Healthcare in Japan


Japanese healthcare is a difficult subject that I’ve been meaning to write about for some time. For those of you living in countries without a national health service the idea of paying for hospital stays and operations may be nothing new, but until I moved to Japan I had never really thought about it. You break an arm, you go into hospital, have an operation, and come out the next day. That’s it: no bills, no nasty fees, nothing.

Most of what is written in this post is based largely on my own personal experiences. If anybody has any further information they would like to share on this subject, please do!

Oi! I thought Japan had a national healthcare system. Doesn’t that mean healthcare in Japan is free?
Yes yes, I know, no healthcare system is free: somebody has to pay for it somewhere along the line. The big difference between Japan and the UK, for example, is how far along that line healthcare is paid for. By and large, in Britain patients don’t pay up front – in part or in whole – for hospital stays or operations. Japan’s healthcare system is not so straightforward. The main Wikipedia article on Japanese healthcare says:

“Japan provides healthcare services, including screening examinations for particular diseases at no direct cost to the patient, prenatal care, and infectious disease control, are provided by national and local governments.”

Some services are “at no direct cost to the patient”, others will cost you. Generally speaking, in their various guises the national healthcare systems pay for 70% of drugs and healthcare costs. The remaining 30% is paid for by the patient.

I’ve just moved to Japan. Do I have to enrol in a healthcare programme?
No, you don’t. Broadly speaking, there are two categories of healthcare scheme: employee health insurance (健康保険 or Kenkō-Hoken) and national health insurance (国民健康保険 or Kokumin-Kenkō-Hoken). In theory all residents of Japan are required to be enrolled in one of these schemes, but for reasons of cost (either personally or to their employer) many are not. Foreigners are recommended – but not forced – to join one of them.

How do I know if I’m already enrolled in either of these healthcare programmes?
Have you got a credit-card sized piece of plastic with either 健康保険 or 国民健康保険 written on the top? If you haven’t, then you’re probably not enrolled. Also, check your pay slip for deductions under 健康保険科.

My company says I have private health insurance, and that it isn’t really worth enrolling on one of the national schemes.
If you’re coming to Japan as an English (eikaiwa) teacher then your company might have a private scheme that you automatically become part of. What this means is that every time you visit a doctor or dentist you might have to pay for the full cost of everything by yourself, rather than the 30% you would be pay under one of the national healthcare schemes. You will need to send all the medical receipts off to your insurer, who will then reimburse the cost – often several months later.

Example: You have private healthcare, but no national healthcare. You catch the flu and visit your doctor. He checks you out and prescribes some medicine. The doctor’s fee comes to ¥6,000, and the medicine costs ¥2,000. If you had national healthcare, this would have cost you ¥1,800 and ¥600, respectively.

If you’re coming to Japan for a year or two. and are fairly confident that you won’t fall seriously ill or have a nasty injury, then a private scheme might be all right for you. They are usually much cheaper (around ¥7-8,000 a month compared with ¥14,000 for national healthcare), and some paranoid twits relish the idea of not being locked into the ‘government system’. However, if you’re going to be here long-term, I strongly recommend you enrol yourself on a national healthcare scheme.

Whoa there, Silver. Let’s go back a step: I thought all companies had to enrol their students on a national healthcare scheme anyway…
All full-time workers should, in theory, be provided with employee health insurance. To get around this many of the shadier companies keep working hours at just below the full-time level. This saves them loads of money, but benefits neither their employees nor the healthcare system in general. The number of part-time workers has sky-rocketed in recent years, starving the healthcare system of much-needed funding.

What about dentists?
As long as you’re not having anything cosmetic done, the same 30% fee applies. If you’ve got national healthcare, that is.

A word of warning: enamel fillings seem to be classed as ‘cosmetic’ in Japan. That doesn’t necessarily mean you have to end up looking like Jaws from James Bond, though: resin fillings are pretty decent these days.

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