Uninsured foreigners in Japan face death threats, soaring medical costs



An invoice issued to an uninsured Filipino at a hospital affiliated with an academic medical school can be seen in this partially edited image. He was charged around 170,000 yen (about $ 1,480), or 300% of the usual amount, for tests and other medical services for skin cancer screening. The support group footed the bill and he has no prospect of treatment. (Photo courtesy of supporters)

OSAKA – The poorly managed medical system at Japan’s immigration centers became a major problem when a Sri Lankan woman died of illness at the Nagoya regional immigration services office in March. However, foreigners without residency status are in danger of death even outside of detention centers.

As they are not allowed to join the country’s health insurance system, in some cases they are not able to pay for the treatment of serious illnesses because they have to pay 100% of the medical costs, which are very expensive. Support groups for foreign residents and medical professionals across Japan are raising their voices in protest.

In the early morning hours of January 23 of this year, a Cameroonian woman named Relindis Mai Ekei died quietly in a Tokyo hospital. The 42-year-old had breast cancer that had spread throughout her body.

Mai arrived in Japan in 2004 on a short-term visa to escape her abusive fiancé and female genital mutilation. However, the security situation in Cameroon has become unstable and she has not been able to return to her country of origin. Mai applied for refugee status, but it was not granted, and she was detained twice in immigration centers. Since then, she had told her supporters that she had chest pains, but could not receive adequate care in institutions.

In 2018, Mai was temporarily released for the second time and then diagnosed with breast cancer. Without residency status and without access to health insurance, his medical expenses were very high. In order to alleviate these costs, supporters and lawyers have repeatedly called on the government to grant her residency status for the purpose of treatment, but the residence card (for a period of one year) did not arrive. in the hospital about three hours after Mai’s death. death.

In total, about 7 million yen (about $ 61,000) in medical bills for May’s care remain unpaid at hospitals. Yoriyoshi Abe, 40, pastor from Ebina City, Kanagawa Prefecture, who supported her, said with regret: “There were times when the hospital refused to treat her because she had no need. ‘Health Insurance. If she had insurance, treatment would have gone better. ”

This provided photo shows the late Relindis Mai Ekei. (Photo courtesy of the Mai Supporters)

Meanwhile, there is a case where the life of a foreigner was saved by being allowed to be covered by the country’s health insurance system. Burgos Fujii, 48, a Japanese-Peruvian living in Nara Prefecture, was granted temporary release from an immigration center in May 2020, but it was later discovered he had pancreatic cancer, which progresses rapidly and is fatal if left untreated. He had been reluctant to undergo surgery for fear of high medical costs.

In mid-September of this year, he was finally granted residency status. Fujii therefore joined the health insurance system and was able to undergo surgery at the end of the month. The cost of the surgery was covered by donations from people across the country.

Generally, Japan has a universal health insurance system. Foreigners living in Japan are also covered, but if they do not have residency status or are only in the country for a short period (90 days or less), they are not allowed to be insured and must pay. the total amount of medical expenses. expenses.

In the case of serious illnesses like cancer, it is not uncommon for the cost to run into the millions of yen. Foreigners without residence status are prohibited from working and cannot benefit from public assistance, so they have no other income than the support of those around them. Medical expenses are a huge burden on them.

The North Kanto Medical Advisory Association in Ota, Gunma Prefecture, which supports medical care for foreigners in the Tokyo metropolitan area, has helped many uninsured foreigners, including Mai. In 2020 alone, it helped 48 people with their medical bills, including nine cancer patients (such as colon cancer and pancreatic cancer) and at least five of them died after the treatment. The total annual cost of support is 4.8 million yen (approximately $ 41,800), much of which is covered by donations.

Masataka Nagasawa, 67, secretary general of the association, said: “There are many cases where people refrain from seeing a doctor or seeking treatment for a long time due to lack of money, and when we let’s get a consultation, it’s already too late. Necessary medical care should be provided regardless of residence status.

For uninsured foreigners, paying 100% of medical bills is a heavy burden. However, according to supporters, in recent years there has been an increase in the number of cases where 200-300% of actual medical bills are billed.

Burgos Fujii, center, is seen with his residence card in hand outside the Osaka Regional Immigration Services Office in Suminoe Ward, Osaka, September 13, 2021 (Mainichi / Ken Uzuka)

According to the Ministry of Health, Labor and Welfare, the cost of medical care is calculated by adding the cost of various medical procedures to 10 yen per point. But in the case of medical treatment of uninsured foreigners, hospitals can, at their discretion, set higher prices, such as 20 to 30 yen per point. This means that a visit to the doctor for a simple cold, which would cost only 3,000 yen (about $ 26) for an insured patient (who pays 30% of the total), would cost 20,000 to 30,000 yen (about 170 to $ 260).

In recent years, the Japanese government has positioned “medical tourism” as one of its growth strategies, assuming that wealthy foreigners will visit the country for medical treatment. This led to the setting of high medical costs for foreign visitors to Japan, but it also had a negative impact on needy foreigners.

According to a survey conducted by the Ministry of Health in fiscal year 2020, 24% of the country’s 4,380 hospitals that responded to the survey set medical costs for foreigners at a unit price of more than 10 yen per point, and this figure rises to 66% when limited to the 86 hospitals that accept a large number of foreigners.

The office of the Ministry for the Promotion of International Medical Development said, “Medical expenses for uninsured foreigners are set at the discretion of each hospital. We don’t have the power to educate hospitals on prices, even if patients need it.

While there has been a wave of costly billing from foreigners, there is also a mechanism to help them. The “free or low cost medical service” provides medical care to the needy regardless of their nationality. Some hospitals designated by the law on social assistance provide free or low-cost accommodation for people with low incomes and homelessness. Although hospitals suffer losses, they have the advantage of having their property taxes reduced or exempted.

However, the percentage of hospitals that have implemented this service is only 1% or less of all medical institutions in Japan. According to supporters, hospital finances are deteriorating as a result of the response to the coronavirus pandemic, and the number of those offering free or low-cost services who are willing to accept patients is declining.

In reality, many uninsured foreigners receive care in hospitals that are not covered by this service, and sometimes hospitals are left with unpaid medical bills. There is a system to compensate for these unpaid expenses by local governments, but only some municipalities, such as the Tokyo Metropolitan Government, have adopted this system.

Supporters call for the need to improve the medical system in response to a spate of costly medical bills for uninsured foreigners, at the Osaka Prefectural Government Headquarters in Chuo Ward, Osaka on October 20, 2021 (Mainichi / Ken Uzuka)

What makes the problem more serious is the growing number of foreigners who are so impoverished by the coronavirus pandemic that they cannot pay their medical bills. Since last year, immigration authorities have placed large numbers of long-term foreign detainees on bail in order to prevent infection with COVID-19.

In addition, there are those who came to Japan as foreign students or technical trainees. But their visa status has expired and they cannot return to their home country as they have lost their income due to the pandemic. If these foreigners fall seriously ill without insurance, their lives will be in danger.

Faced with this dramatic situation, the Japan Migrant Solidarity Network (SMJ), an NGO working in favor of foreign residents, is currently carrying out a campaign to collect signatures until the end of December, calling on the government to improve the medical system, under the slogan “Do not take expensive medical bills from people who have no money”.

In January this year, a group of foreign supporters and medical professionals from the Kansai region of western Japan launched a study group on medical care for foreigners without residency status. At the end of October, they submitted a letter of request with a goal similar to that of SMJ to the prefectures and cities designated by ordinance in the region.

In the meantime, many Japanese are also suffering from the consequences of the pandemic, such as loss of jobs and declining income, and this tends to lead to the argument, “Why help foreigners at a time like this?”

Kaoru Hashimoto, 68, a board member of SMJ, who is involved in supporting the homeless and foreigners mainly in Kobe, said: “The United Nations Sustainable Development Goals include ‘good health and well-being. -be ‘for all. foreigners cannot return home, cannot work and cannot benefit from social assistance. So how can they afford the high cost of medical care? It is clearly a human rights issue to abandon foreigners in life threatening situations. ”

(Japanese original by Ken Uzuka, Osaka Photo Department)



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