{
  "abstract": "Objectives: This study aimed to examine whether ministry-level parliamentary workload was associated with outpatient medical costs among Japanese national civil servants, who are exempt from the Labor Standards Act’s statutory limits on working hours.\n\nMethods: We conducted an ecological study of headquarters branches (“Kasumigaseki”) of ten major cabinet-level ministries, 2016–2023. Participants were Japanese national civil servants aged 18–50 years. The analysis included 6454 outpatient claims adjudicated in April of each year. The outcome was sex- and age-standardized per-capita monthly outpatient costs, estimated using Horvitz–Thompson weighting. Inter-ministry differences were decomposed by ICD-10 category. Parliamentary (Diet) workload was annual deliberation time of standing Diet committees responsible for each ministry’s policy areas, divided by insured headquarters members. Weighted least-squares regression examined the association between prior-year deliberation time and standardized outpatient costs.\n\nResults: Standardized per-capita outpatient costs varied more than twofold across ministries, from $19.8/month at the Ministry of Foreign Affairs to $42.7/month at the Ministry of Health, Labour and Welfare (MHLW). At MHLW, mental and behavioral disorders accounted for the largest above-average cost component. MHLW also had the longest deliberation time. Adjusting for year fixed effects, a 1% increase in deliberation time per civil servant was associated with a 0.25% increase in standardized per-capita outpatient costs (95% CI 0.04–0.46), driven by claims per capita rather than cost per claim.\n\nConclusions: Greater parliamentary workload was associated with higher outpatient medical costs among Japanese national civil servants. Enhanced occupational health monitoring and support in ministries with persistently high workloads may be worth considering.",
  "abstract_shown": true,
  "affiliations": [
    "Faculty of Policy Management, Keio University, Kanagawa, Japan .",
    "School of Economics and Business Administration, Yokohama City University, Kanagawa, Japan .",
    "Department of Health Promotion and Behavioral Sciences, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan .",
    "Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan",
    "Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston MA, United States ."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Koryu Sato"
    },
    {
      "affs": [
        1
      ],
      "name": "Hirotaka Kato"
    },
    {
      "affs": [
        2
      ],
      "name": "Kosuke Inoue"
    },
    {
      "affs": [
        3
      ],
      "name": "Naoki Kondo"
    },
    {
      "affs": [
        4
      ],
      "name": "Ichiro Kawachi"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4qn3sqpj0hdpk.bib",
  "cited_by": 0,
  "doi": "10.5271/sjweh.4338",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13733483/",
  "id": "4qn3sqpj0hdpk",
  "issns": [
    "0355-3140",
    "1795-990X"
  ],
  "landing_url": "https://doi.org/10.5271/sjweh.4338",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Article"
    ],
    [
      "openalex",
      "2739|Workplace Health and Well-being"
    ]
  ],
  "openalex": "W7221443654",
  "pdf_url": "https://www.sjweh.fi/download.php?abstract_id=4338&file_nro=1",
  "pmcid": "PMC13733483",
  "pmid": "42859854",
  "published": "2026-11-01",
  "publisher": "Nordic Association of Occupational Safety and Health",
  "ris": "https://research.draconitic.com/paper/4qn3sqpj0hdpk.ris",
  "sources": [
    {
      "first_seen": "2026-11-08T12:23:15Z",
      "native_id": "PMC13733483",
      "source": "pmc",
      "url": "https://doi.org/10.5271/sjweh.4338"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2739|Workplace Health and Well-being",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Parliamentary workload and outpatient medical costs among Japanese national civil servants: An ecological study in Kasumigaseki",
  "title_text": "Parliamentary workload and outpatient medical costs among Japanese national civil servants: An ecological study in Kasumigaseki",
  "type": "peer-reviewed",
  "updated_at": "2026-11-08T12:23:15Z",
  "url": "https://research.draconitic.com/paper/4qn3sqpj0hdpk",
  "venue": "Scandinavian Journal of Work, Environment & Health",
  "versions": []
}