Health Insurance and Healthcare in Japan Explained

How Healthcare Works in Japan

Japan’s first form of public healthcare began in 1927. In 1961, they adopted a universal healthcare system. Today, this system is one of the best in the world, placing special emphasis on preventative care.

It is a legal requirement that everyone over 20 years of age be covered by public or private health insurance. If you plan on living and working in Japan, it is essential that you get healthcare coverage as some hospitals and clinics have been known to deny patients who cannot provide proof of coverage. Most clinics and hospitals will also not accept foreign healthcare coverage, leaving you liable to pay 100% of the medical costs.

Japan Healthcare Facts

• Japan has one of the highest life expectancies in the world. For those born in Japan, life expectancy for women is about 88 years old. For men, it is 75. Women also have a 50% chance of reaching 90 years of age. For men, the percentage is just below 30%.
• Because of high medical school costs in the country, there are fewer doctors per capita throughout Japan. However, hospitals and clinics are still excellent thanks to the country’s emphasis and advancement in technology and medical equipment.
• Despite what may be true in other countries, a greater concentration of doctors is found outside of the Japanese cities. This is because doctors see a higher quality of life in more rural settings as well as lower stress environments.
• Conditions not covered by Japan’s national healthcare scheme include mental healthcare, contraception, and birth. However, residents giving birth are given vouchers. See more in our section about Giving Birth in Japan below.
• It may surprise some expats to learn that ambulance rides are free.
• Medicine in Japan is stronger than what is available in other countries. Because of this, you may need a prescription for items as surprising as ear drops.

The Japanese Healthcare System Explained

Does Japan have public healthcare? Yes, they do, and foreigners living in Japan are able to use it with all the same rights as a Japanese national. As an expat, learning how healthcare works in Japan is simple. First, you need to know that there are two main public schemes available:

• Japanese National Health Insurance, Kokumin Kenko Hoken (国民健康保険): This health insurance scheme is available to unemployed people, those working less than 30 hours a week, and students.
• Japanese Health Insurance, Kenko Koken (健康保険): This is available to full-time employees.

With both of these schemes, users will pay 30% of their healthcare costs in Japan. The other 70% will be covered by the government. The percentage may vary slightly depending on your family and income, but at most, you should only be expected to pay 30%.

Japanese National Health Insurance / Kokumin Kenko Hoken (国民健康保険)

If you arrive in Japan without a job, you will need to register for the Japanese National Health Insurance. This health insurance is required of everyone staying in Japan for longer than 90 days unless you are covered by another country’s private insurance.

The Japanese National Health Insurance scheme covers people who are unemployed, work less than 30 hours per week, are self-employed, or students. With this health insurance plan, you are required to cover 30% of your healthcare costs. The Japanese government will cover the other 70%.

How to Sign Up for Japanese National Public Health Insurance

Once you find a place to settle down in Japan, you will need to inform your prefecture’s local government. Depending on the prefecture, finding someone who speaks anything other than Japanese may be difficult.

Once you have registered your address and contact details with this local government office, you will go to the National Health Insurance department and fill out another form. On this form, you will need to provide:

• your name and address;
• passport;
• residence card (Zairyu Card);
• MyNumber card (social security card);
• monthly income.

Your health insurance premiums will be based on your monthly income. If you are a student or unemployed, you will pay less than those with employment. The cost will also be dependent on where you live.

Is Health Insurance Mandatory in Japan?

If you are in Japan for more than 90 days and you do not register for the National Public Health Insurance right away, you will still be charged for the months that you were in Japan. You will pay this even if you did not require medical services or a doctor’s visit.

If you move to a different municipality or prefecture in Japan, be sure to report this change to the National Health Insurance. Premiums differ slightly based on where you live and you may be paying more than you should.

Japanese Health Insurance / Kenko Koken (健康保険)

The Japanese Health Insurance plan can also be called the Employee Health Insurance Plan. This plan is for people who are employed full-time (30 hours or more). The Japanese employer is in charge of setting this up. The most they should need from you is

• your address;
• passport;
• residence card;
• MyNumber card.

The cost for this will come out of your paycheck. It should take a little less than 10% of your monthly salary.

What Does the Public Healthcare Cover?

The Japanese National Health Insurance and Employee Insurance cover between 70 to 90% of costs for medical appointments and procedures that deal with illness, injury, and dental care. This includes, but is not limited to, the following:

• general medical check-ups
• preventative care
• prescription medication
• injury due to an accident
• hospital stays, including some meals
• blood transfusion
• acupuncture and/or other therapy prescribed by a doctor
• birth and pre-natal costs

The Japanese healthcare system is comprehensive. Whether you are paying for a doctor’s appointment, surgery at a hospital, or prescribed medication from a pharmacy, at least 70% of the costs should be covered. This percentage changes only depending on age.

• Infants: 80% of medical costs are covered
• School-aged children to 69 years old: 70% of medical costs are covered
• Adults 70–74 years of age: 90% of medical costs are covered

Residents between the ages of 40 and 65 will pay an extra 2% for a nursing care fee.

Japan Healthcare Costs

Healthcare costs in Japan will differ depending on the medical treatment needed, length of time spent with the doctor, and the type of doctor you see (general or specialist). However, in general, if you have health insurance you can expect to pay anywhere between 5,000–10,000 JPY (45–90 USD) for a consultation at a clinic, and 10,000–15,000 JPY (90–140 USD) at a hospital. Without insurance, these costs will go up to 20–50,000 JPY (180–460 USD). Follow up appointments should cost less.

Appointment and medical check-up costs do not change from prefecture to prefecture. Medical services throughout Japan are required to charge a uniform fee.

Japan Healthcare System Pros and Cons

Pros

• Because Japan is such an expensive country in nearly every aspect of daily life, many expats may wonder why Japanese healthcare is so expensive, too. The truth is, it is not. Hospitals and clinics in Japan are run as non-profits, which helps keep costs low, even for those without health insurance. Any entity offering medical services must be owned and operated by a doctor.
• Patients undergoing cancer treatments in Japan have a higher life expectancy rate than when compared to other countries. Surgical treatments for cancer patients in Japan tend to be more aggressive, as are late-stage chemotherapy sessions. Japan particularly excels with the treatment of lung cancer, colon cancer, pancreatic cancer, and liver cancer.
• Organ transplants in Japan also have a higher success rate when compared to other countries. Even for heart transplants, which have a global five-year survival rate of 72%, in Japan, the rate jumps to 96%.

Cons

• There is no concept of a “family doctor” in Japan. This means that every time you seek medical treatment for a new ailment, you will have to start with a totally new doctor. While all healthcare professionals in Japan are highly trained, this can lead to dissatisfaction with some doctors and a more time-consuming process as each new doctor will need to familiarize themselves with your medical history each time.
• While English is growing as a second language in Japan, it is still common to find medical practitioners who are not proficient in English.
• As is common throughout the Asian continent, the Japanese health system does not place great importance on mental health. Therefore, services in this area may be more outdated and less effective.

An Overview of Private Health Insurance

If you are wondering how private health insurance works in Japan, this section will tell you all you need to know. The first thing you should be aware of is that, when comparing public and private health insurance coverage in Japan, the differences are a lot less than in many other Asian and Western countries. For starters, there is no such thing as a private hospital in Japan. Private coverage does not allow for substantially more coverage, nor does it provide a great amount of advantage when looking for a doctor. However, that being said, private health insurance is still used by both Japanese natives and foreigners in Japan.

The most popular type of private health insurance in Japan is for people with long-term illnesses or foreigners on a temporary stay of just a few months.

In Japanese, private insurance is referred to as shiteki (private insurance/私的保険) or ryokou hoken (travel insurance/旅行保険).

Do you Need Health Insurance in Japan?

Yes, you do. Health insurance coverage is mandatory in Japan, and it can either be through the public healthcare system or private. Private health insurance is gaining some popularity among Japanese residents, but it is still not as commonly used as public healthcare. In fact, those that use private health insurance are largely tourists and foreigners staying in Japan for only a few months. Health insurance is mandatory in Japan and many hospitals and clinics will not easily accept a foreign international healthcare plan.

Want to know how to get private health insurance in Japan? Some Japanese companies will provide private health insurance schemes for their employees. If your company does not and you still want private insurance, you will need to sign up for it yourself through the private provider. This can normally be done through their website.

Benefits of Private Health Insurance in Japan

The benefits of private health insurance coverage in Japan are not many, but there are a few. For instance, there are some types of health insurance plans that cover the 30% co-pays that are usually the responsibility of the individual when using public health insurance. Therefore, some Japanese residents use private health insurance as a means to supplement what’s not covered in their public health insurance plan.

What does Private Health Insurance Cover?

Likewise, private health insurance can be ideal for those with serious medical problems. Japan’s public healthcare system is required to cover pre-existing conditions, but this does not stop the bills from adding up over time. Expats who have to visit the hospital frequently, or who must undergo major surgery, may find that having private insurance cover their normal 30% payment will end up saving them a good deal of money. Private health insurance may also include more extensive coverage for expats who plan to use it abroad from time to time.

It is also worth bearing in mind that while Japanese public health insurance is extensive, it does not cover absolutely everything. Therefore, if you want/need truly extensive, comprehensive medical coverage, then having private insurance is a good idea.

For Employees

A final benefit of private medical insurance is that it may be offered through your Japanese employer. This is a benefit because it saves you the hassle of having to sign up for the National Health Insurance yourself.

Health Insurance Cost

How much is private health insurance? As expected, private health insurance will cost you more in Japan. The average cost of health insurance in Japan is about 35–40,000 JPY per month (330–370 USD). Your medical bills will remain the same and you can use the lump sum given to you by your private insurance to pay the 30% that is normally left over after the public health insurance coverage.

Be sure to always bring your health card with you whenever you seek treatment. If you do not, you will be required to pay 30% of your medical fees.

How to Find a Doctor or Dentist

If you want to know how to find a doctor or dentist in Japan, there are a few things that may surprise you. For instance, general practitioners are not common in Japan. This means that expats who normally want to know how to find a family doctor when they arrive in a new country will find no such thing. Instead, each time you visit a doctor, you will most likely be starting with someone new who will need to familiarize themselves with your health history. Of Japan’s pristine healthcare system, this may be one of the few drawbacks.

Things to Know

• Drugs in Japan are highly regulated, and newcomers may be surprised at the types of medicines that require a prescription. For example, ear drops, which in many countries are easily purchased in pharmacies, require a prescription in Japan.
• Depending on your needs, the average wait time to see a doctor in Japan is anywhere between an hour to a few days. Walk-in appointments are common.
• English is not widely spoken, even by doctors.
• Locals visit hospitals even for minor treatments such as colds and sprained ankles.

Visiting a Clinic

Because general practitioners and family doctors are not common in Japan, if you are sick, the first place you will want to go to is a clinic. Most clinics do not require an appointment, but you should check online with the specific clinic you want to visit to be sure. Do not forget to bring your health insurance card.

Once you check-in with the receptionist, you will be asked to fill out your medical information and health history just like you would when visiting doctors in any other country. Once your examination with the doctor is through, you must return to the waiting room and wait to pay. If you are prescribed any medication, you will receive this information when you pay as well as the pharmacy where it can be collected. If you have a more serious condition, you will be recommended to visit a hospital.

How to Find Specialists

You can find specialists in Japan at clinics or in hospitals. Because general practitioners are not common, you do not need a referral in order to see a specialist. Simply show up to a clinic for a walk-in or check if you should book an appointment online (this varies from clinic to clinic).

How to Find a Dentist

The main difference between dentists (called haisha/歯医者) and other medical professionals in Japan is that you must book them by appointment. You can usually call their office or book online. If it is your first visit with that dentist, it is customary for them to take an X-ray. Be prepared to spend at least 5,000 JPY (50 USD).

Giving Birth in Japan

Infant and maternal mortality rates in Japan are some of the lowest in the world, making it one of the best countries in which to give birth. Non-residents giving birth in Japan find the process safe and efficient, with the biggest complaint being the extremely low recommended weight gain (an average 7–8 kg). Expectant women should be prepared to receive some criticism from their Japanese doctors should they go over the recommended weight gain amount.

Having a Baby in Japan as a Foreigner

Most births in Japan happen in hospitals or birthing centers and clinics. Mid-wives and homebirths are possible, but not as common. Expats interested in waterbirths will also find plenty of opportunities.

Prenatal care is important in Japan and expats will find a wide variety of birthing courses from traditional Lamaze classes to yoga and even Hypno-birth therapy.

Cost of Having a Baby in Japan

As a foreigner, you are legally obligated to have Japanese health insurance, so giving birth in Japan without health insurance will only occur if you are a tourist without coverage. Many hospitals will not accept foreign insurance, so if you give birth without being covered under a Japanese health scheme then prepare to pay for everything yourself upfront.

That being said, Japanese health insurance does not cover prenatal, birth, or ante-natal care. Instead, expectant mothers are given “maternity vouchers,” which offers discounts to be used for check-ups and other birth-related expenses. The Japanese health scheme offers these vouchers instead of general coverage because the idea is that every birth and birth-need is specific. By offering the vouchers, women are welcome to spend them however they see fit. Be advised that the amount offered in the vouchers will vary slightly from prefecture to prefecture.

The first few check-ups will cost around 20,000 JPY (180 USD). Other following regular check-ups will be about 5,000 JPY (50 USD) per visit. In Japan, it is common to have around 15 check-ups in total.

The basic fee for a natural, uncomplicated birth at a hospital, which automatically includes a five to six-day stay, ranges between 500,000 to 700,000 JPY (4,600–6,400 USD). This fee includes the stay in the hospital plus three meals a day. Hospitals may provide the option of a private room, which will be more expensive.

Benefits of Giving Birth in Japan

Besides the overall benefit of giving birth in a country with extremely safe and efficient maternal and infancy care, another benefit of giving birth in Japan is that the Japanese government gives “child benefit payments” to each family from the time a child is born until they turn 15. The amount you will receive depends on the income of your household, but these are the average prices:

• 0–3 years of age: 15,000 JPY (140 USD) per month
• 3–12 years of age: 10,000 JPY (90 USD) per month
• 12–15 years of age: 10,000 JPY (90 USD) per month

To begin receiving these payments, you need to submit a Birth Notification to your local municipal office. Payments are distributed three times a year.

Giving Birth in Japan for Citizenship

Being born in Japan does not grant automatic citizenship unless one of the parents is a Japanese national. If both parents are non-residents, then the child will be given the nationality of the parents.

Even if you have given birth in Japan as a permanent resident, you will need to register your child’s birth. You will need to do this within 14 days of the birthdate. To register you will need:

• an application form for a Birth Report and Birth Certificate. This form will be one sheet of paper, but one side will be filled out by the doctor/midwife and the other side will be filled out by the parents;
• Mother and Child Health Handbook (this should be picked up from your local municipal office once you learn that you are pregnant);
• health insurance card;
• passport of both parents;
• residence card of both parents;
• Hanko

After this, the last step will be to apply for your newborn baby’s residence visa. You will need to do this within 30 days of the birthdate. To do this, you will need to submit the following to the local immigration office:

• application form for Permission to Acquire Status of Residence
• passport and residence card of both parents
• baby’s passport (if you do not yet have a passport you can say that you applied for one)
• proof of employment from at least one parent
• most recent tax payment certificate
• details of your personal information
• Letter of Guarantee
• Certificate of Acceptance of Birth Report
• Mother and Child Health Handbook
• residence record of the family

You do not need a photo of your baby. There should also not be a fee.