[Distribution of medical expenditures for the elderly]

The distribution in medical service use by the elderly was examined by using data from medical fee claim records of the Medical System for the Elderly for one year. The following are among the main findings: More than 50 percent of the patients consumed less than 300,000 yen per year, and those patients whose annual medical expenditures were between 600,000 yen to 4,000,000 yen consumed 54 percent of the total expenditures of the elderly. The top 10 percent of patients consumed 50 percent of medical expenditures, and top 1 percent consumed 10 percent. Lorenz curves of medical expenditures for different regions were relatively similar despite the large differences in medical expenditures per patient. Medical expenditures per patient did not appear to be related to the concentration in distribution of expenditures, although the former was strongly related to the proportion of long-term hospitalized patients. After various measures to control the increase rate of medical expenditures in 1980's, public attention has shifted slowly to the quality of services provided and cost-effectiveness of medical services. The concentration in distribution of medical expenditures was considered to be a meaningful approach to investigate the effectiveness of medical services.