2017 Volume 5 Pages 38-44
The health insurance systems in Japan include a substitutional mechanism of payment to a victim on behalf of an individual at fault. The patient must submit a notification of third-party infringement if he/she wants to use this optional mechanism. As this notification plays the role of a trigger for a claim for compensation, patients and physicians’opinions regarding this notification may often be in disagreement. In particular, an ethical dilemma may arise if a victim was negative toward the claim for compensation and demanded the usual Medical Treatment Benefits from the physician instead. Ethical matters concerning physicians have not been studied in Japan in relation to this substitutional payment mechanism or notification of third-party infringement.
Herein, we report two cases in which an ethical dilemma arose concerning this notification. In these cases, the contribution of third-party infringement to the hospitalization was not conclusive. The one submitted the notification affected by physicians’persuasion, but the other did not. Problems on the substitutional payment mechanism are also discussed using the cases. Management of treatment expense claims in cases whose sickness or injury is partially attributed to third-party infringement should be discussed further and better organized in the future.
