One possible mechanism is that highly educated individuals might respond to new information and change their behaviors more quickly. While most empirical studies to date focus on the causal effect of education on health, less attention has been paid to the specific underlying mechanism, which Grossman pointed out is an area of future work that has important implications for effective health policy implementation. Since Grossman, the relationship has been actively investigated both theoretically and empirically, with the literature reviewed by Grossman and updated by Eide and Showalter and Grossman.

A secondary analysis implies that the difference in cognitive functioning test scores may be a critical factor in explaining the heterogeneous responses to the reform, suggesting that thoroughly well-articulated recommendations for healthy behaviors are needed in order to improve reform uptake.Įconomists are increasingly interested in the effect of education on economic and non-economic outcomes, especially the relationship between education and health. This highly educated group increased their physical activity, brought energy intake close to an ideal level, and achieved significant weight loss and BMI reduction to levels that minimize all-cause mortality among middle-aged Japanese.

We found that the reform caused significant changes in health behaviors and outcomes only among university graduates who were at a relatively high risk of metabolic syndrome. Using institutional information, a difference-in-differences estimation was conducted with salaried workers as the treatment group and self-employed workers as the control group. As the checkup is mandatory only for salaried workers, their participation rate is significantly higher than other workers thus, they were most affected by the reform. In April 2008, the annual checkup was redesigned to address concerns about metabolic syndrome. This study analyzes the role of education in the outcomes of the reform of the Japanese annual health checkup program.

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