Global Asbestos Congress 2004

Check of Medical Receipts for Detection of Pneumoconiosis and Asbestos-Related Diseases at the Tokyo Construction Health Insurance Society

Kyoichi Yamada
Tokyo Construction Health Insurance Society, Tokyo, Japan

There are four types of medical insurance in Japan: "Employees' health insurance" for employees of business organizations (68.67 million subscribers); "Mutual aid associations" for public employees (10.01 million subscribers); "Municipalities-operated national health insurance" for people not covered by other schemes, including self-employed workers (43.37 million are insured); "National health insurance society" operated by fellow industries (4.25 million are insured).

The Tokyo Construction National Health Insurance Society (TOKEN-KOKUHO) was established by seven construction labor unions, which organize employees of construction industries, in July 1970. There are 15,646 union members in the Society and, including members' dependents, 34,740 persons are insured as of 31 May 2004.

TOKEN-KOKUHO has checked receipts of medical remuneration since 1994 in order to identify our colleagues who have been suffering from pneumoconiosis and help them obtain compensation for absence from work by way of workers' accident compensation insurance, because anybody who had been engaged in construction work could have used asbestos-containing materials and been exposed to asbestos dust, and as a result fallen victim to pneumoconiosis. We also addressed ourselves to this action as enlightenment about asbestos hazards.

The TOKEN-KOKUHO has checked the receipts of medical remuneration since January 1994. Once a month, our staff extract the receipts of medical remuneration of our colleagues who have at least one of eight types of disease (1. lung cancer, including suspected, 2. silicosis, 3. pneumoconiosis, 4. lung fibrosis, 5. mesothelioma, 6. lung phthisis, 7. asbestosis, 8. pleural plaques) from a total of 31,000 receipts, and send them to the medical institution designated by the TOKEN-KOKUHO to be assessed by physicians.

The physicians rank the extracted receipts Special A, A, B, C in order of causation between diseases and jobs. Workers who are suffering from diseases which are considered to have the clearest relation to their jobs are ranked Special A. The TOKEN-KOKUHO notifies the Special A-ranked workers and their labor unions that they are allocated so. It is necessary to investigate their job history and whether they have subscribed to workers accident compensation insurance. Since 1990, public health nurses belonging to the designated medical institution and staff of labor unions, to which the Special A-ranked workers belonged, have visited them to explain pneumoconiosis using booklets, and inquired about their job history and whether they had subscribed to industrial accident compensation insurance. They also recommend that the Special A-ranked workers take medical advice from Hirano Himawari Clinic, the designated medical institution.

We have thus far visited over 50 Special A-ranked patients since 2000, and achieved recognition for 9 of them as having occupational diseases (compensation benefits for absence from work and/or bereaved family compensation).

We have accomplished certain results. However, several colleagues could not apply for the insurance program because they did not take out workers accident compensation insurance. We need to strongly recommend to our colleagues that they take out workers accident compensation insurance, in cooperation with labor unions which comprise the TOKEN-KOKUHO.