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Health care in Japan

It’s hard to navigate a health care system when you’re in a foreign country — the guide below aims to answer some of your burning questions.


Despite ranking poorly for such aspects as finance, property and making friends, Japan ranks 16th for health in the 2017 HSBC’s expat survey. Medical facilities are abundant in Japan, with treatment and medicine being of a high quality. Japan’s health care ranked fourth best in the world by Business Insider in 2018 and the Prosperity Index in 2017.

 

The country’s health care system itself is one of the most cost-efficient on the planet. It costs less as a percentage of the economy than almost any of its rich-world peers. While the US spends 16% of GDP, France spends 13% and the UK spends 10%, Japan spends only 9.5% despite its ageing population (Bloomberg.)

 

Health care system
Japan has a hybrid system — Statutory Health Insurance System (SHIS) — which combines government-funded programmes and private insurance.

 

The government pays 70% of the cost of all health procedures, unless you’re a low-income elderly resident, when it can pay up to 90% of bills. This is also true for other groups — including people on low incomes, people with disabilities or certain chronic conditions — when the government pay a higher proportion of costs.

 

The remaining 30% of costs are covered by private health insurance, which can be employer-sponsored or bought privately. Spending on private health insurance to cover the 30% co-pay is partially tax-deductible.

 

Enrolling in SHIS means paying tax. The amount varies depending on your employer. Your employer deducts a monthly contribution from your pay packet (unless you need to submit your own taxes, which is forwarded, along with the company’s contribution, to the social insurance agency. Because the proportion contributed by the company and the employee varies, it is a perk if you work for a company that takes on a larger slice of the overall contribution. It is mandatory for companies that employ more than five individuals to provide health care for their employees, so many employers prefer employees who use the national health care scheme. Expats can also decide if they would prefer to use international private health insurance (see below.)

 

Health care in Japan is compulsory for expats who have either a resident’s visa or work permit. There are two public schemes — one for salaried workers and one covering the remaining population — and a private system of health insurance. It is mandatory for expats with any visa exceeding three months to be registered on one of the two public insurance schemes.

 

 

This hybrid system developed as a supplement to life insurance and provides additional income in case of sickness. This usually takes the form of lump-sum payments when insured people are hospitalised or diagnosed with cancer or another specified chronic disease, or through payment of daily amounts during hospitalisation over a defined period.

 

Primary care practices usually have teams comprising a doctor and a number of nurses. While clinics can dispense medication directly from doctors, the use of pharmacists has been growing.

 

Individuals can drop into any clinic, except those requiring appointments, because patients don’t have to register with a single practice. That said, the government encourages patients to choose their preferred doctors, and there are patient disincentives for self-referral, including extra charges for initial consultations at large hospitals with many specialties.

 

In 2014, 15% of hospitals were owned by national or local government or closely related agencies, the rest being private and non-profit entities some of which receive subsidies as playing semi-public roles. The private sector has not been allowed to manage a hospital, except in the case of existing hospitals established by for-profit companies for their own employees.

 

Standards of care
Strict immigration controls mean that Japan is largely free of ‘non-contributors’ seeking free health care. As such, Japan can afford to be more ‘generous’ with the care it provides residents and citizens.

 

In 2015 the Organisation for Economic Co-operation and Development (OECD) reviewed the Japanese health care system. Its report — with data from 2012 — details its strengths as including:

 

  • The highest number of hospital beds among OECD countries (13.4 beds per 1,000 population compared with five across OECD countries)
  • The longest lengths of hospital stay.
  • Very low hospital discharge rates (which may reflect the availability of rehabilitative and chronic care in hospitals and weak availability of post-acute care settings to provide rehabilitative and long-term care services after discharge).
  • Japan appears to be performing well based on OECD indicators related to five-year survival estimate for cancer. Japan was also in the top four countries for five-year survival estimate for cervical and breast cancer.
  • Japan’s in-hospital case fatality rates within 30 days after admission for ischemic stroke was (in 2011) the lowest among all OECD countries.

 

The Japanese health care system also has an operational policy to reduce the harmful use of alcohol and inactive lifestyles, and to promote physical activity and healthy diets.

 

The OECD report did find areas for improvement. For example, while the Japanese are less likely to die of ischemic heart disease compared with people in other OECD countries, they are more likely to die once admitted into hospital for acute myocardial infarction (AMI) than patients in other OECD countries.

 

In recent years, one issue Japan faced was ‘bed blocking’. In an effort to give the best care, many patients are kept in hospitals long term as they recover. This has the knock-on effect of increasing the chance of infection.

 

At the time, a senior spokesman for the Japanese health ministry explained that they were tackling the problem:

 

“Many patients stay not for medical reasons, but for long-term care. We’ve been trying to sort this for 30 years. We introduced long-term care insurance, shifting them into care homes but we are dealing with private sector facilities.”

 

Access
All SHIS plans provide the same benefits package. This covers hospital, primary, specialty and mental health care as well as approved prescription drugs, home-care services by medical institutions, hospice care, physiotherapy and dental.

 

The Japanese system doesn’t cover glasses or contact lenses unless recommended by physicians for children under nine, or optometry services provided by non-physicians. Preventive measures, including screening, health education, and counselling, are covered by health insurance plans, while cancer screenings are delivered by municipalities. Home-care services by non-medical institutions are covered by long-term care insurance.

 

Primary care (GP/family doctor) is provided at most clinics and some hospitals. While around 30% of physicians are employed by clinics, most are self-employed. Many clinics are owned by doctors themselves or by medical companies, which have a status best described as legal entities for health-care management, usually medical institutions owned by those doctors. They can also be publicly owned.

 

The national insurance programmes are only designed to cover medically necessary services as defined by Japanese law. Services may exclude:

 

  • Some dental operations, such as orthodontics
  • Any medical treatment that results from a fight or drunkenness
  • Vaccines
  • Medical check-ups
  • Cosmetic surgery
  • Obstetrics
  • Contraception.

 

Health insurance
Foreign travellers and short-term residents (up to 90 days) won't be eligible to apply for the national health care cover but can still purchase travel or international Private Medical Insurance (iPMI) from private companies.

 

If you're moving to Japan long term or permanently, then you're required by law to enrol in either the National Health Insurance (NHI) or the Employee Health Insurance. If you're not employed at a company, it is possible to avoid registering for the NHI, but — while this is not strictly enforced — if you’re caught, you may be required to pay for the full duration that you were not covered.

 

Despite the thoroughness of the public system, private insurance (local and international) remains popular. However, private insurance, is limited. Japan doesn’t have a system of ‘private’ hospitals offering bespoke care as in many other countries. What private health insurance offers in Japan is generally a lump sum payment if you’re in hospital for a certain period, or if you’re diagnosed with a serious condition. Individuals usually have to pay medical bills in full and up-front before filing a claim.

 

Because health insurance is mandatory in Japan, it is affordable and easy to obtain. This is because all medical fees — including surgical procedure fees and medical prescriptions — are reviewed and regulated by the Ministry of Health, Labour and Welfare, as well as the Central Social Insurance Council.

 

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Additional sources

 

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