As taxi driver Hirohisa Mitsuda washes his vehicle prior to a day’s work, he tries to make sure the windows are spotless because his passengers hardly ever get to enjoy the outdoors.

“This is a rare chance for the passenger to go outside and see,” he said.

Mitsuda drives a so-called nursing taxi, catering specifically for the elderly and disabled. He takes care to keep the ride smooth for his passengers, avoiding sudden braking or turns. He also helps his passengers, who are often in a wheelchair or an ambulance bed, get in and out of the vehicle.

The nursing-taxi service was originally launched in 1998 by the Medix cab company in Fukuoka Prefecture. It has since expanded to more than 170 companies nationwide. including Suginami Transportation where Mitsuda works.

Mitsuda and other cabbies offering the same service hold second-grade licenses as “nursing caretakers.” The service has helped people who have difficulty using public transportation to get out more often.

Masato Ando, 83, often uses a nursing cab for the one-hour ride to his twice monthly checkup at a medical center.

He is unable to speak or stand on his own after suffering a stroke 1 1/2 years ago. Ando’s face lights up now when he watches the view from the windows of the taxi, having been a frequent traveler in his younger days.

His daughter, Setsuko Nitta, stressed that the transportation service has not only eased the family’s burden but also helped to add spice to Ando’s life.

That’s why she never hesitates to pay the 6,000 yen fare for each leg of the two-hour ride to and from the medical center.

However, the nursing-taxi service, despite its growing popularity, has been a source of bureaucratic contention.

A typical nursing-taxi service costs 2,100 yen per 30-minute “nursing fee,” in addition to the normal taxi fare — an amount that would be too expensive for passengers who would use the service on a regular basis.

So when the nursing-care insurance was introduced in April 2000, many taxi operators applied to have their service covered by the scheme, which would have allowed passengers pay just 10 percent of the entire cost.

But the Health, Labor and Welfare Ministry turned down these applications, stating transportation services are not covered by the insurance, which covers only in-house care at home or at an institution.

Many taxi firms then started charging only the nursing-care portion of their service — helping passengers get in before the ride and get out afterward — while offering the transportation either free or at a discount so their service could be covered by the nursing insurance.

The Land, Infrastructure and Transport Ministry responded by arguing that the discount service amounted to discriminatory fares and the free taxi service was illegal.

According to a health ministry survey, 52 percent of nursing-taxi operators offer a discount on taxi rides, while 36 percent offer the transportation service free of charge.

Suginami Transportation is one of a small number of nursing-cab operators that charge the entire taxi fare. “We want to stay out of the legal quagmire and maintain the business,” said Hidesuke Eto, Suginami Transportation’s welfare department manager.

The bureaucracy has since eased its stance in the face of growing demand for the service.

The transport ministry said in January 2001 it would “condone” the discount or free-ride service.

The health ministry is also expected to make the nursing-taxi service coverable under the nursing-care insurance scheme starting in April.

But users will probably pay much more than the regular 10 percent of the entire fare, as the ministry still considers the taxi service to be in a different category from conventional nursing care.

Masaaki Ito, spokesman for the Special Transport Network of Tokyo, a volunteer group working to provide transport for the disabled, said 5 percent of Japan’s population has a latent demand for such services.

It is not clear, however, whether the nursing-taxi service, despite growing demand, can survive without administrative support.

“Mobility is one of our fundamental rights, but it’s not institutionalized in Japan,” Ito said. “It’s still left to individual responsibility.”

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