The Yomiuri Shimbun(Oct. 1, 2009)
Give more thought to mixed treatment issue
The nation's courts have adopted different stances on the government's ban on mixing medical treatments that are covered by health insurance with treatments that are not.
In 2006, a male cancer patient filed a lawsuit with the Tokyo District Court, claiming the government was in the wrong to deny him the right to receive two types of treatment--one covered by his health insurance and the other paid for out of his own pocket.
Though the district court ruled in favor of the patient, the Tokyo High Court on Tuesday reversed the lower court's decision, saying the ban on mixed treatment was valid.
Under the current health insurance system, patients are only supposed to pay 30 percent of medical fees when their treatment is covered by health insurance. However, in the case of mixed treatments, people are expected to stump up the full amount for all the medicines and therapies they receive.
Ability to pay
The man who filed the lawsuit wants to receive interferon treatment, which is covered by health insurance, and another form of treatment, which is not. However, if he decides to go ahead with both courses of treatment, he must pay 100 percent of all costs, including the full fees associated with the interferon treatment. The man's lawsuit was based on the premise that the government line is unfair, as it reduces his medical options.
Many people likely sympathize with the man's predicament.
However, the Health, Labor and Welfare Ministry has certain reasons for prohibiting mixed treatments.
If such a practice was allowed, medication and therapies that have not been proven safe or effective might become widespread. Furthermore, it is possible that patients could be saddled with heavier financial burdens if unscrupulous doctors were to casually conduct expensive medical tests or administer costly medicines that are not covered by the health insurance scheme.
If self-funded treatments become mainstream and treatment covered by health insurance becomes marginalized, the quality of medical care that patients can receive might hinge on the amount of money they are able to pay.
Many people oppose the full deregulation of mixed treatments.
However, we believe that exceptions should be made in cases involving certain serious diseases, such as cancer. More than a few patients pin their hopes on new drugs or therapies after treatments covered by health insurance have proved ineffective.
Responding to calls for deregulation, the health ministry has been working on a system to allow for more exceptions.
For example, under the current system, a patient could combine health insurance treatments and new therapies if the patient's medical institution successfully applies to the health ministry to use the new therapy as an advanced treatment.
The ministry has already developed a system that speeds up decisions on whether to approve the use of unapproved drugs in certain cases of mixed treatment.
However, we are still not fully satisfied with all facets of the system, including the speed of the approval process. The system should be further improved to allow new drugs to be approved for mixed treatments more quickly in necessary cases, and pave the way for adoption under the insurance scheme.
The lawsuit will now go to the Supreme Court. Regardless of the top court's ruling, however, the ministry should improve the system so it can better meet the needs of patients.
In the face of demand for full deregulation, the ministry has been approving mixed treatment in an increasing number of cases. The high court ruling should not be used as an excuse to stop this trend.
(From The Yomiuri Shimbun, Oct. 1, 2009)
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