According to the World Bank data for 2020, Japan had the highest life expectancy of 85 years, as per the latest data for 2021. While Japanese food habits are famous for their health consciousness and are among the top two most active nationalities in terms of walking (source), longevity is also a testimony that the Japanese healthcare system is one of the best in the world.
Moreover, Japan also ranks number one globally, with a Health Index score of 86.6, and apart from a healthy lifestyle, it also reflects the easy access to the efficient health insurance system of Japan,
The Japanese healthcare system became more standardized after the Meiji Restoration and the introduction of Western medicine. The universal health care system was first introduced in 1961, allowing almost everyone to become insured and have medical fees determined by a person’s income.
Japan places a heavy emphasis on preventative health care. Foreigners are often surprised to see locals visitin g a doctor in Japan for something as simple as a small cough. Labor laws in Japan mandate companies to have yearly health checks for their employees.
The Japanese healthcare system can initially seem confusing, but once you dive deep, it is straightforward.
This article will discuss the healthcare system in Japan, including Japanese health insurance, medical helplines for ex-pats, and medical tips that a foreigner in Japan may need.
In this article
Japanese law requires all residents of Japan to be enrolled in medical insurance.
In Japan, you can get Health Insurance in two ways:
As the name suggests, Employee Health Insurance (Kenkō hoken) is health insurance for salaried employees.
Kenkō hoken is a part of Social Insurance in Japan. Social Insurance comprises the following:
Any business employing 5 employees or more must cover all its full-time employees under Employee Health Insurance. The employer also must cover the part-time employees who meet the following conditions:
Please note that even in the absence of the above conditions for mandatory coverage of the part-time employees under the Employee Health Insurance, a Japanese company can also have individual agreements with the part-time employees to cover them under the health insurance.
The responsibility to do all paperwork to enroll the employees under the health insurance lies with the employer.
Employee Health Insurance premium depends on the total income, including salary, bonuses, and other employee allowances.
The employer contributes 50% of the insurance premium, and the remaining 50% is deducted from the employee’s income.
In Japan, Employee Health Insurance, 70% of your and any dependent’s medical bills
All the following dependents of an insured employee are also covered under this health insurance plan:
However, please note that all relatives above must financially depend on the insured employee.
An employee covered under Employee Health Insurance also received a lump-sum childbirth allowance of JPY 420,000 per childbirth.
An employee can claim medical expenses for self and dependents for any treatment taken overseas during visits abroad.
Please note that a translation of the receipts in Japanese may be required to make a claim. However, anyone, including the employee, can do the translation.
In case the spouse of an employee covered under the health insurance is earning, they can still be covered under the health insurance of the employee if any of the following conditions are met:
All residents of Japan who are not eligible for Employee Health Insurance coverage must register for National Health Insurance (kokumin kenkōhoken).
The following table shows the eligibility criteria for National Health Insurance coverage in Japan:
| Eligible for National Health Insurance | Ineligible for NHI |
|---|---|
| People working part-time, freelancers, or self-employed and who are not eligible for Employee Health Insurance. | People above 75 years of age. |
| Any foreigner with a visa validity of over 3 months. | Temporary visitors with up to 3 months’ stay in Japan. |
| Foreign students. | People receiving any welfare benefits or are in Japan on a visa for medical treatment. |
As a foreigner, if you come to Japan on a temporary visa for 3 months and the visa validity is extended towards the end of the 3 months, you must apply for National Health Insurance. Please note that you should apply for health insurance even if the extension is for the next 3 months or less.
Moreover, even if you are covered under some international insurance system meant for overseas travelers, you must enroll for the National Health Insurance in Japan if your stay in Japan is over 3 months.
To apply for National Health Insurance, visit the Residential Affairs Division at your municipal office or the ward office of the metropolitan area with jurisdiction over your place of stay.
Unfortunately for foreigners, there likely will not be any English forms available, and it’s wise not to expect there to be someone who speaks English. It is recommended that you bring a friend along if you cannot understand Japanese.
Eligible foreigners must apply for National Health Insurance within 14 days of arrival in Japan. However, the enrolment date will automatically be the day of your arrival in Japan.
Like Employee Health Insurance, National Health Insurance covers 70% of your and your dependents’ medical treatment bills.
Like Employee Health Insurance, National Health Insurance coverage also ensures JPY 420,000 as the childbirth allowance for each child’s birth.
Also, as with employee health insurance, any medical expenses incurred overseas during any foreign travel can be claimed by the insured person.
In case of the insured person’s death, the deceased person’s family members can also claim a funeral fee of JPY 50,000. In addition, an insured person can claim the same funeral fee if any dependent dies.
The insurance premium for the National Health Insurance depends on the following:
Please note that foreigners will have a fixed standard premium fee during their first year in Japan, as the insurance premium depends on the previous year’s income. Moreover, the insurance premium will increase with any increase in dependents.
Depending on the municipality or ward office, international students without any income to show during their previous year in Japan may be eligible for a discount on the insurance premium fee. Such a discount can also apply to other foreigners new to Japan.
Foreigners need to contact the concerned municipal or ward office to enquire about the possibilities of such discounts.
Unlike Employee Health Insurance, where the employer is responsible for paying the insurance premium, National Health Insurance requires the insured person to make the payment themselves.
The municipal or ward office concerned sends the payment slip for the insurance premium every month to the home address of the insured person. After receiving the payment slip, the payment can be made by various convenient options as follows:
Before leaving Japan, a foreigner must withdraw from the NHI coverage. To do that, go to the ward office and complete the necessary forms. Please note that you must pay any remaining insurance premiums for the remaining days before you depart.
What if I were 75 years old?
People over 75 years of age are not eligible for the NHI and must insure themselves under the Latter-Stage Elderly Healthcare System (Koki Koreisha Iryo Seido). However, the following people will not be eligible for this healthcare system:
Please note that the Latter-Stage Elderly Healthcare System also applies to people 65 years old or over with a certain designated level of disability. You can contact your ward office for guidance and instructions.
The benefits of the latter-stage elderly healthcare system are the same as those of the national health insurance but with a much-reduced insurance premium of 10%. However, please note that the reduced premium is only applicable if the income is less than a specified level of the particular municipal government.
Moreover, as the terms for this elderly healthcare system vary from municipality to municipality, it is recommended to contact the municipal office with jurisdiction over your place of stay.
The Long-Term Care Insurance system in Japan is meant for people with health problems who need long-term nursing care because they are bedridden or have conditions like dementia.
There are two categories of people who can avail of this facility:
For people 65 years or older who are not insured under another healthcare system, the premium must be paid to the municipal government or the ward office of the metropolitan area.
For the second category of people in the 40 to 65 age group under Employee Health Insurance, the employer makes the insurance premium payment and bears part of the additional premium. However, the government bears part of the additional cost for those under National Health Insurance.
Private health insurance is also available in Japan but is not as popular since most clinics or hospitals rarely accept it. Such Insurance is typically used to cover orthodontics, plastic surgery, and chronic medical diagnosis.
There are two main types of facilities where patients can receive medical treatment: hospitals (byouin or 病院) and clinics (kuriniku or クリニック).
Clinics in Japan are medical facilities with 19 beds or less and treat mild illnesses and injuries.
Japanese hospitals have 20 beds or more and can conduct specialized medical treatments and operations.
Many people will be surprised that general practitioners aren’t commonly found in Japan. Instead, physicians typically specialize in one field rather than practice a general field of medicine.
For those experiencing general symptoms like stomach aches or fevers, it is best to visit an internal medicine (naika or 内科) specialist. Although general practitioners are uncommon, the Japanese Ministry of Health, Labor, and Welfare recommends that residents regularly consult with a family doctor in their local neighborhood.
Visiting dentists (haisha or 歯医者) in Japan is much like anywhere else. They are by appointment only; you are expected to make multiple visits yearly for regular checkups.
The Japanese National Health Insurance also covers dental procedures but only covers what is medically necessary. For example, although a root canal is necessary, the Insurance might only cover basic filling and dental caps. So be sure to ask what the Insurance covers before scheduling your appointment.
In Japan, natural health therapies like acupuncture, moxibustion, and health massages are also covered under medical insurance. However, you must receive such treatments from a licensed therapy center to take advantage of the insurance benefit.
You can claim health insurance benefits for health massages, acupuncture, and moxibustion for the following health issues in Japan:
Despite its advances, Japan is still a country of tradition over modernity. As a result, many expats find it surprising that therapies like acupuncture, health massages, moxibustion, etc., are also covered under health insurance. However, many foreigners fall in love with such therapies after experiencing them.
General health trends among Japanese and other populations differ greatly as well. The preventive health care system strongly emphasizes screening for cancers early on, particularly stomach and breast cancer.
The language barrier and differences in health trends often lead to misunderstandings about medical treatment for foreign patients.
The rise of foreign nationals has increased the need for medical services accommodating foreigners. Although you are likely to find English-speaking doctors in large cities outside the metropolitan areas, it’s unlikely that any English-speaking staff will be.
To help the international community receive proper medical care while living in Japan, various services can help you find the proper accommodating institution and offer appointment bookings and even interpretation services.
JNTO provides guides for multilingual hospitals outside of Tokyo. The website’s search engine allows visitors to choose the prefecture where they are staying to help narrow down the best location. A PDF guide that lists various symptoms you can use when describing your ailments is also available.
Japan Health Information is a free online service that helps people find English-speaking clinics and hospitals in Tokyo and other major cities. They also provide informational guides on sexual, mental, and child health services.
Many foreigners try to avoid visiting a doctor in Japan for small ailments. However, there will come a time when a quick checkup or treatment is necessary.
To ease the anxiety, I recommend you become acquainted with a family doctor in your neighborhood when you first move to Japan. That’ll make visiting the hospital when you’re sick less stressful.
Moreover, it is recommended to always carry your Japanese health insurance card with you to avail yourself of the benefits of the Japanese health care system in sudden emergencies.
Keeping your health insurance card with you will save you a lot of pain. If you visit a Japanese hospital or clinic without a medical insurance card, you must pay in full for the treatment and medicines. Of course, the insurance money will be refunded to you later, but it will cause unnecessary inconvenience initially.
A long-term ex-pat in Japan, Himanshu comes with an IT background in SAP consulting, IT Business Development, and then running the country operations of an IT consulting multinational. Himanshu is the co-founder and Managing Director of ReachExt K.K. and EJable.com. He is also an Advisory Board Member of a Silicon Valley AI/IoT startup.
