Intergenerational Inequality and the Contract Out Policy in Public Health Care

Abstract This study investigates the impact of a Japanese public health care reform—called the contract out policy—on intergenerational inequality and the probability of a surplus in medical saving accounts. First, I investigate the change in the lifetime net burdens for each generation and public health expenditures and conduct simulation analyses to consider the effects of contracting out public health insurance on intergenerational inequality using the generational accounting method. Next, I simulate the probability of a surplus in medical savings accounts using the transition probability of health care expenses based on individual health data, such as receipt data. According to the simulation results, the net lifetime burden on future generations after contracting out shows a 1% reduction compared to the base case, which is not implemented in public health care reform. In addition, the probability of medical savings accounts remaining in surplus, including cases of zero medical expenses, is 69.6%.