Health Insurance and Healthcare in Japan Explained

Jump right in

• How healthcare works in Japan
• An overview of national & employee health insurance
• An overview of private health insurance
• How to find a doctor or dentist
• Japan healthcare system pros and cons
• Giving birth in Japan

How healthcare works in Japan

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’s essential that you get healthcare coverage as most clinics and hospitals won’t accept foreign healthcare coverage, leaving you liable to pay 100% of the medical costs.

The Japanese public 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
• Japanese employee’s health insurance, kenko koken: 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%.

Is health insurance mandatory in Japan?

Yes. Health insurance coverage is mandatory in Japan, and it can either be through the public healthcare system or a private healthcare insurance. If you are in Japan for more than 90 days, you need to get health insurance If you don’t register for health insurance right away, you’ll still be charged for the months that you were in Japan. You will pay this even if you didn’t 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 or your private insurance company. Premiums differ slightly based on where you live and you may be paying more than you need to be.

An overview of national & employee health insurance

The Japanese National Health Insurance scheme covers people who are unemployed, who work less than 20 hours per week, are self-employed, or students.

How to sign up for Japanese national public health insurance

Once you find a place to settle down in Japan, you’ll need to inform your prefecture’s local government. Once you’ve registered your address and contact details with this local government office, you’ll get your social security number, which you’ll need for your health insurance application.

Next you'll go to the national health insurance department and fill out another form. On this form, you’ll need to provide:

• your name and address
• passport
• residence card (Zairyu Card)
• your “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’ll pay less than those with employment.

Japanese employee health insurance / Kenko koken

This plan is for people who are employed full-time, work more than 20 hours or more per week, and earn at least 88,000 JPY (approx. 580 USD) per month. The Japanese employer is in charge of setting this up. The most they should need from you is:

• your address
• your passport
• your residence card
• your “MyNumber” card

The cost of the health insurance premiums will come out of your paycheck. This should equal approximately 10% of your monthly salary.

What does the public healthcare cover?

The Japanese national health insurance and employee insurance cover 70% of the costs incurred for medical appointments and procedures that deal with illness, injury, and dental care. This includes, but is not limited to, the following:

• emergency care
• prescription medication
• injury due to an accident
• surgeries
• hospital stays, including some meals
• blood transfusion
• acupuncture and/or other therapy prescribed by a doctor

The Japanese healthcare system is comprehensive. Whether you’re 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 years of age or older: 70–90% of medical costs are covered

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

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 the following prices:

Follow-up appointments should cost less.

An overview of private health insurance

If you’re wondering how private health insurance works in Japan, this section will tell you all you need to know. Firstly, private health insurance in Japan typically works as a supplement to the mandatory public system by covering the 30% of medical costs you’d otherwise pay out of pocket. It may also offer additional benefits, like lump-sum payments for serious illnesses or long hospital stays, rather than covering every medical service.

Private health insurance in Japan doesn’t offer significantly more coverage or easier access to doctors than public health insurance. However, it’s still used by both locals and foreigners, especially those with long-term illnesses or foreigners staying temporarily for just a few months.

In Japanese, private insurance is referred to as shiteki (private insurance) or ryokou hoken (travel insurance).

What does private health insurance cover?

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’s also worth bearing in mind that while Japanese public health insurance is extensive, it does not cover absolutely everything. So, getting private insurance could be valuable, and it can also be structured as an add-on to a life insurance policy. Therefore, if you want/need truly extensive, comprehensive medical coverage, then having private insurance is a good idea.

How to get private health insurance

Some Japanese companies will provide private health insurance schemes for their employees. If your company doesn’t and you still want private insurance, you’ll need to sign up for it yourself through a private provider. This can normally be done through their website. Some popular private insurance companies for expats include:

• Axa
• Allianz care
• Cigna Global
• Img Insurance
• Bupa Global.

Private health insurance premiums

The average cost of private health insurance in Japan is about 35–65,000 JPY per month (approx. 230–420 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 don’t, you’ll be required to pay 30% of your medical fees.

Japan healthcare system pros and cons

Pros

• Low costs: Hospitals and clinics in Japan are run as non-profits, which helps keep costs low, even for those without health insurance.
• Excellent cancer treatment: Patients undergoing cancer treatments in Japan have a higher life expectancy rate compared to other countries. Japan particularly excels with the treatment of lung cancer, gastric(stomach) cancer, colorectal cancer, and liver cancer.
• Successful organ transplants: Japan also has a high transplant success rate when compared to other countries. Even for heart transplants, which have a global five-year survival rate of 72%. In Japan, this rate jumps to 96%.
• 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 ‘s 81.
• It may surprise some expats to learn that ambulance rides are free.

Cons

• While English is growing as a second language in Japan, it’s still common to find medical practitioners who aren’t proficient in English.
• As is common throughout the Asian continent, the Japanese health system does not place great importance on mental health.
• Certain areas of Japan face shortages of medical staff, especially nurses and other healthcare workers, leading to uneven distribution across the country.
• Because of the high cost of medical school, there are fewer doctors per capita throughout Japan. There is a relatively low number of 2.6 doctors per 1,000 people.

How to find a doctor or dentist

Unlike in some countries, general practitioners are not common in Japan. Instead, you typically visit a specialist directly for your specific health concerns. For expats accustomed to having a family doctor manage their care, this can be surprising. Each time you seek medical attention, you’ll likely meet a new doctor who is unfamiliar with your medical history, meaning you'll often need to explain your background and health issues from the beginning.

Things to know

• Drugs in Japan are highly regulated, and newcomers may be surprised at the types of medicines that require a prescription.
• 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

Most clinics do not require an appointment, but you should check online with the specific clinic you want to visit to be sure. Don’t forget to bring your health insurance card. Once you check in with the receptionist, you’ll 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’re prescribed any medication, you’ll receive this information when you pay as well as the pharmacy where it can be collected. If you have a more serious condition, you’ll be advised 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 don’t 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). Generally, to find any doctors around your prefecture you can check sites like Medical Doc or read more information about healthcare in Japan.

How to find a dentist?

The main difference between dentists (called haisha) and other medical professionals (such as gynaecologists and paediatricians in Japan is that you must book them by appointment. You can usually call their office or book online. If it’s your first visit with that dentist, it’s customary for them to take an X-ray.

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. Expats giving birth in Japan find the process safe and efficient, with the biggest complaint being the extremely low recommended weight gain (an average 7–12 kg).

Most births in Japan happen in hospitals or birthing centers and clinics. Mid-wives and homebirths are possible, but not as common.

Cost of having a baby in Japan

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 doesn’t cover prenatal, birth, or ante-natal care directly. Instead, expectant mothers with health insurance are given a childcare lump sum grant of 500,000 JPY (approx. 3,300 USD) which can be used for check-ups and other birth-related expenses (including the birth itself).

The Japanese health scheme offers this grant instead of general insurance coverage because the idea is that every birth and birth-need is specific. By offering the grant, women are welcome to spend them however they see fit.

The first few check-ups will cost around 10,000 JPY (approx. 65 USD). Other following regular check-ups will be about 5,000 JPY (approx. 33 USD) per visit. In Japan, it’s common to have around 14–15 check-ups in total.

The basic fee for a natural, uncomplicated birth at a hospital, which automatically includes a five to seven-day stay, ranges between 500,000 to 700,000 JPY (approx. 3,250–4,540 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 (approx. 99 USD) per month
• 3–15 years of age: 10,000 JPY (approx. 66 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-citizens, 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 permit. 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
• birth certificate
• mother and child health handbook
• residence record of the family

You don’t need a photo of your baby, and there shouldn’t be a registration fee.