Hospitals free to inflate charges for uninsured patients

A 54-year-old Filipino woman living in Inage, Chiba Prefecture, was taken ill in April and had to use an ambulance to go to a hospital in the city of Chiba. She was suffering from acute appendicitis and needed immediate surgery.

The hospital, managed by the Chiba Municipal Government, asked if she was covered by health insurance. She wasn’t. The woman, who asked not to be named, has been overstaying her visa since late 1995.

Her family knew that medical care for an uninsured patient would be extremely expensive in Japan. But they were outraged when they found that Chiba’s two city-run hospitals charge uninsured patients 50 percent more than numerous other hospitals do.

Many hospitals — private and public alike — charge uninsured and insured patients at the same rate for a given medical procedure. But others, like the hospital she was taken to, bill 150 percent. “I would have never guessed hospitals run by the city would charge us 150 percent,” fumed the woman’s Japanese son-in-law. “We had no choice but to accept it because her life was at stake.”

She was billed about 780,000 yen for her treatment, including two weeks of hospitalization. Had she been insured, the hospital would have collected only two-thirds of that amount — around 520,000 yen — from her and her insurer. The woman’s son-in-law, who works for a shipping company, says such a rule is outright discrimination against foreigners who cannot afford health insurance.

Officials at the Chiba Municipal Government, however, say the hospital is only complying with the law. Hiromi Iijima, chief of the city’s hospital management section, said a municipal by-law mandates that its two hospitals charge all uninsured patients 150 percent of what is billed to insured people and their insurers. Hospitals in the city of Chiba run by the prefectural government, on the other hand, charge the same rate for uninsured and insured patients; the prefecture’s ordinances do not include a clause permitting higher bills.

All Japanese nationals are entitled to health insurance. Foreigners with valid visas for one year or more who are not insured through their employers can join the national health insurance scheme by reporting to their local governments upon their arrival. Policy holders pay monthly premiums, and their insurers — either the national government, local governments or insurance corporations — cover 70 percent or 90 percent of the bill.

Immediate family members of the insured are entitled to health benefits as well. Iijima said the “150 percent clause” was squeezed into the city’s by-law in 1972. But no one in the municipal government knows why, he said, adding that the city’s bureaucracy has since been restructured and related official papers cannot be located.

He did say, however, that the city surveyed how much public and private hospitals in its vicinity charge uninsured patients. It turned out many were charging the uninsured more, and he suspects the results prompted his government to follow suit.

A random review of billing policies in the Tokyo metropolitan area reveals that some cities allow their hospitals to charge uninsured patients up to 150 percent of what they collect from insurance-covered care. Among the nation’s 12 largest cities, nine say their hospitals charge uninsured patients 100 percent of the medical cost. The other three, including Chiba, let their municipal hospitals bill more from uninsured patients.

For medical institutions, the most serious problem involving non-Japanese patients is that many of them fail to pay their bills at all, Sekiyama said, citing a survey of public hospitals run by local governments. The survey found that 589 such hospitals had some 3.4 billion yen in uncollected bills in March 1995, with foreign patients accounting for 4.7 percent. The report pointed out that foreigners with unpaid bills are on the rise.

The Filipino woman’s son-in-law said he tried to negotiate with hospital officials, offering to pay 500,000 yen up front if the hospital charged just 100 percent. But the hospital refused, saying all other patients not covered by insurance are paying 150 percent, he said.

When she checked out of the hospital, the woman signed an agreement to pay off the full amount. She will pay 10,000 yen a month through an installment plan. It will take her more than six years to pay off the debt.