Points of View Public Attitudes and Behaviors Concerning Saving on Medical Expenses -Report on the Results of the Survey on Public Awareness of Prices, Systems, and Value of Pharmaceuticals, Part 4-

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The Office of Pharmaceutical Industry Research Akiko Yoshida, Senior Researcher

1. Introduction

In June 2022, the author conducted a web-based questionnaire survey, "Survey on Awareness of Prices, Systems and Values of Pharmaceuticals" (hereinafter referred to as "this survey"), with the purpose of understanding the actual status of awareness and interest in the prices, systems (medical care at the time of consultation, drug prices and medical insurance systems related to pharmaceutical products, etc.) and values of pharmaceutical products by various attributes. The results of this survey are reported in Part 1 of this report.

As part 1 of the results of the survey, we found that the public's awareness of and interest in the price and system of pharmaceuticals was high, at 70%, and that the characteristics of those with high awareness and interest tended to be highly involved in medical care, including opportunities to receive medical treatment, while others were not highly involved in medical care (those with high levels of perceived healthiness). The second point is that some respondents recognize and place importance not only on "medical value," which is based on a medical perspective, but also on "non-medical value," which is realized as a ripple effect of treatment with medicines, etc., as well as on their own and others' circumstances (presence or absence of disease, type of disease, disease being diagnosed, work, family, etc.). The results also showed that there are differences in the values that people value depending on their own and surrounding circumstances (presence or absence of disease, type of disease, diseases being diagnosed, work, household chores, caregiving, etc.). The third factor is that the public expects to know about the price, system, and value of medicines, and that the content of their expectations will not only increase their awareness, interest, and concern, but also change their behavior when faced with medical care, such as proper use of medicines and consultation with doctors and pharmacists, which they consider desirable. The results also showed that there are differences in the means, opportunities, and timing of the desired actions depending on the attributes of the respondents. The results were reported in OPIR Views and ActionsNo.67 and No.681 ^, respectively.

In this paper, we report on the results of this survey, Part 4, and discuss the public's awareness and behavior regarding saving on medical expenses. Saving on health care costs is not only an individual issue, but also one that involves social influences.

According to the Act on Securing Medical Care for the Elderly (Act No. 80 of 1982) ²⁾, in order to ensure the sustainable operation of the system, the national government and prefectures, with the cooperation of insurers, medical personnel, and others, should establish a basic policy for the optimization of medical care costs for a period of six years in order to promote health improvement and optimization of medical care costs for the population, ⁴⁾ FY2023 is the final year of the third phase of the medical cost optimization plan. The estimated effect of medical cost optimization on outpatient medical expenses is about 80 billion yen for prevention of severe diabetes, 20 billion yen for promotion of specific health checkups and health guidance, 400 billion yen for promotion of generic drugs (80% target), and 60 billion yen for appropriate use of pharmaceuticals, resulting in an estimated optimization effect of about 600 billion yen in FY2023. The amount of the optimization effect is expected to be about 600 billion yen in FY2023.

Against this backdrop, the government's "Basic Policies for Economic and Fiscal Management and Reform 2022" (hereinafter referred to as the "Basic Policies") ⁵⁾, as well as the pharmaceutical industry and ^others6) have been promoting various initiatives for health promotion and optimization of medical costs, and educating the public.

Therefore, we conducted an analysis to understand the actual status of awareness and behavior of individual citizens regarding saving medical expenses, with reference to various initiatives and awareness-raising items for the public regarding health promotion and optimization of medical expenses.

Survey and analysis methods

Survey Methodology

The web-based survey was conducted using the following method. It should be noted in advance that there are limitations to the characteristics of the survey, such as the fact that the respondents were limited to those with access to the Internet.

Survey Methodology

Crosstabulations and multiple regression analysis using a linear probability model were used.

Respondent Attributes

The main information on the attributes of the respondents is given at the end of this section.

Survey and Analysis Results

4.1. characteristics of awareness and behavior regarding saving on medical expenses

First, in order to grasp the actual status of the respondents' own awareness and actions regarding saving medical costs, we asked them about "what they think is appropriate to save medical costs (whether or not they themselves are doing it)" (awareness) and "what you yourself are actually doing" (actions), and obtained 9 options and "nothing you think" / "nothing you are doing" / "nothing you are doing. The respondents were asked to choose one of nine options, and to select "nothing that you think" or "nothing that you are actually doing" or "other" (multiple answers). The nine options were set based on the "Goals of the Plan for Adequate Medical Expenses" (Figure 1), the "Framework Policy", the "How to get good medical care project " ⁷⁾, and items described in the JPMA's website "Promoting the Proper Use of Pharmaceuticals (Pharmaceutical Industrial Policy Committee) " ⁸⁾. The results are shown below, sorted by awareness and behavior in descending order of response rate. (Figure 2)

First, in order of the percentage of respondents' awareness of the need to save on medical costs, the most common responses were: "Choose generic drugs when available" (55.9%), "Get a medical checkup" (55.8%), " Use prescribed drugs correctly as directed" (48.9%), "Have a family doctor" (45.7%), "Tell my doctor if I have extra Do not take more medicine than necessary" (43.7%), "Do not visit medical institutions unnecessarily" (40.4%), "Avoid duplicate visits and ladders" (28.7%), "Avoid visiting doctors after hours, such as on holidays and at night" (22.2%), "Use OTC (over-the-counter) medicines for Self-medication with OTC (over-the-counter) medicines" (11.5%), "Nothing that I think is appropriate to save on medical costs" (4.5%), and "Other" (1.1%) followed. The "other" category included "health care," such as sleep, nutrition, and exercise, as well as "preventive awareness.

In descending order of the percentages of responses for actions related to saving on medical costs, respondents selected "Get a checkup" (50.5%), " Choose generics when available" (49.3%), "Use prescribed medicine correctly and as directed" (45.3%), "Have a family doctor" (40.5%), "Do not visit medical institutions unnecessarily" (40.5%), "Do not go to medical institutions unnecessarily" (40.5%), "Do not go to medical institutions unnecessarily" (40.5%), and "Do not go to medical institutions unnecessarily" (40.5%). Do not visit medical institutions unnecessarily" (37.1%), "Tell your doctor if you have extra medicine and do not take more medicine than you need" (29.2%), "Avoid duplicate visits and ladders" (23.4%), "Avoid visiting doctors after hours such as holidays and nighttime" (22.9%), "Use over-the-counter (OTC) medicines for Self-medication with OTC (over-the-counter) medicines" (9.4%), followed by "I have never done so" (6.5%) and "Others" (0.5%). The "other" category included their own "health management, such as sleep, nutrition and exercise," and "understanding of medicines.

In common, "choosing generic drugs when available," "getting medical checkups," and "using prescribed medicines correctly as directed" showed high percentages of awareness and action, while "self-medication with OTC (over-the-counter) medicines" was selected by only 10% of the respondents, showing a low percentage. On the other hand, "Self-medication with OTC (over-the-counter) drugs" showed a low response rate of around 10%.

Overall, the items for which the response rate exceeded half of the respondents (50%) were two items for awareness and one item for action (underlined), indicating that the response rate did not exceed 50% for most items and that many of the awareness and actions for saving medical costs were not sufficiently taken.

4.2. characteristics of awareness and behavior regarding saving on medical expenses by attribute category

In order to examine the characteristics of respondents' awareness of and actions to save on medical expenses, we analyzed the relationship between each of the demographic categories (used in previous analyses). (Table 1) Multiple regression analysis using a linear probability model with each awareness/behavior item as the explained variable, taking 1 if the respondent responded by choice and 0 otherwise, and the attribute category as the explanatory variable, shows the results of statistically significant attribute characteristics, by awareness and behavior, in Tables 2 and 3.

The main characteristics of the attributes with high probability of selecting awareness and behavior related to saving on medical expenses were "female," "unemployed," "diagnosed with a medical condition," and "high medical expense burden. The coefficient for "have a medical condition" was the highest, suggesting that the opportunity to receive medical care has a significant impact.

For the three items with the highest percentage of responses ("choose generics when available," "get medical checkups," and "use prescribed medications correctly as directed"), the probability of selection was higher for both awareness and behavior in the attribute of "high perceived healthiness".

4.3. characteristics of behaviors related to drug use with the intention of saving medical costs

As mentioned in 4.1, the actual situation of the respondents' own awareness and actions regarding the saving of healthcare costs indicated that many of their awareness and actions to save healthcare costs are not being taken. Therefore, in order to help the pharmaceutical industry consider which groups of respondents should be further educated in the future, we decided to analyze the groups of respondents' behavior regarding the use of drugs with the intention of saving medical costs. 9 options were selected, and 3 items related to the use of prescription drugs in particular ("use prescribed drugs as directed", "use generic drugs", and "use prescription drugs as directed") were selected. Use prescribed medicines correctly according to instructions," "Choose generics if available," and "Tell the doctor if you have extra medicines, and do not take more than necessary"), and three groups were created based on whether or not the respondents were taking these actions, regardless of their awareness. The groups were set as follows: a high behavioral group of 297 (14.0%) who were doing all three behaviors, a medium behavioral group (1,214, 57.3%) who were doing one or two of the three behaviors, and a low behavioral group (607, 28.7%) who were doing none of the three behaviors. (Figure 3)

The results of the characteristics of the attributes that were statistically significant by multiple regression analysis with a linear probability model, with each population as the explained variable and attribute category as the explanatory variable, are shown in Table 4. As the main characteristics, in the high behavior group, the selection probability was high for the attributes that were answered as "female," "unemployed," "have family members in need of care," "have a medical condition to see," and "have a high medical cost burden.

In the medium behavior group, the selection probability was high for the attributes of "female," "older age," "unemployed," and "no family member in need of care. In the low behavior group, the selection probability was high for the following attributes: "male," "employed," "no medical conditions seen," "low medical expenses," and "low perceived health.

The coefficients were higher for the attribute "with a diagnosed disease" in the high behavior group, and for the attribute "male," "no diagnosed disease," and "employed" in the low behavior group, suggesting that the characteristics of each of these attributes affect the characteristics of the group as a whole.

In Figures 4 and 5, the characteristics of each attribute are cross-tabulated and shown in graphs. The graph shows that the percentage of "male" respondents is higher in the lower groups: high action group (34.3%), medium action group (45.4%), and low action group (59.8%). The percentages for those in their 20s to 50s were higher for the lower groups: high activity group (42.8%), medium activity group (54.3%), and low activity group (73.6%). The proportion of "employed" was higher in the high (46.8%), medium (56.0%), and low (70.7%) groups, respectively. By occupation, the percentage of those working part-time or other short-time jobs was almost constant across all groups, while the percentage of those employed full-time, such as company employees, was higher in the high (25.3%), medium (34.6%), and low (48.6%) groups, indicating that the percentage was higher in the low group. The proportion of "housewives/househusbands" was lower in the high (27.6%), medium (20.5%), and low (12.7%) groups, respectively. The percentage of respondents who had a medical condition was lower in the high (78.8%), medium (58.6%), and low (37.4%) behavior groups, respectively. The proportion of respondents who had medical out-of-pocket expenses ranging from 0 yen to less than 50,000 yen was higher in the high (54.2%), medium (66.6%), and low (77.7%) behavior groups, respectively. In particular, the percentage of those who spend less than 10,000 yen is higher in the low group (19.9%, 29.0%, and 50.2%) than in the high group (19.9%, 29.0%, and 50.2%). The proportion of respondents who felt "burdened by medical expenses" was lower in the low group (68.7%), medium group (66.6%), and low group (58.6%). The percentage of "perceived health" in the two categories of "very healthy" and "healthy" was higher in the high (19.9%), medium (23.9%), and low (27.2%) behavior groups, indicating that the percentage was higher in the low group.

Based on the above analysis, the characteristics of the groups acting with regard to drug use with the intention of saving medical costs were "female," "unemployed," "with a family member in need of care," "with a disease to be seen," and "with a large medical cost burden. In other words, except for "have family members in need of care," the characteristics of the group were the same as those of the item-by-item group. Conversely, the characteristics of the group that did not act were "male," "age" was "20-50s," "employed" (few respondents were "full-time housewives/househusbands" and many were full-time employees such as company employees), "no medical conditions seen," "small medical cost burden" (especially, a high percentage of respondents spent less than 10,000 yen), and "small sense of medical cost burden," which were the characteristics of the group that acted in a manner that was at odds with the The characteristics of the group that was acting in a way that was contrary to the characteristics of the group that was not acting were revealed.

Summary and Discussion

In this paper, we have analyzed the characteristics of awareness and behavior regarding the saving of medical expenses by attribute, and the behavioral group regarding the use of drugs with the intention of saving medical expenses, and have described the results.

In the overall, the characteristic trends of the attributes of awareness and behavior regarding the saving of medical costs by item, the attributes with the highest awareness and behavior were those who had the opportunity to receive medical treatment. The three items with the highest percentages of responses ("choose generics when available," "get physical examinations," and "use prescribed medications correctly and as directed") showed high levels of awareness and Y-row behavior among those who were "highly aware of their health," that is, those who considered themselves healthy regardless of the disease for which they received medical care. Conversely, those with low Y-row awareness and behavior were those who had no or few opportunities to receive medical examinations. Although the choice to "undergo a medical checkup" could be made even in the absence of a medical checkup or disease, the presence of a medical checkup or disease clearly increases the probability of making such a choice. Therefore, the results suggest that the opportunity to receive medical care may function as a trigger for saving medical costs and increasing health awareness and behavior. It can be inferred that the experience of receiving medical care may lead individuals to take pharmaceuticals or pay out-of-pocket for medical expenses, which may become an individual action and change their awareness, or increase their awareness and become a behavior. In addition, there were cases in which even those who considered themselves to be in good health, regardless of the occasion of receiving medical care, also became aware or took action. This suggests that those who had the opportunity to receive medical care but were health conscious, and those who were health conscious on a regular basis even if they did not receive medical care, had a high level of health and prevention awareness and health literacy (in general, the ability to find health-related information, understand and It may also be useful to provide opportunities and tools to increase health and prevention awareness and health literacy (the ability to find and understand health-related information, use it to make decisions, and take appropriate health actions in general). If people have appropriate information and a high awareness of the need to save on health care costs before they develop a new disease, it is expected that they will be able to prevent diseases, detect them early, etc., thereby increasing the effectiveness of health care cost savings for individuals and society.

The characteristic trends of the attributes of the behaviors related to drug use with the intention of saving medical costs for each behavioral group were also generally similar to the characteristic trends of the attributes of the attitudes and behaviors related to saving medical costs for each item. The groups that were acting were more likely to be unemployed, to be of older age, to have a certain degree of opportunity to receive medical care, and to actually have a disease to be diagnosed or to have a certain amount of medical cost burden. Conversely, the group that was not acting was more likely to be in the working age group that had no medical conditions to receive medical care and few opportunities to receive medical care.

In other words, this suggests that the opportunity to receive medical care may also function as one catalyst for behavior by those who do not take action related to drug use with the intention of saving money on medical costs. The experience of receiving medical care may lead individuals to take action by becoming more willing to take pharmaceuticals or to pay for their own medical expenses. In addition, one of the characteristics of the attributes of those who do not engage in behaviors related to drug use with the intention of saving on medical costs is that they are workers (few are "housewives/househusbands" and many are full-time employees such as office workers), and workers who have few opportunities to receive medical care also have few opportunities to take drugs, making it difficult to take such behaviors. How can these workers who have few opportunities to receive medical treatment raise their awareness?

In a working environment where people generally spend a lot of time, it is important to raise awareness of the importance of maintaining one's own health, and to create mechanisms to naturally raise awareness of health and medical care, and to increase the awareness and interest of each individual. Then, starting with knowing one's own medical cost burden, provide opportunities (e.g., apps, SNS, video ^{distribution9 )} that workers will want to access and use to naturally understand the situation of medical costs and drug costs in society, the medical insurance system including drug prices, etc., and that will help them understand in a short time, easily, and in a simple manner. By doing so, they will increase their awareness of the need to participate in healthcare and society, from thinking of it as their own business, thereby increasing their own and society's awareness of the need to save on healthcare and drug costs. It is estimated that it will be difficult to move awareness in a short period of time and will take a long period of time, as in the case of opportunities to receive medical care, but because they are workers, they may easily become aware of the need to save not only individual but also societal medical costs.

In a climate of saving future individual medical care expenditure and medical care expenditure in society as a whole, we believe it is necessary to raise the public's awareness of the need to save on medical care costs.

Conclusion

Recently, against the backdrop of the revision of the Law Concerning Stabilization of Employment of Older ^{Persons10) and} the decline in the labor force due to the shrinking population, companies, including pharmaceutical companies, have begun to review their employment systems for the elderly, for example, by extending the retirement age. In addition, by 2030, the number of "business caregivers" who are engaged in caring for family members and other family members while working is expected to increase. ¹¹⁾ It will become increasingly important for workers to manage and promote their own health. Therefore, we should aim for a situation in which each citizen is able to save not only individual but also social health care costs before facing medical treatment or nursing care. In the age of 100 years of life, the key will be for "healthy workers" to gradually increase their awareness of the need to save on medical costs and to take action, or for their actions to change their awareness.

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