Get with the program. No, literally now. If you are living in Japan, you legally must enroll in the National Health Insurance or prove that you have coverage from an accepted alternative healthcare plan. Below is all you need to know about the Japan healthcare system, including how to enroll in the National Health Insurance plan, how much it costs, and how to find an English-speaking doctor or hospital in Tokyo.

How does the Japan healthcare system work?

Japan has a public healthcare system that covers every citizen and resident. The fees are reasonable and the standard of healthcare is high.

The healthcare system covers you for everything from a doctor’s visit for a cold to emergencies and hospitalization. If you need to see a doctor, you can freely choose the clinic or practice you want to visit. In most cases, no referrals from a family doctor are needed, but hospitals charge a slightly higher fee if you come directly without a referral. Just make sure it isn’t a private clinic (albeit rare in Japan) and that they accept National Health Insurance (NHI).

Generally, short waiting times and same-day or no reservations are the rule and not an exception in Japan.



Other helpful information

By the way, take a look at this article if you are looking for specific advice on safe sex and STI testing in Japan. And you can find information about women’s health and birth control in Japan in this article. Lastly, check out this article for information on mental health resources in Tokyo.

Enrollment in Japan’s public health insurance

If you are staying in Japan for 90 days or longer, you legally must have health insurance, which means being enrolled in either Japan’s National Health Insurance or an acceptable alternative (e.g. international health insurance if you are staying on a working holiday or student visa).

While some foreign residents fly under the radar for years without paying health insurance, if you get caught, you will need to make back payments for all the months (or years!) you have missed.

nurse hospital doctor healthcare
Photo by iStock/TommL

The two main options for enrollment for foreigners are:

  • by yourself at the city hall or ward office, or
  • through your company if you are a full-time employee.

Enrollment in the Japanese National Health Insurance plan (Kokumin Kenko Hoken)

If you are a student, freelancer or otherwise living in Japan but not working full-time, you will need to enroll in the mandatory NHI plan. You do this when you register at your local ward office or city hall (which is also another mandatory thing to do!). They will send you to the health insurance counter and produce a NHI card for you. You will need it for all doctor and pharmacy visits to claim your coverage, so keep it on you at all times.

The cost is based off of last year’s income, so if you just arrived, you will be in luck and probably pay only the minimum fee until the next fiscal year starts.

The bills are sent to your home once per year, usually in April or May after your tax return. In the envelope, you will find 9 numbered bills, one for each month from July to March (there are no bills from April to June as taxes are being assessed during that time). The option to pay a lump sum of the entire amount is also available. You can make payments at the convenience store.

Calculation breakdown for Kokumin Kenko Hoken

The exact calculation varies depending on the city or ward that you live in, but here is a basic calculation for informational purposes only.

Base amount = taxable income (salary minus exemptions) – 330,000 yen

Note: The taxable income amount is shown on the tax adjustment slip you get from your employer for the previous year under 所得.

Then, there are three components for those 40 and older or two for those who are under 40. The calculation is as follows:

  • a. health component = base amount x 7.25%
  • b. support component = base amount x 2.24%
  • c. nursing care component = base amount x 1.76%

If you are under 40, your total is A + B.

If you are 40 and over, your total is A + B + C.

Example scenario: If you are a single freelancer or self-employed person under 40 with an annual salary of 4,000,000 yen and a taxable annual income of 3,000,000 yen, then the base amount is 2,670,000 and the health insurance calculation is as follows:

(2,670,000 x 7.25%) + (2,670,000 x 2.24%) = 253,383 yen

If you divide 253,383 yen into 9 monthly payments, then it would be 28,154 yen/month for 9 months.

You can use this tool to help you calculate health insurance base amount by municipality. Using that tool, the base amount on an annual income of 4,000,000 in most central Tokyo wards was around 236,000 yen, while Fujisawa in Kanagawa Prefecture was 255,000 yen. Amounts in cities in Western Tokyo tend to be much cheaper (like Fuchu at 170,000 yen and Kunitachi—the cheapest city in Tokyo—at 161,000).

Enrollment as part of the Japan’s social insurance (Shakai Hoken)

If you are a full-time employee, your employer must enroll you in the national social insurance (Shakai Hoken). It is much more comprehensive then Kokumin Kenko Hoken—in addition to health insurance, it includes unemployment insurance, labor (accident) insurance, and the national retirement plan.

The payments will be taken directly out of your paycheck for all three plans together, which is a better deal than just paying the health insurance by yourself. In short, Japan really wants you to have a full-time job.

Calculation breakdown for Shakai Hoken

The rates vary depending on the prefecture (not by ward or city like Kokumin Kenko Hoken). The latest rates for this year for Tokyo are as follows:

  • health component = 9.87% for under 40 and 11.66% for 40 or older (the difference of 1.79% is a “nursing fee”)
  • pension component = 17.828%
  • unemployment insurance component = 0.4%

Example scenario: If you are an employed English teacher under 40 with a taxable income of 300,000 yen/month, the calculation would be as follows:

(9.87% x 300,000) + (17.828% x 300,000) + (0.4% x 300,000) = 84,294 yen

Of that amount, the employer pays half, so the final total monthly amount deducted from the employee’s salary would be 42,147 yen.

Cost per visit and caps

The government will foot 70% of all your medical bills and prescriptions, while you are responsible for the remaining 30%. The maximum amount that you could pay per month is capped though, so if you have exceptionally high costs (e.g. for long-term treatment or surgery), rest assured. When you sign up, they will hand you a booklet that lists all the caps and maximum amounts.

Those who become pregnant will receive prenatal checkup vouchers and a lump-sum allowance to help cover labor costs. The lump sum (420,000 yen) may not cover the total costs, so you will need to pay for the remainder out of pocket.

Blood test
Photo by iStock.com/Tero Vesalainen

Healthcare in Japan for tourists

If you are a tourist and you need to see the doctor during your trip, you will need to pay upfront in most cases and then get reimbursed by your health insurance. Most insurance policies let you freely choose the clinic or hospital. However, some insurers have ties to certain practices or clinics, meaning you don’t have to pay upfront, so take a look at your insurer’s policy.

Here is an overview of the best travel health insurance plans for Japan, from basic to comprehensive coverage.

Finding English-speaking doctors in Tokyo and Japan

Most doctors will speak at least a bit of English and often also have point-and-speak sheets in English available that allow you to describe your condition by pointing at the relevant symptoms and phrases on the sheet. If you are looking for fully English service, we recommend the King Clinic in Harajuku if you are on NHI.

If you are on an international plan, Tokyo Medical and Surgical Clinic should be your first choice. They have a line-up of Japanese, British, German and other doctors who speak several languages and are highly qualified. As they are a private clinic, they do not take NHI, but your international health insurance plan should cover it.

If you are looking for other specialists, these websites are extremely useful:

  • Himawari Tokyo: Provides a medical referral service, lists doctors and hospitals in Tokyo and has an overall explanation of the Japanese medical system. This is an official government site that has an auto-translation function into English, Chinese and other languages.
  • AMDA International Medical Information Center: This site lists a number of English-speaking doctors in Japan.
  • US Embassy Site: Another great English resource of useful sites, and doctors and hospitals that cater to the international community.

In case you’re meeting with a non-English-speaking doctor and need to communicate, here is a basic Japanese language guide to visiting the doctor (with audio).

What to do in case of a medical emergency

The number to call an ambulance in Japan is 119. The call can be made free of charge from any phone, including public pay phones. Note that they might not speak any English. Check this site for useful phrases to call an ambulance in Japanese.

A word of warning on ambulances in Japan

The so-called “tarai mawashi” (ambulances being rejected by multiple hospitals before an emergency patient is admitted) has become a problem in some parts of Japan, including Tokyo. In 2007, it was reported that more than 14,000 emergency patients were rejected at least three times by hospitals in Japan before getting treatment.

Ambulance paramedic Tokyo Japan
Photo by iStock.com/TkKurikawa

The reason for this seems to be that the cheap and easy access to medical facilities in Japan is sometimes abused. Patients with mild illnesses go straight to hospital emergency departments rather than a doctor’s office. Half of all ambulance rides in recent years were for conditions so mild that the patient could have taken a taxi instead. That causes delays in caring for people who have more urgent and severe conditions. The issue has made the news in recent years and it seems that things are improving, but keep this in mind when calling an ambulance.

Disclaimer

This article is intended only as a basic guide to Japan’s healthcare system. Of course, we make every effort to ensure that the information in this article is accurate and up to date, however, information is subject to change at any time. We recommend that you speak with your local ward office or obtain professional advice regarding health insurance in Japan. Fast Train Ltd. cannot guarantee the accuracy, currency or completeness of any of the material and information in this article and accepts no responsibility or liability arising from or connected to the material provided above.

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