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Managing the Cost of Healthcare in Japan

Make sure your next trip to the hospital doesn’t leave your wallet feeling sick, too.

By 10 min read

Sports injuries are never fun.

I was recently reminded of this when I clashed with another teacher at my city’s inter school teacher basketball tournament. I didn’t even know red cards existed in basketball — until I received one!

In my anger — and with the adrenaline still flowing — I hadn’t noticed the damage this surprising physical contact had caused. My little finger seemed to be hanging awkwardly. A couple of days later, it still wasn’t right. I couldn’t straighten it and there was a shooting pain whenever I tried to use it. A trip to the hospital seemed to be the only way to go.

It turned out I had sustained a broken finger with a fracture right on the joint of two of the bones. Surgery was going to be needed — and this is where the real nightmare began.

Hopefully today, you can learn from my experience and avoid some of the costs I incurred as a result of this injury with a little planning and knowledge of Japanese national health insurance.

Accidents and insurance

The insurance coverage provided for competitors in this event — which I was signed up for automatically via my workplace — only covered up to ¥3,000 for a hospital visit. Considering that many hospitals charge around ¥5,000 just for a consultation, this wasn’t going to get me very far at all.

A note on this point for those just starting work in Japan: employers should  have employee accident insurance — always. As a teacher, this is something you should ask about as soon as you begin employment. My board of education (BOE) has this, however it didn’t apply in my case.

If you choose to participate in school events such as sports tournaments or parties outside of your working hours, any injuries sustained at these events  will not be covered by employee accident insurance. In the case of the school tournament I was in, the burden of insurance fell upon the local teachers union who sponsored the event. The union has little available funds and that was why the coverage was minimal.

Of course, I’m on the Japanese national health insurance plan. However, unlike my native Scotland where universal health care ensures that all costs are covered — Japan’s system only covers 70 percent. This is still a big help, of course, but even with this assistance my treatment to date has still left me tens of thousands of yen out of pocket. Further surgery may be required later, with the possibility that there may be long-term damage.

… all foreign residents in Japan (those staying here for more than three months) are required by law to enroll in one of the two national healthcare programs.

Had I known then what I know now about Japan’s health insurance system, some of this pain — in the financial sense at least — could have been avoided.

As you’re probably aware — and it bears repeating — all foreign residents in Japan (those staying here for more than three months) are required by law to enroll in one of the two national healthcare programs: kokumin kenko hoken (Japan’s National Health Insurance) or kenko hoken  (Employee Health Insurance offered through your workplace).

Kenko hoken is available to full-time employees of companies in Japan, with the company paying half of your premium and you paying the remainder.

Kokumin kenko hoken works the same way but is intended for unemployed, self-employed or contract workers. For more details on these two types of insurance, check out our two-part GaijinPot guide to understanding the Japanese health insurance system in Japan.

Employee benefits

Those working in the English teaching sphere need to be particularly careful in this regard as a number of schools and companies try to shirk their responsibilities for getting employees properly enrolled in the healthcare system and meeting their own financial obligation in this regard.

They do this via the “29.5-hour contract.” This comes from an advisory statement — not a law — handed out by the Japanese government years ago that said, in principle, workers who worked less than a 30-hour week, were considered part time and not eligible for shakai hoken (social insurance, or the combined payment of health insurance and pension that is automatically taken from the salaries of full-time employees with the employer paying 50 percent of the premium).

Companies justify this stance by saying that, as English teachers, we should only be paid for time spent teaching in class. Of course, as any half-decent teacher will tell you, the classes themselves are just one element of the job and teachers need time to plan and prepare lessons as well as to do their admin duties.

Doctors, Dentists and Staying Healthy

It’s your own call, but I strongly advise against taking any job with one of these 29.5 hour contracts. This stance has been challenged legally on a number of occasions and a number of teachers have eventually won their right to shakai hoken. Nevertheless, there remain companies that persist with what is, at best, a legally dubious policy.

If you want to keep yourself right legally and avoid being caught without any coverage in the event of an emergency, I recommend going to your local city hall or ward office and registering for the kokumin kenko hoken as soon as you start your first job. Your employer may well transfer you over to the kenko hoken at a later date. Beware of companies that offer “health coverage for the right candidate” or “insurance coverage after completing X months of service.”

Such actions are illegal. Healthcare coverage in Japan is a legal right. It’s not a perk, privilege or a carrot for employers to dangle in front of employees.

For a detailed breakdown of exactly how Japan’s health insurance system works, the Ministry of Health, Labour and Welfare put together this handy visual guide.

Optional insurance

As good as the health insurance system is here in Japan, it still leaves open the possibility of considerable financial burden to the patient. So what can one do to lessen that extra remaining 30 percent? Thankfully, there are insurance policies available to help cover some of this extra cost.

A quick online search reveals plenty of options, with a variety of price plans ranging from as little as ¥5,000 to ¥7,000 yen per month depending on the type of coverage and its various limitations.

Perhaps the best all-round plan is offered by NOW Health International. It comes in at ¥6,200 per month and includes both in-patient and out-patient services with a maximum payout of ¥165,800,000 (approximately US$1.5 million). In other words, any care that costs above this amount would need to be paid for by yourself, but I think you’d have to be phenomenally unlucky to run into a problem requiring such expensive treatment

This plan, however, does not include maternity coverage, so women planning to have children may want to consider taking out additional coverage. The Japanese government offers payouts of around ¥420,000 to mothers upon childbirth, but the criteria for this is a little vague. See the above guides to Japan’s healthcare system for more information.

Lady Doctor Basics: Women’s Health in Japan

A number of health insurance options are also offered by AFLAC (Japanese). These are often bundled alongside their life insurance policies. Unlike other providers, AFLAC also provides specific additional coverage in the event of a cancer diagnosis. Prices for this are dependant on a risk assessment but start from around ¥1,800 per month, in addition to a conventional health insurance package.

AFLAC’s site is presently available only in Japanese and — much in the same vein as mobile providers in Japan — policies seem quite complicated, with a number of bespoke plans tailored to individual requirements. If you aren’t confident with both written and spoken Japanese, then I’d strongly recommend asking a Japanese friend to help you with both the internet search and follow up phone calls.

There are plenty of insurance aggregator sites out there, so it’s wise to shop around and see what type of plan might work best for you. Most of the plans offered on these English language sites are a bit more expensive than those in Japan, but the coverage they provide is worldwide. You can save a bit, too, if you aren’t planning to travel to the U.S. anytime soon. Policies that exclude the U.S.A. are considerably cheaper.

If you already have car or life insurance packages, it may be possible to extend this policy to incorporate healthcare, too. My girlfriend has a unified policy through AXA and its affiliates, that provides car, health and life insurance all for the reasonable sum of ¥7,000 per month.

Also, if you do take out additional health insurance, please remember that you will still need to pay the initial 30 percent cost upfront when you visit to the hospital. You will claim it back from the insurer afterwards, once you have the receipt. Depending on the company, it can take anywhere from 48 hours to several weeks to receive payment.

Reduce upfront costs

There is one final option for those of you who want to be proactive and limit your healthcare costs without taking on the financial burden of additional health insurance.

You can apply to your local government (depending on where you are, the office may be in your local city hall or a prefectural building elsewhere) for a document called a gendogakuninteishou (限度額認定証), or limit certificate.

With this document, you will not have to pay medical fees that rise above a certain amount each month. This amount varies according to your salary but in the case of most English teachers — in the ¥250,000 to ¥300,000 per month salary range — this limit amount comes in at ¥82,000 per month.

For example, if you are charged ¥100,000 for treatment at a hospital, you would only need to pay ¥82,000 on the day if you present this document. If you don’t have the form, you can pay ¥100,000 on the day and then claim back ¥18,000 of this once you get the document later on. Bear in mind, though, that it can take up to three months for this payout to come through.

With this document, you will not have to pay medical fees that rise above a certain amount each month.

As for me, my finger may never quite be the same again. Hopefully, once the steel pins are removed next week, some normality can return.

To date, I’m about ¥45,000 out of pocket but I will reclaim about ¥15,000 to ¥20,000 once the event insurer pays out. Of course, the damage would have been a lot more had I not had my health insurance card on me (remember to carry this with you at all times, just in case).

My coworkers also stepped up when they were needed.

Unbeknownst to me, while I was undergoing surgery, they took up a collection for me, raising ¥15,000 to go towards my medical bills. Such generosity — especially to people they don’t know all that well — is what sets the Japanese aside from so many other groups on this earth.

In all, this isn’t an experience I’m keen to repeat. I’m at least one more surgery away from the finish, but the care I have received both from my doctors and from my colleagues, has reaffirmed my belief that there’s no place I’d rather be than Japan!

What are your thoughts on Japan’s healthcare system? Do you have any tips for fellow patients? Leave a comment below and tell us your thoughts.

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