医療保険の成立要因に関する研究

Japan's medical expenditure has been growing rapidly year by year, and the rate of the national subsidy has inevitably been rising too. This has consequently become an urgent financial problem for the Government along with the Pension problem. Linked to this, there is also the bad financial state of the Society-managed Health Insurance Scheme, which is one of the main health insurance schemes in Japan, along with the Government-managed Health Insurance Scheme and the National Health Insurance Scheme, and which had been financially better-managed than the others. In this study, the author examined the factors influencing the financial balance of 1570 societies in this scheme from 1974 to 1981, by analyzing 20 of 213 items obtained from the report on striking a financial balance. The results are summarized as follows: (1) 'The ordinary financial balance of each society' is influenced by both 'the type of enterprise' and 'the type of society', with the former more influential than the latter. (2) Among societies, there are greater differences of factors, such as 'the sex ratio of insured persons', 'the total costs for health and welfare facilities', 'the ratio of costs for health education', 'the ratio of costs for preventive measures', 'the ratio of costs for promotion of sports', 'the costs for additional benefits per one insured person', 'the costs for additional benefits per one dependant', 'the total costs for benefits per capita', than other factors, when the author compares them. (3) From the result of the correlation analysis among the factors, 'the mean age of insured persons' shows a high correlation not only with 'the ordinary financial balance of each society' but also with many other factors. 'The total costs for health and welfare facilities' does not directly reflect the health care activity of each society. (4) 'The number of insured persons' has not directly influenced 'the ordinary financial balance of each society' but shows the financial stability of the society among the special type of society. (5) To show the synthetical character of each society, such factors as 'the average monthly standard remuneration', 'the type of enterprise', 'the type of society' and 'the number of insured persons' are adequate in respect of the total financial balance. In the same way, 'the total costs for benefits per capita', 'the number of insured persons' and 'the costs for additional benefits per one dependant' are adequate in respect of expenditure.(6) In excluding the confounding factors in the analysis, it can be seen that 'the average monthly standard remuneration', 'the mean age of insured persons' and 'the number of dependants per one insured person' have a significant influence on 'the ordinary financial balance of each society'.