title: Subsidy and parental attitudes toward pediatric health care in the Tokyo metropolitan area.
abstract: BACKGROUND
  In Japan, the number of municipalities that offer free medical care for children has increased. This policy, however, might unintentionally aggravate the overcrowded situation of pediatric ambulatory services in Japan. We investigated the relationship between parents' health-care seeking attitudes according to child symptom severity and the amount of copayment, as well as parents' socioeconomic and demographic factors.
  
  
  METHODS
  We used data for 4385 people from the Japanese Study of Stratification, Health, Income and Neighborhood (J-SHINE), which consisted of stratified random sampling of those aged from 25 to 50 years who lived in Tokyo and neighboring areas. Outcome variables were respondent health-care seeking attitudes toward their children's mild and severe symptoms of cold. Logistic regression models were developed for each dependent variable.
  
  
  RESULTS
  A total of 1606 respondents with one or more children under the age of 15 years were included in the analysis. For mild symptoms of cold, no subsidy (OR: 0.51, 95%CI: 0.38-0.69) and partial subsidy (OR, 0.71; 95%CI: 0.54-0.95) were associated with fewer "visit on that day" answers, compared with full subsidy. Income and respondent educational level were not associated with the outcome. For severe symptoms of cold, the OR of no subsidy (0.61; 95%CI: 0.30-1.23) and that of partial subsidy (0.91; 95%CI: 0.40-2.07) were not statistically significant.
  
  
  CONCLUSIONS
  Imposing a small copayment might prevent visits to medical facilities for mild symptoms of cold, but will not prevent visits for severe symptoms of cold.
authors.affiliation: Department of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Higashi
authors.affiliation: Department of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Mitsuko
authors.initials: M
authors.lastname: Itoh
authors.affiliation: Department of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Toyokawa
authors.affiliation: Department of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Kobayashi
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005380:Financing, Government / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007564:Japan; D008297:Male; D008875:Middle Aged; D010290:Parents / Q000523:psychology*; D010372:Pediatrics; D012959:Socioeconomic Factors; D014041:Tokyo
keywords: copayment; government subsidy; health policy; health-care seeking behavior; primary care