Don’t make the poor pay for expensive medical bills!
Don’t make the poor pay for expensive medical bills!
In March 2021, Wishma Sandamali, a woman from Sri Lanka who was detained at Nagoya Immigration Service Agency, suffered to death after being rejected to get proper medical treatment.
It is also happening to others. Mai from Cameroon was diseased after being detained and was left untreated for a year. After her symptom got worse, Mai was released with the provisional release status. However, she could not go to a hospital, because migrants and refugees with the provisional release are not allowed to obtain national health insurance. After all, she died after fighting cancer for three years.
There are many migrants and refugees facing the same situation in Japan. They are not allowed to have National health insurance and cannot afford expensive medical bills. Even if their life is in danger, they would not be admitted to a medical facility.
Migrants and refugees who get unexpected medical problems and those who support them, including medical facilities and NGOs, are doing everything they can. However, their effort is reaching the limit. One of the goals for Suitable Development Goals (SDGs), ratified by Japan, is “good health and well-being” that will allow “access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines”. In order to build a society where everyone’s human rights are respected and lives of migrants and refugees who are in imminent danger are protected, we need to demand health insurance and well-being for everyone regardless of their nationality and visa status. To achieve this, we demand the following policies from the Japanese government to be enacted.
Issue a residency status for migrants and refugees to be able to have health insurance. This will allow people to receive medical care during their provisional release. Even if that residency status could not be provided to migrants and refugees, the Immigration of Services Agency has to be responsible for medical expenses, by expanding the scope of application of rules for the treatment of detainees.
In order to ensure health insurance for migrants, refugees and people who have difficulty returning to their home country due to COVID-19 and who cannot obtain health insurance, the existing programs that assist foreigners with unpaid medical expenses should be improved and expanded.
1) Implement a national system to assist foreigners with unpaid medical expenses, which is already adopted by some municipalities. Additionally, expand the current coverage, time period, and the level of compensation
2) Include public, national hospital, and local government hospitals to be a part of the program that assists foreigners with unpaid medical expenses
3) Implement similar measures for people who have difficulty returning to their home country due to COVID-19
4) Cover 70% of medical expense when medical facilities that provide Free/Low-Cost Medical Care Program accept people with no insurance which can result in expensive bills
3. Stop medical facilities from charging expensive medical fees to migrants and refugees without health insurance and make a rule that people who are without health insurance and struggling to make ends meet can go get treated at a cost calculated at 10 yen per point.
4. In order for people whose first language isn’t Japanese to be properly treated and have the opportunity to consult about medical fees and life assistance, prepare public translation system in medical facilities, similar to those in European countries
Secretariat / Address for submitting signatures
〒110-0005 3rd Floor, 1-12-6, Ueno, Taito-ku,
Tokyo Solidarity Network with Migrants Japan
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(Please read this too)
What is happening to migrants and refugees now?
There are technical intern trainees who lost jobs and residency status, international students in Japanese language school who could not pay tuition because of poverty and were expelled, and refugee applicants who were severely sick.
In Japan, people who have shorter than 3 months residency status or those who lost residency status for any reason would not be eligible for universal health insurance. Because it is hard to pay medical expenses without health insurance, some people are denied treatment in medical facilities. Or when they do receive treatment, it is too late, leading to death. Emergency rooms are in deep trouble as serious cases are rejected in many medical institutions. Even those hospitals that accept severely sick patients have a heavy burden to bear.
For migrants and refugees who cannot pay health insurance and cannot pay medical expenses, small and mid-sized hospitals felt the duty as medical practitioners and did their best to accept patients by utilizing the Free/Low -cost Medical Service Program. Furthermore, some bigger size hospitals accepted patients, knowing that they may not be able to collect medical fees. In reaction to this, NGOs did their best to support migrants and refugees who had to pay expensive medical fees.
However, there’s no public support for these efforts and the spread of COVID-19 has been threatening the lives of migrants and refugees. There are fewer and fewer medical facilities that accept migrants and refugees without health insurance. On the other hand, as medical tourism for the wealthy is becoming more pervasive, not only private but public medical institutions are increasing medical fees for people without health insurance, just because they are foreigners by changing calculation from 10 yen per point to 20-50 yen per 1 point.
Thanks to the recognition that emergency medical treatment is a human right, EU countries are constructing systems that provide emergency medical care regardless of residency status for migrants and refugees who are struggling economically.
If there are incidents that severely sick migrant and refugee patients from overseas die due to avoidance of medical treatment in Japan where such system is not in place, Japan would be reported as a country that “discriminates life” based on nationality, residency status and the ability to pay, undermines human rights and life, and would lose the international trust completely. At the very least, we should immediately evaluate the “abandonment policy” that would leave detainees who are sick alone without medical coverage.
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(Explanation of terms)
In Provisional Release, foreigners who went against the immigration law are placed in custody temporarily. Because people who are provisionally released do not have residency status, they cannot work, have no health insurance and are forced to live a hard life.
Residency status decides what foreigners can do in Japan. It is divided into three types of permits, ones based on residency itself, ones based on work and others. Foreigners on work and other permits are only allowed to do certain things and they can lose it easily due to unemployment and medical reasons.
In Japan, the Immigration and Residence Administration Office assesses refugee status approval. However, the process takes a long time and is extremely strict. Therefore, there are many people living close to extreme poverty who do not have proper residency status and are waiting for application results.
The Free/Low-Cost Medical Care Program
Based on the Social Welfare Act, this program treats poor, homeless people and victims of domestic abuse and human trafficking for free or at low cost.
Calculation at 10 yen per point
All medical procedures use a point system. ¥10 translates into 1 point and resources from health insurance companies and public fees are used to pay the medical facilities. On other occasions, medical facilities can “freely” set the pricing.
The wealthy can go overseas to receive sophisticated medical services. In recent years, Japan is encouraging policies that cultivate medical tourism as a part of its economic growth strategy. However, some who are opposed to this phenomenon are fearful because this can destroy medical equity.
The program that assists foreigners with unpaid medical expenses
Local governments made this program to save an increasing number of heavily sick foreigners who cannot obtain health insurance in the early 1990s. When people cannot pay the medical fee for a valid reason for over a year, the local government subsidizes a part of it. However, only a few local governments budget this and there are many limitations to the policy, such as that the national public hospitals cannot be a part of it, the period of hospitalization has to be less than 2 weeks and that the medical fees have to be less than ¥1,000,000.
Translators who have professional skills that assist in communication between patients and medical facilities. Medical facilities are obliged to have medical translation without having patients pay in the majority of European countries. However, in Japan, according to the Ministry of Health, Labor and Welfare, medical facilities are not required to do medical translation and they can decide how much they charge to patients.