Rate of health insurance reimbursement and adherence to anti-hypertensive treatment among Japanese patients

Background: Although several studies have reported the effects of free medi cal care on compliance in patients with hypertension, no study has reported the effects of an economic incentive, such as subsidized medical costs, on compliance with medication protocol, in patients with hypertension. The un ique characteristics of the Japanese health insurance system provide for a 10% decrease in the subsidy for medication immediately on retirement (appro ximately 60 years of age) for insured patients, and a 100% subsidy for insu red patients who are 70 years of age or older. We examined the association between level of health insurance coverage and follow-up rate of medical tr eatment among Japanese patients with hypertension. Methods: The subjects, f rom throughout Japan, were patients with hypertension (n = 1236). The study was conducted in 1991. The odds of completing a 1-year treatment in relati on to the rate of health insurance reimbursement were calculated using mult iple logistic regression analysis. Results: We found the following. (1) Com pared with the base group, the odds of completing a 1-year treatment increa sed to 2.62 or 2.51 in the group whose reimbursement rate was 100%. (2) Com pared with the base group, the odds of completing a 1-year treatment was no larger than 1 in the group whose reimbursement rate had been 100% for more than 6 years ('76-'). (3) Compared with the base level, the odds of comple ting a 1-year treatment increased to 1-1.81 in the group whose liability de creased to 80%. Conclusion: Although the results imply that even a small ec onomic incentive might be effective in securing a patient's compliance with anti-hypertensive medical treatment, the effect appear limited in both dur ation and magnitude. (C) 2001 Elsevier Science Ireland Ltd. All rights rese rved.