Health and Welfare

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, closer to the UK's NHS. If you find 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 and you generally choose your clinic based on your specific needs, whether it be ear, nose and throat, pediatrics, skin conditions, etc.

Many 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 manner and medical ethics are not generally taught in Japan. Recent years have seen several big news stories about hospital deaths caused by nursing errors. And there is often a tendency to dole out medication for anything and everything.

All that having been said, there are good clinics and doctors out there and the best thing to do is get a recommendation of a friendly and conveniently located ear, nose and throat clinic and a dentist (haisha). Except for dental clinics, an appointment is not usually necessary and you can go to any facility you choose, but you'll need to register on a first visit. There are a number of hospitals and clinics that employ foreign or English-speaking staff.

When you visit a general hospital (sogo byoin) 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 but the pharmacy is almost 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 (45 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.

As someone who lived in Japan for more than twenty years, it's easy for me to forget just how much of an adjustment it was getting used to life here all those years ago. Not only was the language seemingly impenetrable, so also were many aspects of the culture. The locals were usually friendly and helpful, but there were invisible borders and barriers that had to be navigated.

In such circumstances, many people resort to overdoing the socializing and partying, very easy to do in Tokyo and the other cities that are on the go 24/7. Alienation, depression, addiction, I've seen all these and more result from an inability to adjust. Leaving Japan may be one option, but sometimes just having a sympathetic ear can make a big difference. And if you can confide in someone knowing it needn't go any further than that, all the better.

Never fear, help is at hand. There are several options to choose from, including foreign-language clinics and help lines. Japan Zone talked with the folks at Tokyo English Life Line to learn a bit about their service, which has helped out many a distressed gaijin over the years. See the Related content section below.

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.

Related content

• Tokyo English Life Line - Need to talk? TELL is here to listen - anywhere in Japan!