Does the Japanese insurance system increase outpatient psychiatric treatment for children and adolescents? A retrospective study using open data from the national claims database for 2016 to 2022.

Aim: The prevalence of mental health issues among children and adolescents in Japan is rising, including school refusal, suicide, and neurodevelopmental disorders. In response, the Ministry of Health, Labour, and Welfare (MHLW) introduced insurance incentives in 2014 to expand access to outpatient psychiatric services for Japanese youth.

Methods: This retrospective cohort study analyzed data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan from fiscal years 2016 to 2022. Outpatient psychotherapy claims under the newly introduced insurance categories were analyzed by year, age group, sex, and prefecture. National trends and regional disparities were assessed using linear regression models.

Results: Nationwide outpatient psychotherapy claims nearly doubled, from 521.0 per 10,000 youth in fiscal year 2015 to 1034.5 in fiscal year 2022 (p < 0.001). The increase was most pronounced among adolescent girls. By fiscal year 2022, 94% of prefectures had implemented the policy. Some regions, such as Tokushima and Yamanashi, experienced more than a threefold increase. Nevertheless, regional disparities between prefectures remained.

Conclusion: The MHLW's insurance reforms significantly increased access to psychiatric care for children and adolescents across Japan. The combined impact of national financial incentives and local medical subsidies likely contributed to increased service utilization, given the reduction in additional costs for families. Ongoing policy efforts are needed to ensure equitable access and high-quality care nationwide.