Medical expenses for foreign residents and visiting foreigners differ in Japan. This article explains Japan’s healthcare system and details the medical costs and systems for foreigners based on their stay, including the requirement to enroll in the National Health Insurance.
Table of Contents
Profile of Writer
Chapter 1: Grasping the Basics
Japan's Healthcare System
Before explaining the medical costs for foreigners based on their type of stay, let’s first understand Japan’s healthcare system.
1. Mandatory Enrollment in Public Health Insurance
In Japan, enrolling in one of the following three types of public health insurance is mandatory, depending on factors such as occupation, employment type, and age:
- National Health Insurance: For the self-employed, freelancers, non-regular employees, and retirees.
- Employee Health Insurance: For company employees.
- Medical Care System for the Older People: For those aged 75 and older.
Japan has a “universal health insurance system.” Everyone joins public health insurance and pays premiums, which helps reduce medical expenses for everyone. For example, people with chronic illnesses who need frequent hospital visits can receive medical care at a fixed cost-sharing ratio.
In some countries, medical expenses can be very high without private health insurance, straining household finances. However, in Japan, enrolling in public health insurance allows everyone to receive affordable, high-quality medical services.
| Japanese | Romaji | Hiragana | Definition |
|---|---|---|---|
|
国民健康保険 |
Kokumin Kenkō Hoken |
こくみんけんこうほけん |
National Health Insurance |
|
被用者保険 |
Hiyōsha Hoken |
ひようしゃほけん |
Employee Health Insurance |
|
後期高齢者医療制度 |
Kōki Kōreisha Iryō Seido |
こうきこうれいしゃいりょうせいど |
For those aged 75 and older |
2. Medical Expenses in Japan
If you are enrolled in public health insurance, you are responsible for “30% of the medical expenses*1” when visiting medical institutions. By presenting your insurance card when receiving treatment or examination at a medical institution, you only need to pay a portion of the medical expenses at the counter.
For example, if the cost-sharing is 30%, you would only pay ¥1,500 at the counter for a ¥5,000 medical bill. The remaining 70% is covered by the insurance premiums you pay each month. Therefore, if you are not enrolled in public insurance, you would have to pay the full 100%, meaning you would have to pay the full ¥5,000.
*1: From elementary school entry to age 69, it is 30%; for children under elementary school age and those aged 70 to 74, it is 20%; for those aged 75 and older, it is 10%.
3. Free Access
Another feature of Japan’s healthcare system is “free access” to medical institutions. Free access means that patients can freely choose a medical institution and receive necessary medical services.
In some countries, you may be required to visit medical institutions designated by your insurance company, and costs may be higher at non-designated institutions. Additionally, in some countries, you may need to see a primary care physician before being able to visit a specialist.
In Japan, when you have a cold or injury, you can freely visit the appropriate department at any time. Rather than “choosing a doctor,” you can choose the “medical institution” that is needed at that time. Additionally, by paying an additional fee, you might be able to receive treatment at major hospitals such as university hospitals and general hospitals without a referral.
In some countries, there may be a fee for requesting an ambulance, but in Japan, you can request an ambulance for sudden illness or injury for free. This is also a major feature of Japan’s healthcare system.
While free access is available, it can be confusing for foreigners to choose a medical institution. In such cases, you can search for medical institutions using the following methods:
- Public relations magazines issued by your local government
- Medical information networks provided by each local government
- Internet searches
Furthermore, the Japan National Tourism Organization (JNTO) website for foreign tourists provides a search function for medical institutions designated by each prefecture for accepting foreign patients.
Chapter 2: Foreigners' Medical Costs Based on Stay Status
Now, let’s explain the medical costs for foreigners based on their stay status: “foreign residents,” “visiting foreigners,” and “travel patients.”
Medical System for Foreign Residents
Foreign residents are foreigners who stay in Japan for more than 90 days. As of the end of 2023, there were 3,419,920 foreign residents, and this number is increasing every year.
Anyone living in Japan, regardless of nationality, must join the public health insurance. By paying insurance premiums and sharing the cost of medical care with society, Japan ensures that foreigners have equal access to medical services.
1. Requirements for Enrolling in National Health Insurance and Insurance Premiums
Foreign residents in Japan are required to enroll in National Health Insurance unless they fall into one of the following categories:
- Individuals under 75 years old who are not covered by workplace health insurance.
- Individuals staying in Japan for less than three months (some residency statuses may allow enrollment).
- Individuals with residency statuses of “short-term stay” or “diplomat.”
- Individuals with the residency status of “specific activities” who are either engaged in “receiving medical care” or “taking care of their daily needs,” or engaged in “sightseeing, recreation, or activities similar to these.”
- Individuals without residency status, such as those staying illegally.
- Individuals from countries that have a social security agreement with Japan, who have received a certificate of coverage from their home country’s government.
Those not falling into the above categories can apply for National Health Insurance through their local municipality. By presenting their residence card or foreign resident registration card at the dedicated window of the city, ward, or town office where they are registered, they can receive their insurance card.
Insurance premiums are calculated based on household income and the number of household members. The copayment is generally 30%, the same as for Japanese citizens.
2. The Late-stage Elderly Healthcare System
For the Late-stage Elderly Healthcare System, individuals aged 75 and above, regardless of nationality, are required to enroll if they are registered residents. Additionally, those aged 65 to 74 with recognized disabilities are also eligible. In such cases, individuals must withdraw from any other public health insurance they may already have.
For those who are not eligible to enroll in the Late-stage Elderly Healthcare System, the eligibility criteria are the same as those for National Health Insurance.
Similar to National Health Insurance, enrollment procedures are carried out at the local municipal office where you reside. The insurance premium consists of a “uniform amount” that each insured person pays and an “income-based amount” that is based on the insured person’s income. The copayment under the Late-stage Elderly Healthcare System is 10%, or 30% for those with income equivalent to that of working individuals.
3. The High-Cost Medical Expense Benefit
In the public health insurance system, if the amount paid at medical institutions or pharmacies exceeds a certain amount within a month, the excess amount will be reimbursed. This is called the “high-cost medical expense benefit.”
The final amount of copayment depends on the insured person’s income level. If you know in advance that your medical expenses will be high, presenting a “certificate of application for the high-cost medical expense benefit” will reduce your copayment at the counter.
| Japanese | Romaji | Hiragana | Definition |
|---|---|---|---|
|
高額療養費 |
Kōgaku Ryōyōhi |
こうがくりょうようひ |
High-Cost Medical Expense Benefit |
|
限度額適用認定証 |
Gendogaku Tekiyō Nintei-sho |
げんどがくてきようにんていしょ |
Certificate of application for the high-cost medical expense benefit |
Medical System for Visiting Foreigners
Visiting foreigners refer to foreigners who come to Japan for travel or business purposes. Since their stay in Japan is short-term, they are not enrolled in public health insurance. Therefore, healthcare costs are fully self-funded and fall under the category of out-of-pocket payments for private medical services.
Therefore, if a visiting foreigner experiences sudden fever, accidents, injuries, or other medical issues during their stay and needs to visit a medical institution, they will be required to pay according to the prices set by the medical institution. It’s important to note that visiting foreigners are not covered by insurance.
Medical System for Travel Patients
Travel patients refer to foreign patients who come to Japan with the expectation of receiving medical treatment. If their purpose of stay in Japan is for medical treatment, they are required to obtain a “Medical Stay Visa.” To apply for this visa, they must have a guarantor who can vouch for them.
Additionally, to obtain a Medical Stay Visa, they must have the financial means to pay for their stay. Since travel patients are also unable to enroll in public health insurance, they must bear the full cost of medical treatment. Therefore, if the patient themselves or their relatives do not have the financial ability to pay for the medical expenses, the visa may not be issued.
Chapter 3: Prices for Private Medical Services and Medical Fee Points
As mentioned earlier, when visiting foreigners and travel patients seek medical care in Japan, they are responsible for the full cost of medical treatment. In most cases, they must pay for the services themselves on the same day of the visit.
For these self-funded medical treatments, hospitals are allowed to set their prices freely. Therefore, it’s important to note that prices for the same treatment can vary between medical institutions.
Many hospitals base their prices on the “medical fee points” established for insurance-covered medical care in Japan. However, some medical institutions may not accept visiting foreigners. Therefore, it’s advisable to research and visit medical institutions that are known to accept visiting foreigners.
Chapter 4: Summary
Foreign residents in Japan can enroll in the country’s public health insurance. In this case, they are generally responsible for 30% of the medical costs. However, visiting foreigners who come to Japan for travel or business purposes, as well as travel patients, are responsible for the full cost of medical treatment as private patients. For short-term stays, it’s also advisable to consider purchasing dedicated insurance to prepare for sudden illnesses, accidents, or injuries.
For these self-funded medical treatments, hospitals are allowed to set their prices freely. Therefore, it’s important to note that prices for the same treatment can vary between medical institutions.
Many hospitals base their prices on the “medical fee points” established for insurance-covered medical care in Japan. However, some medical institutions may not accept visiting foreigners. Therefore, it’s advisable to research and visit medical institutions that are known to accept visiting foreigners.
References
- Ministry of Health, Labour and Welfare, 我が国の医療保険について, June 2024, https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/iryouhoken/iryouhoken01/index.html
- The Ministry of Justice, 医療, June 2024, https://www.moj.go.jp/isa/content/930004444.pdf
- Japan Medical Association, 日本の医療保険制度の仕組み, June 2024, https://www.med.or.jp/people/info/kaifo/system/
- Japan Medical Association, 日本の医療保険制度の優れた特徴, June 2024, https://www.med.or.jp/people/info/kaifo/feature/
- Ministry of Health, Labour and Welfare, 外国人患者の受入れのための医療機関向けマニュアル, June 2024, https://www.mhlw.go.jp/content/10800000/000601513.pdf
- Immigration Services Agency of Japan, 令和５年末現在における在留外国人数について
, June 2024, https://www.moj.go.jp/isa/publications/press/13_00040.html - Ministry of Health, Labour and Welfare, 医療機関における外国人患者の 受入に係る実態調査 結果報告書, June 2024, https://www.mhlw.go.jp/content/10800000/000956428.pdf
- Ministry of Health, Labour and Welfare, 訪日外国人旅行者の 診療における診療価格, June 2024, https://www.mhlw.go.jp/content/10800000/000477607.pdf
- Ministry of Economy, 渡航受診者の受入支援（インバウンド）, June 2024, https://www.meti.go.jp/policy/mono_info_service/healthcare/iryou/inbound/index.html
