Cost of Healthcare in Japan
There are 2 types of insurance:
1. Shakai-Hoken – Employees Insurance for those on a full-time contract. The deal here is that company and employee contribute 50/50
2. Kokumin-Hoken – Everyone else who doesn`t fall into the above category. It means freelancers, small business owners, temporary employees, unemployed. In this case, your own contribution is 100%
We will focus here on Kokumin-Hoken as the most common among foreigners.
National Health Insurance premiums are based on your earning. Shortly saying, the more you earn, the more you pay. What seems cheap at the very beginning for new arrivals, gets often quite expensive a year later. Many new residents are shocked to see a jump in premium from basic JPY5,000 a month to as high as JPY25,000 a month. It may be less or more. On top of that, you may be obligated to contribute to a pension scheme with its minimum amount of JPY15,000 a month. Please don`t be surprised to pay JPY40,000 a month for basic social security.
How the Japanese National Insurance is calculated?
Unlike Expat Health Insurance which has premiums fee based on age, National Insurance is calculated according to your last year income. This is why the first-year premium is very low because you did not have any income in Japan yet.
The tax year in Japan starts on April 1st and ends on March 31st the following year. Taxes for last year income are to be filed from mid-February until the end of March.
Once you do this, the details are passed to the appropriate Ward Office where you live. According to numbers on your tax form, city officials will calculate your Resident Tax 住民票 (Jyuuminhyou) and Health Insurance premium for the current year. You will receive your bills by post around June. The good thing is that you will have a choice about a payment frequency. Resident Tax is another bill, which may hurt you too. It may even be as high as your one-month worth salary. Please be aware of it.
住民票 = exact translation is “Resident ticket”. It`s not a joke, but it is like a high price “ticket”
The calculation is quite complicated, and it depends on the city you live in, the premium varies. Basically, it is about 9,4% of your income after all deductions. If you are 40 years old and above, you must pay an additional 1,4% for Long Term Health Insurance. Therefore, the cost is higher for that age group.
When you visit a doctor, or you are admitted to the hospital you always pay 30% of the cost. Basically, one time visit a local physician when one gets ill is not very expensive. The dentist is a different story. I will write more about it in another post. I can reveal that ordinary Japanese dentist will ask you to come back multiple times to treat just one tooth. This is how the system works.
When you are admitted to a hospital, you still must pay 30% from your pocket money, but this is a whole different calculation. At least it won`t cost you 30% of JPY2,000,000 bill for surgery. There is an upper limit to patients` co-payments (see below). One thing is certain, hospitals in Japan are like hotels where you must pay from your own pocket for your meal and bad. The price again depends on your income. Also, if you choose to spend weeks in bed with more than 6 people in one room, (think of it as a Youth Hostel) then the room is free of charge (you still pay for food).
According to official figures, it cost about JPY10,000 per day to stay in the hospital and this is not reimbursed. In addition to this comes treatment cost, which is calculated accordingly.
Upper limits to monthly patients’ co-payments (the amount exceeding the upper limits will be subsidized):
Individuals younger than 70:
\\80,100 + (medical care costs – \\267,000) x 1%; Majority of residents fall under General
\\35,400; (low means income below JPY980,000 a year)
\\150,000 + (medical care costs – \\500,000) x 1%
Unlike other countries where they “kick” everyone out of the hospital within a couple of days to avoid high-cost healthcare, in Japan is the opposite. You can expect to stay 2-3 weeks or longer. ) Japan is infamous for its long hospital stays. Even women after giving birth are kept a week or two. In western Europe, most of them would likely to be home the next day. Looking at the positive side of it, the doctors in Japan want to make sure you are getting better, so you can go home. On the other side it is all about business for the hospital, but not for you. More about maternity I will write in another post.
The Cost of Treatment in a small hospital outside Tokyo.
This is a real example from October 2018.
A female friend had minor surgery to remove a small tumour. Doctors suspected cervical cancer. Fortunately, it was not as serious as they thought. She has only Japanese National Health Insurance which cost her JPY25,000 a month. She stayed in the hospital for 9 days. Her own contribution was JPY260,000 (not reimbursable). Some people may say: not bad, but for the majority means a lot. She told me that she needs to keep saving money for follow up visits and check-ups. As long as she relies only on JNHI, she must be prepared to spend own “pocket money”.
NOTE: Private health insurance is to protect us against the risk of incurring high medical expenses. it provides financial protection in case you have a serious accident or sickness. Those without insurance or only with national one are exposed to these costs. Unfortunately, for my friend and many others who think to take additional insurance now, when they became sick is too late. We cannot help them anymore. Majority of private insurers will not cover their current condition because it would be treated as a “pre-existing health condition”.
What is the pre-existing condition?
Healthcare cost worldwide rise every year due to better technology and inflation. Social Insurance does not guarantee us a 100% cover for any sickness that may occur. However, we should be prepared to bear our own cost for our treatment or purchase additional insurance. I advise you to take it now when you are still healthy before it is too late. Today you may not think about “investing” into another health insurance because you feel good. You probably don`t think that something may happen to you either. Unfortunately, most of us won`t stay this way forever. Things happen, but we don`t know when it will happen. Be prepared today.