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This is a preliminary guide to Japan's health and welfare system. Unlike
in the US where public and private health insurance
are often combined to provide proper coverage, Japan enjoys a more logical approach to health coverage.
If there are any errors or other relevant information, please
let us know.
General Health
Annual health checks (kenshin) are provided free to just about
everyone in Japan, including foreigners. They are provided once
a year for company employees employed for over a year, and at
junior and senior high schools. Pre-school children, the elderly
and the self-employed receive free or subsidized medical care
through their local ward or city office. (For more details on
checkups, see the links below)
Japan provides a wide variety of options when you're in need of
medical help. There are private and public hospitals and clinics
but there is no 'family doctor' system. Many, if not most, foreigners
have a less than good impression of Japanese medical professionals.
Studying medicine or dentistry is hugely expensive and practicing
it is hugely rewarding, financially. Many doctors are second or
third generation practitioners who simply went into the lucrative
family business. Bedside manners and medical ethics are not generally
taught in Japan. And recent years have seen several big news stories
about hospital deaths caused by nursing errors. All that having
been said, the best thing to do is get a recommendation of a conveniently
located general hospital (sogo byoin) and dentist (haisha). Except
for dental clinics, an appointment is not usually necessary and
you can go to any hospital you choose. There are a number of hospitals
and clinics that employ foreign or English-speaking staff.
When you visit a hospital or clinic, you will need to show your
health insurance card. If you don't have one, you will probably
be charged a nominal fee. Otherwise, you'll pay 10 or 30 percent
of the costs, depending on which kind of insurance you have (see
below). In addition, you'll be given a prescription for any necessary
drugs, which you take to be filled at a pharmacy. I'm not sure
why the pharmacy is always located in a separate, but nearby,
building.
A personal anecdote: a while back, when I had no insurance cover
- nobody ever asked and I never needed it, but see below - I suffered
from some lower back pain. I thought maybe it was a slipped disc
so I went to a local chiropractic clinic. I was asked for my insurance
card and I said I'd forgotten it. I was seen by the doctor, had
a couple of x-rays taken, did a session on a stretching machine
and received a bunch of muscle relaxants and pain killers and
a belt/girdle. For all of which, I was much relieved, I only had
to pay 5,000 yen (60 dollars). Getting married later made me think
again about not being insured so I went with an international
insurance scheme. This kind of scheme has flat rates, regardless
of your income. In my case, this comes to about 15,000 yen a month,
less than I'd pay for Japanese insurance and it covers me abroad,
too. Mind you, I've yet to have a need to use it, in Japan or
elsewhere.
Mental health
You're most likely not in need of this information now. But a
couple of years in Japan can change that. The stress of just dealing
with a foreign culture and language can be bad enough. If other
negative factors come into play, running up a huge tab at the
nearest hostess bar or hopping on the first flight home are probably
not the best ways to keep your life in Japan on an even keel.
Never fear, help is at hand. There are several options to choose
from, including foreign-language clinics and help lines.
Health Insurance
Japan has a system of universal health coverage, but exactly how
it applies to any given person depends on several factors: whether
you're working, visiting or a student, your age and so on. Variations
in how the different systems are translated into English can also
cause confusion. There are two main systems and both have subcategories
and other complications so the descriptions here have been simplified
and will apply to most foreigners in Japan.
Medical insurance can be divided into two broad categories: the
community-based system of National Health Insurance (kokumin
kenkou hoken, or kokuho) and Employees' Health Insurance
(shakai kenkou hoken, or shakai hoken). Membership of one or
the other scheme is compulsory. Monthly premiums are calculated
slightly differently for each but are based mostly on salary.
Coverage for medical costs also vary between the schemes.
Employees' Insurance
Employees' Health Insurance (sometimes referred to as Society-managed)
has a few subcategories but broadly speaking it applies to people
who are:
- working for medium to large companies
- working for national or local government
- working for private schools
The employer provides a health insurance certificate to employees.
Premiums are calculated based on the insured person's monthly
salary (not including bonuses, which are taxed separately), are
divided equally between the employee and their employer and are
deducted form the monthly paycheck. On average, the deduction
is around 4 percent. Premiums are calculated based on the previous
year's salary so newcomers to Japan will have very low premiums
in their first year. The sudden jump in premiums in the second
year can come as a shock for this reason. The insured is exempt
from premium payments for up to one year taken for child-care
leave. Members of the Employees' Insurance scheme must also join
the Employees' Pension Insurance scheme (see below).
Members of this scheme pay only 20 percent of their medical costs.
Family members pay 20 percent when hospitalized and 30 percent
for outpatient costs. There may be minor additional daily costs
for drugs. The insured shares the cost of medical treatment up
to a certain ceiling, above which they receive full coverage.
The insurance covers sickness, injury and necessary dental work.
In the case of long-term sickness or childbirth, the insured (or
their spouse in the latter case) will receive an allowance, based
on the insured's salary. In the case of the death of the insured
or their dependents, an allowance for the funeral is paid.
National Insurance
If you are not covered by Employees' insurance, and are entitled
to stay in Japan for a year or more, you need to apply for National
Health Insurance. You will need to produce your Alien Registration card (gaikokujin toroku shomeisho, often called a gaijin card) when
you visit your local ward or city office. You also have to do
this if you are: joining an employees' insurance scheme; moving
to another city or town; going back to your country; changing
your name or address. Moving to a different ward in the same city
involves temporarily withdrawing from the system and is sometimes
used as a way to get out of it.
National Insurance (sometimes referred to as Government-managed)
applies to people who are:
- not employed (expectant mothers, students, retirees etc)
- self-employed
- working in agriculture, forestry or fisheries
Members of this scheme and family members pay 30 percent for inpatient
or outpatient costs. There may be minor additional daily costs
for drugs. The insured shares the cost of medical treatment up
to a certain ceiling, above which they receive full coverage.
Foreign students are entitled to a reimbursement of 80 percent
of their medical costs, meaning they pay about 6 percent.
Premiums are calculated based on the insured person's salary,
property, and the number of dependents. On average, premiums are
around 4 percent of salary. There is a cap of 530,000 yen per
year per household, if you're lucky enough to be earning those
kind of big bucks! Premiums can be paid by bank transfer or at
the local ward or city office.
As with the Employees' scheme, the insurance covers sickness,
injury, necessary dental work, childbirth and death of the insured
or their dependents. A working mother, for example, would withdraw
from her company's insurance and join the National scheme at her
local ward or city. The local office provides a lump sum towards
childbirth costs (on average around 300,000 yen) and a small monthly
allowance afterwards. Children's medical costs are usually fully
covered up to age six. Treatments not covered include orthodontic
work, cosmetic surgery, vaccinations, abortions, injuries incurred
while drunk or fighting and treatment outside Japan. In case of
injury in a traffic accident, the perpetrator bears all costs.
If this is impossible, National insurance will cover all costs.
There is also a National Health Program for the Elderly, for people over 70, which is funded by contributions from the
two main schemes. They currently pay 10 percent of costs, though this figure is expected to be increased in the near future.
Pension
If you have paid into Employees' Pension Insurance for at least
six months, you will be entitled to a refund when you leave Japan.
The refund varies between half and three times your monthly salary.
You need to visit your local ward or city office and get an application
form, which you must send back within two years of leaving the
country.
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