Gov't Loses Healthcare Insurance Court Case

[Mulboyne]

Yomiuri: Govt ban on 'mixed' treatment ruled illegal
The Tokyo District Court on Wednesday ruled that the government erred in not allowing a patient to be provided with two types of medical treatment--that covered by health insurance and that purchased by the patient at his own expense. Presiding Judge Makoto Jozuka said, "There's no legal basis for banning 'mixed' treatments," referring to the government policy prohibiting the mixed use of treatment that is covered by health insurance and that which is not. The judge thus granted the plaintiff, a cancer patient in Kanagawa Prefecture, the right to receive health insurance benefits. The patient had been told by his hospital to pay all the costs of treatment he was receiving although only part of the treatment was not covered by health insurance. He filed a lawsuit at the district court demanding confirmation that he has the right to receive benefits where due. This is the first court ruling that has said the ban on using both types of treatment for a patient--a long-held premise for Japan's health insurance system--is illegal...more...

This is a significant ruling. It could add to the costs of healthcare in the country and may encourage more patients to question the efficay of the course of treatment they are offered under insurance. The rest of the article is in the next post.

[Mulboyne]

Continued

The ruling is likely to force the Health, Labor and Welfare Ministry to drastically review the way it deals with mixed treatment. Mixed treatment refers to the mixed use of treatments covered by health insurance and those purchased at the patient's own expense. In principle, such treatment is prohibited. Therefore, when a patient is administered with an anticancer drug that is not approved by the government, for example, the patient must pay for all the treatment he or she receives, even that which is usually covered by insurance, such as hospitalization and tests. However, the government allows mixed treatment in 16 fields, including some advanced medical care, as exceptions.

The defendant is Nobuhito Kiyosato, 60, of Fujisawa, Kanagawa Prefecture. According to the ruling and other sources, Kiyosato received a course of interferon treatment, which is covered by health insurance, and another form of treatment that is not covered by insurance from September 2001 to treat kidney cancer. In October 2005, however, the hospital told him that it could no longer provide him with the treatments because they constitute mixed treatment. The biggest issue in the court case was whether there was any legal basis for the government policy of banning mixed treatment in principle.

The government claimed that medical treatment covered by insurance under the Health Insurance Law is that which has been confirmed as safe and effective by the government, and therapy that includes treatment not covered by insurance should not be covered by health insurance. But the ruling pointed out an error on the part of the government in interpreting such a case, saying, "Whether a certain medical treatment is covered by medical insurance should be judged on a case-by-case basis. Even if it includes treatment at the patient's own expense, this does not mean that the patient must pay even for the part of the treatment that is covered by insurance."

[Iraira]

What the hell are they talking about by "another form of treatment"? Aside from requesting medical marijuana, the article was very vague about what is not considered a safe and effective therapy. While I'm not going to tell a cancer patient to chew on some valerium root and not do their chemo, it'd be nice to know what is covered under the national health scheme (scam) and what isn't.

[L S]

I used to get accupuncture treatments done for sinus problems in Shibuya and it always surprised me that I could use national insurance.

[Mulboyne]

What the hell are they talking about by "another form of treatment"?..it'd be nice to know what is covered under the national health scheme (scam) and what isn't.

The Asahi writes:

The public health insurance does not cover costs for new treatment methods or for new medicines that have not been approved...the decision could encourage the use of unapproved treatments and also widen the disparity among patients in the accessibility to advanced treatments, depending on their financial means.

Trying a treatment which is used outside Japan but has not yet been approved by Japan will not invalidate your insurance coverage.