 This study investigated the cost-sharing effects based on income status on hospital service utilization of different services among elderly people in Japan. It found that those with lower incomes had higher hospitalization rates and longer lengths of stay in medical chronic care and psychiatric beds compared to those with higher incomes. Additionally, the total hospitalization costs for those with lower incomes were significantly higher than those with higher incomes. These findings suggest that the current cost-sharing policy in Japan may need to be revised to ensure access to health care services for all elderly people regardless of their income level. This article was authored by Yunfei Li, Akira Babazono, Aziz Jamal, and others.