Do individualized health promotional programs reduce health care expenditure? A systematic review of controlled trials in the “Health-Up” model projects of the National Health Insurance

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  • OKAMOTO Etsuji
    National Institute of Public Health, Department of Management Sciences

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Objectives The aim was to summarize the outcomes of the controlled trials in the “Health-Up” model projects of the National Health Insurance to quantify the effects of individualized health promotional programs (IHPPs) on outpatient and pharmaceutical health care expenditure.<br/>Methods Reports submitted to the Ministry of Health, Labor & Welfare by municipalities participating in the projects were reviewed and monthly per-capita outpatient and pharmaceutical expenditures were extracted. Comparisons were made between the intervention and control groups as to temporal changes between one year before and the one year after the programs. Temporal changes were evaluated with reference to effect ratio with 95% CI.<br/>Results A total of 31 programs conducted in 17 municipalities were included in the review. A total of 2,947 people participated in the IHPPs and 6,666 people were assigned to the control group in a randomized or matched manner. IHPPs varied widely as to the effects on health care expenditures: Sixteen programs demonstrated reduction effects (ER<1), of which two were statistically significant, while fifteen programs demonstrated inflationary effects (ER>1), of which two were significant. Overall, per capita health care expenditure of all participants increased by 4.7% (95%CI: 1.003-1.094) or 6,697 yen above the controls. The pooled ER was 1.044 (95%CI: 1.000-1.091) indicating a 4.4% inflation of the per capita health care expenditure of participants compared to the controls during the year after the interventions.<br/>Conclusions Overall, IHPPs demonstrated slight but significant inflationary effects on outpatient and pharmaceutical health care expenditures. Follow-up studies must be conducted to adjudicate the long-term effects of IHPPs on health care expenditure.

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