assist in developing policy measures to help the middle-aged population make healthy transitions from work to retirement.

© 2016 The Author(s). Background: It is well known that informal caregiving negatively affects caregivers' mental health, while social activities improve mental health outcomes among middle-aged and elderly individuals. The goal of the present study was to examine how participation in social activities affected the trajectory of an informal caregiver's psychological distress. Methods: We used the data from a nationwide nine-wave panel survey of the middle-aged individuals (aged 50-59 years at baseline) in Japan conducted in 2005-13 (N = 24,193 individuals;12,352 women and 11,841 men), mainly focusing on the respondents beginning to provide informal caregiving during the survey period. We employed linear mixed-effects models to explain how the trajectory of psychological distress, measured by Kessler 6 (K6) scores, was associated with caregiving commencement and duration, as well as social activity participation. Results: Participation in social activities was associated with mitigated K6 scores at caregiving commencement by 66.2 and 58.2 % for women and men, respectively. After caregiving started, participation in social activities reduced the average rise in K6 scores, per year, by 65.6 and 89.6 % for women and men, respectively. We observed similar results when focusing on participation before caregiving commencement to avoid endogeneity problems. Conclusion: Results suggest that participation in social activities can alleviate caregivers' psychological distress. Policy measures to support social activities are recommended for the health and well-being of current and potential caregivers.

本稿の目的は，2000年に導入された公的介護保険が家族介護者の介護時間に与えた効果を，『社会生活基本調査』のマイクロデータを用いて検証することである. 「介護・看護」に費やした時間を被説明変数とし，介護保険給付の対象となる65歳以上の高齢者を介護している家族介護者をトリートメントグループ，64歳以下の者を介護している家族介護者をコントロールグルーブとしたdifference-in-differences (DID)推定を行った. ADLが指す行動と近似する「身の回りの用事」について，一人で自立してできる程度を介護必要度の代理変数として用いて男女別分析，女性については学歴別分析を行ったところ，公的介護保険の導入は，高学歴の女性の介護時間を統計的に有意に減少させていた. その他の生活行動についてDIDを追加的に行ったが，高学歴女性のグループで仕事時間の増加は確認されなかった. 高学歴女性は家族介護を公的介護で代替し，時間配分を効率化したと考えられるが，その時間が労働市場で有効に使用されたという結論には至らなかった.This study examines the impact of public long-term care (LTC) insurance, which was introduced in year 2000 in Japan, on the time spent on informal care by at-home caregivers. The present paper utilizes the micro data from the Survey on Time Use and Leisure Activities (STULA) and a difference-in-difference estimation is conducted to assess the policy effect. Considering DID between the treated and the controlled, which are at-home caregivers who care for the elderly aged 65 or older who are eligible for the LTC insurance and those who care for other family members respectively, it is found that availability of LTC insurance significantly decreased the time spent on informal care among female caregivers who have higher educational background.

© 2014 Oshio and Kan; licensee BioMed Central. Introduction: It is well known that lower income is associated with poorer health, but poverty has several dimensions other than income. In the current study, we investigated the associations between multidimensional poverty and health variables. Methods: Using micro data obtained from a nationwide population survey in Japan (N = 24,905), we focused on four dimensions of poverty (income, education, social protection, and housing conditions) and three health variables (self-rated health (SRH), psychological distress, and current smoking). We examined how health variables were associated with multidimensional poverty measures, based on descriptive and multivariable logistic regression analyses. Results: Unions as composite measures of multiple poverty dimensions were more useful for identifying individuals in poor SRH or psychological distress than a single dimension such as income. In comparison, intersections of poverty dimensions reduced the coverage of individuals considered to be in poverty and tend to be difficult to justify without any explicit policy objective. Meanwhile, education as a unidimensional poverty indicator could be useful for predicting current smoking. Conclusions: Results obtained from the current study confirmed the practical relevance of multidimensional poverty for health.

This paper examines the effect of being out of work, which is in a broader category of unemployment, on the physical and mental health of younger Japanese men using panel data. A fixed effects model, widely used to control for unobserved individual heterogeneity in panel data analysis, was used for this analysis. Using the first through the fifth waves of the Japanese Life Course Panel Survey, the first wave of which was conducted with people aged 20-40 yrs in 2007, it is found that being out of work has no observable effect on self-assessed physical health. However, being out of work has a negative effect on mental health as measured by the five-item version of the Mental Health Inventory. It is difficult to clearly distinguish the direction of causality even after controlling for individual heterogeneity that is constant over time. An analysis was done with a sub-sample to mitigate a possible reverse causality. The results consistently show that being out of work has a negative effect on mental health. © 2013 National Institute of Occupational Safety and Health.

In this paper, we investigate the effects of cost sharing on the demand for physician services in Japan by using a natural experiment, namely, the increase in the coinsurance rate for household heads in 1997. Our primary finding from the two-year data, which includes the transitory effects of the reform, is that the effects of the reform on the frequency of physician visits were negative and statistically significant, and that the effects of the reform on expenditures per visit were also negative. Based on these results, the arc elasticity of demand for physician services is -0.055. When we exclude the transitory period using the three-year data, the effects of the reform on the frequency of physician visits turn to be positive. It seems that the patients marginally curtailed the number of physician visits immediately after the reform; however, this effect was not sustained in the six months after the reform. We conclude that Japanese patients are not very price sensitive within the 10-20 percent range of coinsurance rate. Another important finding in our study is that the decrease in expenditure per visit retained even after the transitory period. This result suggests that the existence of a possible moral hazard in the treatment intensity although the decision-making process on the treatment intensity needs to be examined more carefully. © 2009 Elsevier B.V. All rights reserved.

PURPOSE: To examine factors associated with participation in a community based comprehensive health check to screen frail elderly before they become in need of long-term care. METHODS: All residents aged 70 years and over living in Kusatsu, Gumma prefecture were surveyed for their sociodemographics, and physical, mental and social functioning through in-person interview in the years 2001 and 2003. In the following years--in 2002 and 2004, respectively--mass screenings were conducted to detect early signs of need for care among the elderly. Using the baseline interview information as explanatory variables, we performed multiple logistic regression analysis in order to examine the social determinants of participation in the mass-screening. RESULTS: For the first mass-screening, having high blood pressure and poor subjective health decreased the likelihood of attending the screening by 34% and 65% respectively. In contrast, one point increases in IADL, mobility and social-role score increased the probability of attendance by 27%, 26% and 26% respectively. After the screening was re-conducted, the factors influencing attendance appeared to have changed. With a third mass-screening, while the IADL and mobility score still had significant effects, elderly having excellent subjective health were less likely to go by some 48%. It was also found that not having visual impairment had a significantly positive effect on attendance. CONCLUSION: If local government conducts community-based mass screening aiming to screen the frail elderly in need of care, it is likely that there are high risk elderly among the non-participants. It is very important to follow up those non-participants using an attendance roll and provide appropriate advice. It is also worth discussing mass screening that focuses more on health promotion than on "screening" itself.

This study examines the effect of the 1997 increase in the coinsurance rate for household heads on the demand for medical care and estimates the price elasticity of demand using the change as a natural experiment. It analyses both outpatient and inpatient utilization by using health insurance claim data from 111 insurance associations. A differences-in-differences type estimator is employed with household heads as the treatment group and dependents as the control group. This represents the first comprehensive analysis of medical care demand in Japan using a natural experiment. The results indicate a price elasticity of outpatient care ranging from -0.05 to -0.06 but no significant effects on inpatient care of the increase in cost sharing. The price elasticity for outpatient care is lower than those from previous studies that have used observational comparisons of individuals in Japan and also smaller than those derived from a randomized experiment in the USA. © 2006 Taylor & Francis.