Problems Associated with Providing Medical Service to Foreigners : Unpaid Medical Bills at Tertiary Emergency Medical Institution in Tokyo

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  • 都心部三次救急医療機関における医療費未払い問題からみた外国人医療の問題点

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最近7年間(1994～2000年)に当施設に入院した外国人患者168人について,医療費未払い問題からみた外国人医療の問題点について検討した.対象例の背景因子は男女比1.2,平均年齢35.6歳で,出身地としてはアジアの隣国,韓国,朝鮮,中国が過半数を占めた.疾病としては男女共に外因性疾患が多く,男性は暴行,傷害例,女性は急性薬物中毒が中でも目立った.当施設では全額未払いが20%に達したが,東京都から行旅法適応や独自の外国人未払い医療費補填制度により約60%の補填がなされた.しかし,今後さらに増加傾向にある外国人医療費問題に対しては,外国人登録時の保険加入や,事業主に対する外国人労働者の保険加入の徹底化など抜本的な施策が必要である.

Over a period of 7 years (1994～2000), a total of 168 foreign patients were admitted to our institution. We investigated problems associated with providing medical services to foreigners from the perspective of unpaid medical bills. The male-to-female ratio was 1.2, and mean age was 35.6 years. More than half of these foreign patients came from neighboring Asian countries such as Republic of Korea (South Korea), Democratic People's Republic Korea (North Korea), and China. For both male and female patients, the most common cause of hospitalization was extrinsic: notable factors included violence and injury for men, and acute drug poisoning for women. At our institution, only 20% of foreign patients had fully paid their bill, and through programs provided by the Tokyo Government, such as the Law for handling sickness, injury or death of travelers (Traveler Law) and Foreigner Unpaid Medical Cost Reimbursement System, we were able to recover 60% of medical expenses incurred from the provision of medical services to foreign patients. However, as the number of foreign patients is expected to increase in future, measures must be established to ensure that foreigners enroll in the national health insurance system when they register for residency or are hired for work.

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