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Japan's national health insurance can save your life and savings


For almost a quarter of a century, my employer in Japan paid for a health insurance policy. It was comprehensive, required of me regular health check-ups, and year by year became more expensive, despite the fact that I never made a claim.

On the rare occasion that I needed to visit a doctor or buy medication, I chose to pay for it, in the knowledge that in the Japanese system, medical expenses in excess of a certain amount can be offset against taxes.

My reasoning was simple: making a claim for a relatively simple procedure would simply have an adverse effect on the weighting of the next year’s premium.

Meanwhile, having the policy in place was a reassurance in case something more serious came along.

Something did. I have written in a previous column about the sudden need for extensive cardiac surgery and the repercussions of the operation.

When I knew I needed to undergo such procedures, I contacted my insurance company (a well-known, UK-based firm with a global reach) and their immediate response was to reassure me but also to ask for the contact details of my regular physician so that they could check my medical records. No problem.

Two surgeries, thrice-daily blood tests, countless X-rays, innumerable ultra-sounds, MRIs and CT-scans later, my two-and-a-half week hospital stay came to an end with a bill of some 10 million yen.

To my great surprise and distress, however, the insurance firm declined to pay, citing a clause in the agreement about “pre-existing conditions”.

All very well, but according to the same agreement such a condition was defined as one which had existed within a two year period prior to the commencement of the policy.

According to this definition, my cardiac disease must therefore have been present as far back as the mid 1980s, yet successive annual medicals had found no trace of it and indeed, as recently as 2008, as a nod to my age, I’d undergone a detailed examination in a Tokyo cardiac center.

All of this information was made available to the insurance firm, which nevertheless continued to insist that I was in default of the terms of our agreement, the small print of which was voluminous.

I was to discover from friends in the industry that this is not an uncommon situation in cases in which a substantial claim is under debate. The insurer hopes that the insured will simply give up under the pressure of increasingly bureaucratic and somewhat threatening language.

I was not about to capitulate; apart from the money itself, there was a principle at stake.

I was fortunate in having gracious lawyers and friends in the insurance industry itself, but I couldn’t help thinking about how I would have felt if I had been elderly and alone without such sources of support.

In addition, as a trained and qualified arbitrator, I had knowledge of the Law of Contract and made sure the insurance company knew that I did, and that I would use it. The minute I flagged this up to them, they agreed to settle immediately, though they did not admit liability.

In the interim, the hospital had been most sympathetic. The administrator suggested that I apply at once for Japanese national health insurance.

I protested that it was a little too late but I was assured that since I would need to backdate my payments by one or two years, I would indeed be covered retrospectively. The amount I would need to pay in was considerably less than the hospital bill.

This advice was sincerely motivated and I am grateful for it. The insurance firm settled the bill in total.

My regular visits to the outpatient department and the substantial amount of medication I must now take are significantly more affordable as a result of national health coverage and, in hindsight, I wish I had signed up sooner.

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Medical care in Japan is excellent.

It sets a high standard.

I cannot understand why the U.S.A. doesn't have a system like this.

It spends ENORMOUS amounts of money on arms and its military but doesn't look after its citizens.

11 ( +15 / -2 )

Medical care in Japan is excellent.

What are you talking about?! I've seen more cases of medical malpractice and outright quackery in Japan in eight years than in the twenty years before coming here! You pretty much take your life in your hands here if it's a serious illness.

-5 ( +8 / -14 )


You are, unfortunately, correct... I and my baby were lucky to still be alive after childbirth. I have also had to change hospitals no less than 4 times for a leg injury that happened 20 years ago and is still bothering me - which explains why I usually go back to Gaikoku when I need medical attention. There is one exception : I finally found a good dentist here - but they are few and far between...

1 ( +5 / -4 )

There are good and bad doctors everywhere. In my case I am eternally grateful for the quick thinking and competent medical staff at both Keio Univ & Showa Univ hospitals who saved my life. You need to look around for doctors who you trust and are comfortable with, but in my view the standard is quite high.

9 ( +10 / -1 )

To clarify, I think the 'system' is good....regarding the low co-pay/government share, and the fact that there IS a provision in place, but sadly, the expertise and medical knowledge seem lacking....

5 ( +8 / -3 )

i have japanese insurance and its fine for small stuff but i am leery of the japanese medical system. where the US has gone overboard with lawsuits, in japan, doctors are god and can pretty much do what they like with very little penalty so there is no incentive to provide that the best quality treatment so quality is spotty. don't get me wrong, there are very good doctors in japan but finding them is hit or miss and there are a lot of very bad doctors who are negligent but still in practice.

9 ( +9 / -0 )

I cannot understand why the U.S.A. doesn't have a system like this.

America's system is, or was, much more fair.

First, you do not need insurance or money to get treated in an Americsn hospital. You are supposed to pay, but you are not required to. You can go to any American hospital at any time, and they will treat you, even if you are a non-citizen, or are in America illegally. By law, you cannot be denied admittance for any reason.

In Japan, you are required to pay, even with National Insurance. You the submit the forms and are reimbursed the 70% of the cost which the national system covers. Next, hospitals in Japan are not required to accept patients. Almost every month we hear a story about someone who has died in an ambulance because they have been refused admittance to as many as six (or more) hospitals.

Lastly, if you are one of those in Japan who is not paying for National Insurance (it is not free) and you need medical treatment, what then? In Japan you will have to pay for treatment, or your family will. If they can't, bankruptcy in Japan is treated as a crime. In America, you are not required to pay, and if you don't, the debt is noted on your credit reports, and then goes away after 7 years. Unpaid medical bills on your credit report will not disqualify you from getting other credit, so there is little consequence for not paying.

America has far and away the best medical care in the world, and those British, Canadian, French, or Japanese who can afford it often choose it over their domestic care. Illegal aliens come in droves to use American hospitals, because they get first rate treatment, without having to pay for it. Try that in any other country in the world, and see what happens.

By the way, my private American insurance cost 20% less than the Japanese National Insurance, yet it offers 100% coverage (rather than the 70% paid by the Japanese plan), and my American plans pays instantly, I don't have to pay cash and wait for the partial reimbursement.

There is no comparison between the systems, Japan's is too inferior to be compared.

-18 ( +2 / -20 )

Japan's system is not perfect. You get shuttled between clinics, hospitals - the paper trail is long and much gets lost. Find yourself moving town? ...watch your medical history evaporate! Not great for tracking conditions or investigating a suddenly presenting symptom. It also loves to use X-Rays, CT-machines and MRIs in place of thinking about what could be causing the symptom. If those machines do not find anything often hands are thrown up in the air and you are out of luck.

3 ( +5 / -2 )

There are good and bad medial practitioners everywhere.

There is a lamentable tendency to over-prescribe here, largely because of the economics of the way the insurance system works (this also tends to make dental procedures stretch out longer than really necessary). There are also some doctors, particularly older ones in my experience, whose egos far outstrip their competence. On the other hand, there are some really good ones, highly professional and very competent, indeed.

I have had major surgery at Toho University Hospital and at Showa University Hospital, and both hospitals were extremely well-run, with competent, efficient, concerned staff, and took the "informed consent" policy seriously. I've had equally good experiences with both hospitals for less serious outpatient health issues.

I also have nothing but praise for two private clinics. One is run by a very skilled guy who is doing GP, minor surgery, and rehab now but who was the head of neurosurgery at a major Tokyo hospital before hanging out his shingle in his hometown in the countryside. Another is an ENT specialist near Oimachi who did part of his training in Southern California, and is almost frighteningly competent. I have also heard very good things from patients at an OB/GYN clinic/surgery out in the Saitama/Gunma border country, but I'm the wrong gender to have first-hand knowledge.

In close to four decades of relying on the Japanese medical system, I've been disappointed/angered four or five times, and badly misdiagnosed once (but that was partly my fault). The rest of the time I have been entirely satisfied (and had my life saved at least once).

I have, however, usually "done my homework" and checked before selecting doctors and dentists.

And whether paying into the national health insurance system through company group or individually, I've kept up the payments and taken advantage of the benefits available...and saved a ton of money by doing so.

Your mileage, as they say, may vary.

8 ( +8 / -0 )

I have been here for 15 years and have used the Japan medical system 3 times.

Twice for the birth of my two children (I was only an observer for those) and once a couple of months ago when I broke my leg/hip.

Each time I have been extremely impressed with the level of facilities and the expertise of the staff.

I'm not saying bad practitioners don't exist here - its important to do your research and find a good hospital in the area where you live.

Each time we used Showa University Hokubu Hospital in Yokohama.

This is a first class hospital and offers the same philosophy around treatment (patient centered) you would find in Australian hospitals. Food was also excellent (honest) and staff (nurses and doctors) were all friendly and would answer any questions I had. (you need to speak Japanese though....)

So if you are living in around Kohoku, Azamino. Tama Plaza region in Kanawaga I would recommend this hospital.

About fees. I am in a typical company insurance program which covers 70% of costs. However if you accrue really high medical fees in a month there is govt system that allows you to pay even less. this will cover you for a major operation of accident.

So I spent two weeks in hospital and had a hip pinning operation which is not too complex but the operation takes about 3 hours or so. Also had 10 sessions of rehabilitation.

The total cost I paid out of my own pocket was about 120,000 yen. I didn't have to pay upfront and get reimbursed , that's all I was charged for.

I'm in a separate insurance scheme with AFLAC which pays 5000 yen per day when I'm in hospital and ten times that for an operation. This costs about 2000 yen per month.

They paid out straight away and so I made money on my stay :)

So if you are in company insurance or the J national health insurance then you have assurance the majority of your medical fees will be covered if something serious happens. I don't really see the need for extra insurance on top of this and will consider opting out of the Aflac scheme.

The one concern I have is if this insurance system be in place in 20 years time when I am most likely to need it most :)

I suspect as some point we are going to have to pay more...

5 ( +5 / -0 )

In Japan, you are required to pay, even with National Insurance. You the submit the forms and are reimbursed the 70% of the cost which the national system covers.

You either are doing it wrong or you have no first-hand knowledge of the system. You simply show your insurance card at the hospital/clinic, and they then only charge you 30% of the total costs. No forms unless you forget your card and have to pay the full price. No doubt that the US has some very good doctors, but they prices for medial treatment are outrageous and you never know when the insurance company will try to find a way out of paying. $5000 dollars or more for a colonoscopy (almost the price of the device itself, which is used over and over)! I got a colonoscopy here in Japan for less than $100 out of pocket (i.e. after national insurance).

8 ( +8 / -0 )

I got a colonoscopy here in Japan for less than $100 out of pocket (i.e. after national insurance).

Fortunately for me, I was one of the 80-odd percent of Americans who had private health insurance, for which I paid about $40 less per month than I pay into the Japanese health plan. My colonoscopy was free.

A coworker of mine here in Japan was diagnosed with stage 3 breast cancer. She was diagnosed and treated at Keio hospital. She had to wait six weeks from the time of her diagnosis for surgery (doctors are limited to the number of treatments they can perform over a given time). Coincidentally enough, my mother was also diagnosed with stage 3 breast cancer, her surgery was performed within 24 hours of being diagnosed. My coworker is still battling cancer after two years of treatment, and is not doing well. My mother's cancer went into remission after a few months of treatment. My mother is twice the age of my coworker.

When I was younger, I worked at the Brooke Army medical center in America, as well as a few other places. I am not at all impressed with the quality of the care, or the skill of doctors in Japan.

-4 ( +4 / -8 )

America's system is, or was, much more fair.

First, you do not need insurance or money to get treated in an Americsn hospital. You are supposed to pay, but you are not required to...... the debt is noted on your credit reports, and then goes away after 7 years. Unpaid medical bills on your credit report will not disqualify you from getting other credit, so there is little consequence for not paying.

So, you refuse to pay any insurance premiums, demand treatment when you need it, refuse to pay the bill, suffer no consequences to your credit rating....You realise that means other people are paying your bills for you? How is that in any way fair?

And knowitall is correct, under the japanese system you do not have to submit forms and wait for reimbursement.

7 ( +8 / -1 )

I think a good indicator of the quality of a doctor in Japan is where they were educated. Doctors who graduated from national universities are generally better than those who graduated from one of the private medical universities (with the exception of Keio) I believe.

0 ( +0 / -0 )

So far, I have had excellent medical care here in Japan. I've had several major operations ... and all were carried out successfully thanks to outstanding doctors and nurses. As for the health insurance system ... I ended up paying very little for my hospitalizations and surgeries thanks to the national health care insurance system and the post office health insurance system. I have put my life in the hands of Japanese doctors before ... and, if necessary, I would do it again.

6 ( +6 / -0 )

Why would America want a Japan style healthcare system? We've got FREEDOM!!

1 ( +4 / -3 )

Sounds like the Japanese have a pretty fair health care system.

4 ( +4 / -0 )

Fortunately for me, I was one of the 80-odd percent of Americans who had private health insurance, for which I paid about $40 less per month than I pay into the Japanese health plan.

No deductibl, no coinsurance, and no copayment and not subsidized by an employer, but less than Japanese national health insurance? I doubt that very much.

National average for kokuho is 85,123 yen a year (actual premium differs by prefecture, income, etc.). Maybe you can get it for less than with shakai hoken, provided by most employers, which includes pension (social security). But from somebody who thinks he has to file paperwork every time he goes to the doctor, I doubt you even know what you are even paying.

If American insurance is so cheap, why does 20% of the population not have it?

4 ( +4 / -0 )

Fortunately for me, I was one of the 80-odd percent of Americans who had private health insurance, for which I paid about $40 less per month than I pay into the Japanese health plan. My colonoscopy was free.

Dubious information here. High premiums, deductibles and denial of coverage are more typical of private insurance than public. That's how they make money. And don't forget, that is their primary function: to make money off the consumer.

At the end of the day you have to ask yourself this question: Do I want a BUSINESS, whose main purpose is to turn a PROFIT, making decisions about my health care? How else are they going to make this profit, other than by charging high premiums, charging high deductibles, and denying coverage? You're right. They aren't, which is why they do these things.

2 ( +2 / -0 )

America has far and away the best medical care in the world, and those British, Canadian, French, or Japanese who can afford it often choose it over their domestic care.

This is nutty. WHO numbers put the US healthcare metrics well into the middle of the pack. US is number 37, just behind Costa Rica. Japan is number 10, way better. And at 1/3 the cost of the US medical system which leaves millions uninsured. That alone in the US causes 25,000 people to die a year. Japan insures everyone, does it cheaper and with far better outcomes. These are real facts, not made up drivel. Healthcare costs in the US are the number one reason families file for bankruptcy. Do not hear about that in Japan.

US healthcare is an expensive mess that basically is a failure for its people. The US is also the only developed country in the world that does not have universal healthcare. You may think those two things are related and if you do, you would be right.

2 ( +2 / -0 )

Japan insures everyone

Actually, this is a common misconception by people outside of Japan. If you do not pay into the Japanese system, you are not insured.

1 ( +1 / -0 )

@edojin 3:21 pm JST I echo those sentiments exactly ! I used the Japanese system for twenty years, and had nothing but excellent care. My Japanese wife had us enrolled in so many other insurance plans that we even made money a couple of times!

0 ( +0 / -0 )

As several here have pointed out, most of what sangetsu03 said is total nonsense. Two other bits of nonsense are that you in fact are liable for payment in the US. Yes, you can declare bankruptcy, but then you will lose most of your assets as they will be sold off to pay creditors. And, depending on the type of bankruptcy, you may still need to pay a portion on a payment schedule. Of course, if you have no assets or income, you 'don't have to pay', but then as noted by others, everyone else picks up the tab. Second, it is not true that health insurance companies will always pay up front. In the case of accidents they will typically not pay, claiming you 'have other insurance'. The idea here is that they are trying to see if some other insurer is liable, just like auto insurers will check on that possibility. But in contrast to any auto insurer, they will try to force you to pay up front while they sort things out. That's totally bogus, and can make a hash of things as the service providers will be coming after you during this period. I know for a fact this happens even with so called 'top rated' health insurers in the US. Lastly, anyone with even a nano-gram of brains knows that healthcare system in the US is totally broken; that's a given. The issues revolve around how to fix it.

3 ( +3 / -0 )

The writer was only charged 1-2 years of back payments to get on the system? A friend of mine was presented a bill in the millions of yen when a similar thing happened to him. Can anyone confirm?

-1 ( +0 / -1 )

I have to wonder if the differing opinions here are due to differences in care between major urban areas and the rest of Japan. I live in Tohoku, and my town has virtually no health care provision save for that targeting the elderly. Our nearest town is better, but the clinics are hit-and-miss, and the one good hospital is bursting at the seams. For child care, both clinics in the city have poor reputations: in one they do not listen to symptom descriptions, the other just gives bad diagnoses.

My wife summed it up perfectly: if we want to see a good specialist we have to travel - but because you can only learn who is good or not by rumour, we're plain out of luck.

0 ( +0 / -0 )

Read the article and mostly agree with the points mentioned. I live in Japan and have been paying into the healthcare system for 12-13 or 14 years now and am content to do so. Peace of mind(70% of bill paid) does give me a nice feeling. As a Canadian, I see the abuse some to the system back home(Quebec) from afar and strongly believe that Canadians should PAY at least some of the medical costs up front. Yes, taxes are high and those monies are supposed to be used to pay the medical costs but, humans being humans, the system is abused. National healthcare in every country should be standard, in my opinion. This is a life issue, not money I'm talking about.

2 ( +2 / -0 )

My wife was diagnosed with colon cancer in November last year and was started on a month of radiation within two weeks after a complete series of tests had been administered. She recovered for one month and then had surgery on January 28th. Our only insurance coverage is Kokumin Hoken, annual premium for two older adults just over ¥200,000.

This was a very educational experience and for our friends around the world an object lesson in why single payer health insurance is the only civilized way for a country to operate. Time magazine published a long article on U.S healthcare in early February that really opened my eyes. A U.S. man diagnosed with cancer was charged U.S$83,900 for his 6 day in hospital treatment plan evaluation and initial chemotherapy treatments. No mention of surgery, radiation, nursing costs, hospital bed costs etc. etc. which U.S. hospitals seem to be very good at calculating.

My wife received three consultations with her surgeon, several MRI and CT scans and other test procedures, a three hour, four doctor surgical procedure, 1 day of intensive care followed by nine days of acute care followed, (with a 1 week spell at home) by a further twelve days in hospital which saw visits from her surgeon each day as well as other specialists.

Total cost including all meetings with the surgeon, tests, chemo and radiation treatments, drugs, meals, hospitalization etc. etc. Y210,000 or rounded up U.S. $2,275.00

What family, What individual can possibly afford to pay $81,625 more for treatment in the U.S. than they would pay under a single payer system? Why do they have to?

5 ( +5 / -0 )

I had to pay 2 years in arrears after I decided to use it. I never thought that I would need it, but just suddenly something happened and I need it. Thank god I have it now. In some countries, the health insurance does not include drugs, but here it does include drugs. I'm so glad I have it now as my old insurance does not want to pay because of the preexisting illness clause. I didn't even know I had the condition.

0 ( +0 / -0 )

By the way, great article!!

0 ( +0 / -0 )

With regards to Shishio's story, the story of a friend of my sister's shows both pluses and minuses to both US and Japanese systems.

My sister's friend, after returning to the US, was diagnosed with a rare form of cancer. He had no doubt that it would not have been diagnosed in Japan due to its rarity. However, his treatment required many cycles of chemotherapy, and after that it was in remission for a while. It came back, and his doctors said he needed more chemotherapy to stop it. His insurers refused, citing their experts who said the chemotherapy would not work. He had to go to court, managed to get a ruling against the insurer - as their expert was not an oncologist - but died before the new treatment could start.

0 ( +0 / -0 )

This is not an article about national health insurance but about why you should avoid American style insurance companies. I have never dealt with insurance companies outside of Japan and am very glad. Here they have paid up fast and quick when they had to to. My life and my bank account were saved three times thanks to socialized medicine. Whether in physical agony or hovering near death, there was always this comforting thought--thank goodness I am in Japan. Whatever else can and should be said about Japan, a place where your taxi fare home exceeds your medical expenses has something going for it.

3 ( +3 / -0 )

Japan is also fast becoming a two tier health care system depending on whether you are a company worker or hired through a dispatch company.

0 ( +1 / -1 )

I got sick while back home in the States and spent two months in the hospital. The bill was a whopping $300,000 as my Japanese insurance did not cover me there. I then came back and spent two and a half months in the hospital here. The overall quality of the care was much better in the States but it was also very adequate in Japan. The prices weren't compatible (I was insured here) and if I had to choose, I would rather get treated here. There were so many outside "experts" coming into my room in the States, whose purpose I wasn't fully aware of, that I'm sure that is what drove up the cost. One guy would come in 3-4 times a week, ask how I felt, examine my feet for swelling and leave within 3 minutes of entering. His bill was well over ten grand, I believe. Totally unnecessary. When you are filled with drugs and in constant pain, you can be seriously vulnerable and can be easily duped. I've gotten less than adequate treatment here on occasion and I think there's an element of "gaijin" treatment here where they just want to get rid of you as soon as possible but I've never gotten a bill that I thought was outrageous. The insurance people here tried extremely hard to help me when I was hospitalized in the States and even paid a small portion of my bill.

1 ( +1 / -0 )

This has been a good comments thread to read through, as many felt compelled to write in response to the pretty much truth-free content of sangetsu03's message at 10:42am. The idea that you have to go through some cumbersome paper-filled reimbursement process in Japan to get 70% of your medical expenses paid is patently false. Japan's system is remarkably easy to deal with when compared to the USA (and by the way, why did this thread turn into a debate about whether or not the USA has the "best health care in the world"?--I'm so tired of reading this phrase, yet another patently false statement uttered by people who have some obsessive agenda that revolves around insisting on America's supremacy because of its lack of a universal insurance mandate until the ACA was passed).

1 ( +1 / -0 )

The National Healthcare Plan is great... if you use it.

I lived in Edogawa ward in east Tokyo for 4 years and paid 46,000 yen a month for PUBLIC healthcare. I earn an average wage and consider myself to be in good health and only make visits to the clinic once or twice a year. 46,000 yen / month is more than I would pay for PRIVATE healthcare back home! You can't help but think that you're merely paying for the elderly / families here, as Edogawa has the highest concentration of elderly people / young families in Japan. This is frustrating.

I did, however, need major surgery (at a major hospital in Tokyo) last year which had me hospitalised for a week. My excess was roughly 90,000 yen, which wasn't too bad I guess. A few things that surprised me were:

They basically refused to see me in the beginning as I was a month behind in my healthcare payments (ah, the joys of being a hakkensha)! I had to pay daily for a room - all "free" rooms (ie. rooms with 6 beds) were taken. I had to go down to the combini (in a gown!) to buy DVT stockings, nappies (yes, that kind of surgery) etc. - all out of my own pocket!

So there's two sides to it all, I guess. Still waaaaay too expensive, though. Every month is a struggle!

0 ( +0 / -0 )

America has an excellent health insurance plan - if you have enough money to pay for it. But of course, American rich couldn't care less about the American poor, so to the rich, the Americans have the best medical system in the world!

It would be laughable if it weren't so disgusting.

2 ( +3 / -1 )

My mother-in-law was diagnosed by liver cancer and went into a coma after having 70% of her liver removed - she was then in hospital for a few weeks - of course this was followed by on going support and treatment - she died 6 years later.

Without the Japanese system we would not have coped:

she was in the public system through city hall we paid 30% of the fees each time (which for the first surgery etc was 1.3 million yen) we then got everything over 65,000 yen refunded each time (I believe it is now 85,000) through the city hall she died in hospital with dignity with her close family near her.

The treatment was kind and responsive to her needs and wishes to the extent that she attended her doctors wedding a few years into the treatment.

Overall, the Japanese system worked well and as it should.

0 ( +1 / -1 )

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