Price of mercy can be dear when it comes to transplants
One of the lesser discussed principles of Japan’s national health insurance policy is that it only pays for treatment. That sounds like a pretty broad mandate, but what most people don’t realize is that “treatment” presupposes a condition that needs to be remedied. In other words, you have to be sick. If you’re not, insurance won’t cover it. That’s why pregnancy testing and periodic checkups are not covered by insurance, though many local governments provide free cancer screenings and other preventive measures to residents of a certain age.
This principle receives a thorough test in the realm of organ transplants. Last week, the Tokyo Shimbun ran a letter from a 65-year-old woman who said that she wanted to donate one of her kidneys to her brother, who had to receive dialysis treatment at least once a week. Living organ donors have to undergo a series of tests to make sure that the organ they are donating is compatible, and the woman spent one week in an Aichi Prefecture hospital where her kidneys, as well as her overall health situation, was thoroughly scrutinized. Afterward, doctors determined that her kidney was “not functional enough” for transplantation into her brother.
A few weeks ago she received a bill from the hospital for ¥400,000, a full year after the tests were administered. She was shocked. Prior to the testing she was made to understand that she would only have to pay about ¥50,000 for “blood tests” and doesn’t remember anything about being told of the other expenses on the bill. She says in her letter that had she known the tests would be that expensive, she “would have thought the matter over more carefully.”
The woman’s national insurance does not pay for the testing because she herself is not receiving treatment. If her kidney had been suitable for transplantation, the cost of her tests would have been borne by the insurance of the recipient of her kidney, her brother. But since her kidney wasn’t used, there is no sick person whom the tests benefit. When a transplant is carried out, the insurance of the recipient pays for both surgeries — the donor’s and the recipient’s.
Tokyo Shimbun brought the matter to the health ministry, which said that if a certain medical procedure is not covered by insurance, then the matter is between the medical provider and the customer; which means there are no rules governing this situation. Apparently, charges for donor testing vary widely from hospital to hospital, which raises questions of gouging. Are some medical facilities using the lack of guidelines to overcharge donors?
The Japan Society of Transplantation says that living donors can only give organs to other family members, which means whatever costs are involved in the overall process are more easily taken care of because recipients and donors know one another closely and so can share the expenses more readily. But while transplants are still relatively rare in Japan, they are also relatively inexpensive because of national insurance. The irony is that testing that results in a judgment of incompatibility can cost more to the donor than an actual transplant operation would cost to the recipient.
Things get even more complicated with bone marrow transplants. If you donate bone marrow to a bone marrow bank, you don’t have to pay for testing because there is no designated recipient. But if you want to give bone marrow to a specific person and it’s found that the two of you are incompatible, then you do have to pay. However, the Japan Organ Transplant Network did find a silver lining in all this. A representative told the Tokyo Shimbun that in the case of a brain dead recipient whose organ is found to be incompatible with someone else, “the donor doesn’t have to pay for the testing.”