The Japanese health system

Updated 2022-12-21 08:59

The Japanese healthcare system is renowned for its efficiency and modernity. It counts numerous doctors, and various specialties, especially in the big cities. The Japanese National Health Insurance is available to all residents of Japan, whether they work or not. If you are planning to move to Japan or are already living there, you should know how to deal with the Japanese healthcare system.

Universal healthcare in Japan

The healthcare system in Japan was established in 1961. It is referred to as a universal health system. The law of 1961 extends the scope of the 1922 legislation, which already provided public insurance to all workers.

Health insurance in Japan covers all those who live in the country for 3 months or more, regardless of whether they are residents or non-residents. All citizens and residents however are required to register with the Japanese health insurance system. Employees are covered by a special health insurance which covers about 59% of the population. Job seekers, pensioners and self-employed people are insured by the regional branch of the health insurance (local or prefectural insurance).

What is covered by health insurance in Japan?

Health care in Japan is renowned for its quality and high standards. Its system is one of the best in the world. This is particularly true of hospitals with state-of-the-art equipment and one of the world's highest bed-patient ratios. This quality comes at a cost, however. If you are not insured, your expenses can quickly skyrocket. National Health Insurance covers several health items, including:

  • Medical consultations
  • Medication
  • Hospitalization
  • Surgical operations
  • Dental care (consultations and dental surgery)
  • Medical treatments and tests

In Japan, pregnancy is not considered a disease. Therefore, it is not covered by health insurance. Instead, the municipalities take over this responsibility. In practice, pregnant women have to register at their city hall to declare their pregnancy. They will receive, in addition to the health booklet, vouchers that make them entitled to free consultations. Local authorities may also grant a sum of money (the amount varies from one municipality to another).

In case of a funeral, the health insurance will provide a lump sum to the family of the deceased.

The demographic challenge for Japan's healthcare system

Japan's population is aging, and this has become a significant issue for the government. The recent pandemic has only made things worse for Japan's demographic problem. According to the Japanese Ministry of Health, Labour and Welfare, women live on average 87 years, and men 81 years. Life expectancy is high, but fertility has been declining over the years. With about 1.4 children per woman, the birth rate in Japan is too low to ensure demographic regeneration.

Japan is far from being the only country concerned. Croatia, Finland, Germany, South Korea and the United States are also affected by a declining birth rate. The health crisis has even led to a worldwide baby flop, which is quite worrisome for health systems.

The reasons behind the demographic decline in Japan

Several reasons explain such a low birth rate. Among them are gender-linked problems like wage discrimination and poor working conditions for women who are often exposed to precarious, part-time and low-paid jobs. There is also a lack of childcare facilities in Japan. In terms of maternity and paternity leave, Japan lags far behind other countries. In traditional Japanese culture, women's place is in the home. They are the ones who raise their children.

As a result, it was common for women to quit their jobs when they were about to get married. The multiple economic crises experienced by Japan since the burst of the financial bubble in the 90's have challenged this notion. Nowadays, Japanese women can claim their independence, and work a lot, but are still underpaid compared to their male counterparts. Moreover, young people do not want to reproduce the family pattern. They believe that having a child is expensive. For them, the State is still not doing enough in terms of parity and aid.

The impacts of an aging population on Japan's healthcare system and economy

The aging of the Japanese population directly impacts the economy. People aged over 65 represent nearly 30% of the population, compared to barely 12% for those aged less than 15. Under such conditions, it is difficult to sustain an economy with a majority of senior citizens in the long term. The elderly generally need more care. They must be able to benefit from retirement and let the young people take over. This is the so-called redistributive health system where the working people, called the active population, pay for the inactive part, who fall in the non-working category. This is how young people are supposed to pay for the elderly. But due to the lack of manpower, and to compensate for pensions that are often too low, seniors are returning to work. It is not uncommon to see them still working at over 70 years old.

Public health insurance in Japan

Japan has two main types of health insurance: the National Health Insurance, NHI (Kokumin Kenko Hoken), open to those who work or not, and the Employees' Social Insurance (Shakai Kenko Hoken), open only to employees.

National Health Insurance in Japan (NHI)

In Japan, the national health insurance system is not free. It covers up to 70% of health-related costs. The rest is paid by beneficiaries according to their age group:

  • Children aged 0 to 5 are covered at 80%. Parents pay the remaining 20%.
  • 6-69-year-olds are covered at 70%. They pay the remaining 30%.
  • 70-74-year-olds are covered at 80%. They have 20% to pay. But if they work, they will pay 30% (depending on their income).
  • People aged over 75 are covered at 90%. They only have to pay for the remaining 10%.

Payments (on a monthly basis) for this insurance plan depend on the previous year's salary. The NHI allows you to have good basic social protection and the same health care as any Japanese. By immigrating to Japan with a work visa, study visa or Working Holiday Visa, you will automatically be affiliated with Japanese health insurance. In addition, you can subscribe to private health insurance.

Health insurance and Covid in Japan

The health crisis has changed travel habits. While most countries have reopened their borders, Japan's borders are still officially closed to the general public. Only a few categories of people can enter the country. Tourist groups have been accepted since June 10, provided they comply with all the conditions imposed by the authorities. This measure is still in effect today.

Every traveler who wants to stay in the territory must have a visa, regardless of the duration of their stay. There are no more visa exemptions (stay of less than 90 days, for instance) until further notice. The same rule applies to health. It is mandatory to have health insurance when traveling to Japan. It must be able to provide coverage in case of COVID infection. Even when there was no health crisis, it has always been recommend to get health insurance before travelling.

NHI payments for expats in Japan

To easiest way to pay for your Japanese health insurance is to go to a konbini (a mini-market open 24 hours a day). Your city hall will send you slips with the monthly amount to pay. The konbini staff will stamp the slip corresponding to the monthly payment. This is a very convenient system. Furthermore, konbini can be found everywhere in Japan, even in remote areas.

Employee Social Insurance

The Japanese Employee Social Insurance covers up to 80% of health care costs. The remaining 20% is the beneficiaries' responsibility. However, payments are made half by the employer and half by the employee, with the employee's share automatically deducted from their salary.

The amount to be paid is based on income and usually rounds up to 10% of the salary. This insurance covers not only the employee but also any dependents (as long as the latter do not earn more than 1,300,000 yen per year, about 9,375 euros) to cover up to 70% of health care costs.

Registering for health insurance in Japan

Registration for National Health Insurance (NHI) is done at the city hall of your place of residence in Japan. The procedure is simple. If you have just arrived in Japan, you can do it when you register at the city hall to obtain your resident card.

You just need to bring your residence card. In case you are affiliated to the employee social insurance, your employer can give you a document that you can submit to the municipality. You willl then be registered you as being covered by the employee insurance.

The same procedure applies to students and people on a Working Holiday Visa in Japan (WHV). The affiliation to the NHI is done at the time of your registration at the city hall.

Moving from one location to another

If you move from a city to another within Japan, you will need to apply for a new insurance card at the city hall of your new place of residence.

The cost of healthcare in Japan

Health care is expensive in Japan. The price of consultations can double depending on the region, the specialty and the facility. In the public sector, the price range is generally between 5,000 yen and 10,000 yen for a basic consultation (between 36 and 72 euros). But beware: there are many private clinics whose prices can quickly strain your finances, especially if you do not have health insurance.

Hence, the Japanese National Health Insurance (NHI) provides 70% of medical expenses in advance. The following is an example of cost for a consultation with a dentist: Normally, if you didn't have the NHI, you would be paying an average of 19,000 yen (about 140 euros). On the other hand, if you do have NHI, you will only pay 5,700 yen (about 41 euros) for a consultation.

If you subscribe to complementary health insurance, it will take care of the remaining 30%. However, this 30% will not be covered by Social Security in your home country. It is up to you to take out a complementary health insurance policy (generally, international health insurance) for total coverage of your needs.

Private health insurance in Japan

Currently, every traveller to Japan needs international health insurance, even for a short trip. Of course, private insurance is expensive, but it is best to include it in your budget to avoid any unpleasant surprise. As mentioned above, it is always recommended that expatriates take out an international insurance policy for complete coverage.

International health insurance allows you to consult the doctor or go to the health facility of your choice. If your illness requires repatriation, the insurer will cover your medical expenses.

Below are the leading international health insurance providers:

Do not hesitate to contact the insurer of your choice according to your needs. You can also get a free quote for Expatriate health insurance in Japan on our dedicated page.

Consultation with a doctor in Japan

Being sick abroad can add extra stress, especially if you don't speak the language. You can find useful information about doctors who speak English, French or other languages on your embassy's website. Also, consider associations of foreign residents', and don't forget word of mouth. Your friends may know doctors who speak your language.

Unless you go to clinics or facilities with staff who speak your language or consult practitioners from your country, the doctors you meet probably speak only Japanese. If you also speak Japanese, fair enough! But if you speak little or no Japanese at all, and you are not able to explain your issue to the health professionals, we're providing you with a small but helpful lexicon below.

General medical terms

医者 (isha) = doctor

患者 (kanja) = patient

熱病 (netsubyou) = fever

調子 (choushi) = physical condition, state of health

診察 (shinsatsu) = medical check-up

痛み (itami) = pain / 痛む (itamu) = to have pain

痛いです(itai desu) = I am in pain / it hurts

病気 (byouki) = sickness / 病気です。(byouki desu) = I am sick

アレルギー (arerugii) = allergy

風邪 (kaze) = cold

風邪をひきました。(kaze wo hikimashita) = I have a cold / I caught a cold

胃 (i) = belly, stomach / 胃が痛いです。(i ga itai desu) = I have a stomachache

気分が悪いです。(kibun ga warui desu) = I feel sick.

ここが痛いです。(koko ga itai desu) = I feel bad here.

医療 (iryou), 治療 (chiryou) = medical treatment, care.

薬 (kusuri) = medicine

薬屋 (kusuriya) 薬局 (yakkyoku) = pharmacy.

Good to know:

There are two types of medicine outlets in Japan:

  • Pharmacies, which dispense medicine with a prescription
  • Drugstores, where you can buy medicine without a prescription.

Explaining pain

The Japanese language uses an innumerable number of onomatopoeias. These are widely used in everyday language. Not surprisingly, many of them are used to explain what you are suffering from. Knowing these onomatopoeias will help you to describe your pain precisely, and, therefore, to communicate better with your doctor.

ガンガン (gangan) = loud, intense noise. This is the sound of a headache.

頭がガンガンします。(atama ga gangan shimasu) = I have a headache.

ゾクゾク(zokuzoku) = chills. To describe a feverish state.

ゾクゾクします。(zokuzok shimasu) = I have chills.

ムカムカ (mukamuka) = nausea

ムカムカします。(mukamuka shimasu) = I feel nauseous

ズキズキ (zukizuki) = sharp pain, for example, when you have a toothache.

歯がズキズキ痛んでいます。(ha ga zukizuki itandeimasu) = my tooth throws me, hurts me a lot.

Useful links:

Ministry of Health, Labour and Welfare of Japan

Find a French or English-speaking doctor; find a hospital in Tokyo and Kyoto

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