The Japanese national health insurance system dates back to 1922 whereby it was originally creates for company employees. After the war in 1961 it was changed to a universal system that was to cover everybody (including foreign people) living in Japan, and not just those who were working. Almost 100 years on, the changes to the system have not been as numerous as the changes to the country and the people it was set up to care for. By its mere existence alone, people living in Japan are still better off than those living in countries whereby there is no government provision of healthcare. Better off still, than those living in countries where healthcare is privatized and rampant profiteering has created an environment whereby only the insurance companies benefit as claimants are literally unable to pay the cost of exorbitantly priced drugs, treatment and care. The stories of people without coverage being hit with tens, if not hundreds of thousands of dollars in medical bills after falling sick or being in an accident are numerous; as are those who are bankrupted as a result.
Depending on whether your Japanese national coverage is via your company (健康保険), or personal/individual (国民健康保険), along with your age and annual salary will determine what percentage of costs you are expected to pay out of pocket, ranging from 10% to 30%. For those proficient in Japanese this is often sufficient. For those not proficient in Japanese (even now the number of doctors who are proficient in English is low), you would probably like to be able to choose a clinic or a hospital based on their abilities and reputation, and not be limited to whether or not you are able to communicate. There may be a few differences to the Japanese healthcare system to those of your home country that you may have already noticed:
1) Hospitals and clinics are not standardised by the government; procedures and protocols vary from hospital to hospital as they are for the most part privately operated. As with any privately operated business there is variation; this means good hospitals, and unfortunately, it also means bad hospitals. Consider checking reviews online before dropping in to your local doctor/dentist/clinic.
2) Doctors do not ordinarily speak English. Although they will have had contact with the English language whilst qualifying to become doctors, they are often unable to communicate fluently in English. If you are suffering from a cold, fever or other such minor ailment this may not be a huge inhibitor to getting appropriate treatment. Consider however, attempting to communicate complex symptoms, or having a complicated procedure (surgery, for example) where there may be risks and ramifications involved. In such a scenario, it would be advisable to choose a practitioner with whom you are not going to have any lost in translation moments.
3) Not all treatments are covered by national health insurance. The Pharmaceuticals and Medical Devices Agency (Japan’s ‘FDA‘) is arguably less progressive than some western government bodies where it comes to deciding what medicines can and cannot be marketed and used domestically. This is not incomprehensible when you consider that many medicines (especially the ones that work) are expensive. If the government is going to have to pay for 70% of a persons treatment, then exposure to expensive drugs (even if they work) is arguably a bad idea for the budget. Because of this, any number of treatments that are widely accepted as standardised treatments in other G10 countries have not received approval here in Japan, and as such are classified as “experimental”– meaning that if you want them- you pay for them.
4) Certain dentists/hospitals/clinics/specialists do not accept national insurance health coverage. I.e they are not reimbursed by the government, so you have to pay the full price. Again, this may be due to the use of contemporary treatments and/or medicines mentioned above, or it may because the facility is “international”. Many of the facilities which offer all treatments and consultations in English do not accept national health insurance cards.
Private Health Insurance In Japan
Many people will look to establish international or “private health insurance” coverage which follows them wherever they go. For expats this has an added benefit, whereby if you become sick in a different country, even if you’ve paid all of your Japanese health insurance premiums, the coverage does not extend outside of Japan. An insurance plan for expats will cover you wherever you go. This aside, for those who rarely travel outside of Japan, the most commonly cited benefits are as follows:
- You are not restricted to places which “accept” national health insurance. This means you go to where you want to go to. Want an English speaking doctor? Go to an English speaking doctor. Want to go to the industry leading practitioner for cancer treatment? Book yourself an appointment and go and see him. (of course, each insurance product will have its own terms and conditions for coverage, but you get the idea…).
- You are not actually restricted to receiving treatment in Japan. Many people will choose to fly back to their home country for treatment there, or anywhere else for that matter, depending on where the best option is at that time.
- Based on which plan you choose, you are able to tailor your coverage (and your costs) accordingly; i.e. minor conditions, minor + inpatient, inpatient + outpatient, dental, opticians etc… Less coverage, lower cost. More coverage, more cost. Simple.
It is important to remember that you will still be paying your Japanese health insurance premiums (or at least, at this point in time, are obligated to do so), and so should be mindful of the total cost of your coverage. It is however possible to structure your private care so that it only meets the cost of larger, critical illnesses and procedures. In doing so the cost is reduced (Why? Statistically it will be used less often than the more comprehensive option which covers coughs and colds). This withstanding, for those with ongoing medical conditions, hereditary illness in the family, children, or no proficiency in Japanese, the risk of being left without options in you or your loved one’s time of need is definitely worth insuring against.
– Japanese Ministry Of Health, Labor And Welfare: Outline of Health Care Insurance System, 2016
– The Commonwealth Fund:International Profiles Of Health Care Systems, 2014
– From the Japanese Association of Medical Sciences, Characteristics of Japan’s Healthcare Systems and the Problems, Yoshio UETSUKAJMAJ, July / August 2012 — Vol. 55, No. 4