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  1. REHABILITATION OF PEOPLE
  1. SUPPORT FOR MEDICAL PATIENTS AND PUBLIC AID FOR PRIVATE MEDICAL FACILITIES

Support for Private Medical Facilities

In the areas hit by the Great Hanshin Earthquake, private medical facilities were also severely affected. Doctors, dentists, their families, staff, hospitalized patients, and their homes suffered great damage by the earthquake and fires. With the medical functions paralyzed, people in the medical field were swamped with temporary treatment which they could manage, medical activities, postmortem examinations and medical care in evacuation centers.

They made every effort in coping with emergency cases as well as in continuing the medical care for chronic invalids, improvement of the sanitation and environment in evacuation centers in the freezing coldness, reinforcement of the medical support system, securing a place for the elderly and the invalid to take emergency refuge, and the establishment of medical activities in temporary housing.

Finding out how serious the damage wrought by the great earthquake was, the national government decided to assist the reconstruction of public medical facilities for full expenses, then of private hospitals and clinics. Also aid for secondary emergency hospitals, preferential measure in the "Project for Modernized Medical Facilities", and a subsidy system to support quake-hit medical facilities was established.

However, such support measures turned out to be far from sufficient. The aid for secondary emergency hospitals could be only applied for the restoration of "emergency sections", and the preferential measure in the "Project for Modernized Medical Facilities" excluded dental facilities. Screening was performed based on attendance record on holidays, on the type of clinic, whether it is set up in an office building and/or it is a medical corporation with only either one or two full-time doctors, and on the discrepancies of the owner's name.

It was to neglect the characteristics of urban disasters and modernized medical facilities in that it excluded those in an office building and/or medical corporations with one or two full-time doctors from the support target.

Still, it is true that direct public aid helped the reconstruction of damaged hospitals and clinics a great deal, including partially collapsed ones, even under the limited conditions. The total amount of the public assistance was 9.4 billion yen for 230 private hospitals and clinics (with the highest amount of 10 million yen for a clinic and 250 million yen on average for a hospital).

Request for Reimbursement of Medical Fees

It was made possible for quake-affected medical facilities to request for reimbursement of medical fees at a rough estimate for a certain period, which was (1) from January 1 through January 16 in the case of medical facilities who lost medical records, etc., due to the damage of total or partial collapse or fire, and (2) a month in the case of those who carried on medical service from January 17 onwards, and in the case of medical and health facilities in the designated disaster-affected areas who were recognized as "it is hard to grasp the medical service performed after the earthquake." The measure rescued medical institutes who were engaged in medical treatment devoting all their energies, having their medical records scattered and lost.

Medical Fee Exemption System for Earthquake-Affected People

There was a system set up to assist earthquake-affected people to be exempt from the payment of medical fees. By this system, (1) those whose home was totally or partially collapsed or burnt, (2) main earner of the household was killed, seriously injured, or ill, and (3) those who were in an equal situation to the above, were given a grace for their obligation part of the medical expenses, and the food and medical expenses while in hospital. In the case of those covered by national insurance, those with the head of the household (1) abandoned or halted his/her business, or (2) lost his/her job and had no income, were added to the target group.

The exemption system was discontinued after a while. In the case of those covered by health insurance it ended after four months, on May 31, 1995, with the exception of those who belonged to the nontaxable income group as to municipal tax--the system continued for them until the end of December, 1995, and reduction of food and medical expenses while hospitalized until the end of May, 1996. In the case of those covered by national insurance, the system terminated at the end of December, 1995. Around that time that the system was discontinued, victims had just moved into temporary housing without much hope for the recovery of their lives, the number of disaster-related deaths were increasing and people's health conditions were ruined and/or deteriorated. Many of the disaster-hit people with health problems were forced to stop receiving medical treatment due to the termination of the system.

(TAKAYAMA Tadanori)