Medicince fee

Matsuno Hiroshi, 31, pharmacist, Akashi-shi

“I’d like to pay for all my medicine bills. I have already cleared all my hospital bills,” said Mr Y as he took out a 10,000 –yen notes from his pocket. Mr Y is a refined, middle-aged gentleman, who always bowed deeply and thanked me profoundly whenever he collected his medicines from me.

I am a pharmacist of a pharmacy that caters mostly to the patients from the newly opened hospital K located on the north of the JR Shinnagata Station. The director of the hospital, a Mr K, is a gray-haired, good-natured doctor. Despite of his advanced age of 70, he has engaged in active medical practice again immediately after the quake.

Do you know that a scheme known as the ‘partial medical fee exemption for quake victims’ was set up following the earthquake? Usually, if you are covered by the health insurance, you will still need to bear 10 – 30% of your medical fees. But with this new system, the government had waived that portion of the fees for the quake victims.

For the purpose of insurance claims, we would ask a patient to circle the word “Exemption” in red on his application form. The exemption was effective for six months.

I did not know how the duration was determined, but at one point, we were notified that the insurance companies would, according to the original agreement, stop accepting such applications from May 31st (extension till December 31st was given to victims with a half/completely destroyed house), and that the National Health Insurance would extend this scheme until December 31st.

Almost all our clients were ‘Exemption’ patients. As people in this district were also covered by the National Health Insurance scheme, we did not see a dip in the number of patients when the ‘Exemption’ scheme of the insurance company had expired. When the scheme run by the National Health Insurance scheme stopped six months later, however, about one-fourth of our patients stopped visiting us.

Some patients had probably collected as many medicines as possible while they were still available free. However, our medication records (we keep detailed records, which includes the medicines provided, their side effects and precautionary points) showed that more than ten chronic disease patients, including those with hypertension, angina, and diabetic conditions, did not came back after December. These patients could not go on without their medicines.

When they did not visit again in February, I jotted down their names and consulted Mr K. He was obviously thinking about the same thing. He retrieved the medical records and said he would contact them. After that, the patients concerned started to come back again. Almost all who came back had either obtained or were applying for the livelihood assistance (a scheme that helps applicants pay all medical expenses). Mr K had telephoned me earlier regarding Mr Y, who was the only one without the assistance.

“Mr Y has lost his factory. Although he did apply for the livelihood assistance, his application wasn’t granted because the factory land is still under his name. He can’t afford to stop his medication. I’m prepared to let him delay paying his consultation fees. Can you do something for him?”

On his next visit, Mr Y looked reddish on his face as if he had had a drop too much just before stepping in. But he did not smell of alcohol when I stood near him. His redness might have been a result of increased blood pressure from heavy breathing. Three types of new hypertensive drug and diuretic were added to the prescription. When I handed him the medicines, he asked apologetically, “
Ur... how much do I have to pay? I don’t have much cash with me...”

“It’s OK if you don’t have the money now. Other patients haven’t paid up either,” my lie came out in a twinkling.

“Is that so? Then, please allow me to pay later,” looking relived, Mr Y said with a deep bow. Since then, he would visit my pharmacy regularly. I tried not to touch on the issue of medicine fees. Then, three months later, he told me he wanted to clear the bills. I hesitated before telling him, “It’s 26,090 yen in total...”

Through the window, Mr Y handed me the 20,000 yen which he had held in hand, and retrieved another 10,000-yen note from his inner pocket. I tried my best to look expressionless when putting the receipt and change on the small mat. He returned the change to his inner pocket, bowed and said, “Thank you very much!” before leaving. Since that day, he did not appear again. ”Why don’t you ring him this time?” Mr K said one month or so later. I did, and was greeted by a recorded message, ‘The telephone number that you have just dialed is not in use.’