Citizens of Japan enjoy high-quality, affordable and easily accessible health care, although there is no centralized publicly run system. Most clinics and hospitals are privately operated, either by corporations, individual practitioners, universities or other non-profit organizations, although there are also hospitals run by cities and even the national government. From the perspective of the patient, however, the experience of using one of these public hospitals does not differ from using a private medical facility.
Visiting a clinic is quite straightforward. There is no GP system, and it is not necessary to register with a doctor in advance of seeking treatment. In addition to clinics specializing in internal medicine, there are many specialist clinics that patients can choose to visit without a referral based on their symptoms. Some clinics allow patients to make appointments over the phone or online, while others require that patients simply take a number and wait to be seen. There is a registration fee payable the first time you visit a clinic or hospital, with a higher fee for hospitals to encourage use of clinics where possible. If you visit a clinic and they lack the facilities or expertise to provide the necessary treatment, the doctor will write a letter of referral to a hospital. However, many hospitals have outpatient departments that do not require an appointment, meaning it is possible to simply walk in and seek treatment in the same way as a clinic.
There are two types of local health insurance. Those who are employed in Japan and are on local payroll are enrolled in their company’s health insurance scheme (same as Japanese employees), while the self-employed and those who are unable to enroll in a company scheme join National Health Insurance, which is administered at the local city/ward level. Strictly speaking, it is a requirement to be enrolled in one or the other, but up to now those who are on expatriate assignments and remain on payroll in their home country have not usually enrolled in either but have used an international health insurance plan instead. Such insurance is not recognized by local clinics and hospitals, so those who are enrolled in international plans will be treated as though they do not have any cover and asked to pay 100% of the cost. The exception to this is clinics that cater specifically to the expatriate community, some of which do not even accept local health insurance. It should be noted that the government is closing the loophole that allowed some foreign residents to avoid paying into the health and pension systems, so anyone currently in Japan who is not enrolled as well as anyone coming in future should expect to need to enroll at some point.
Those who are enrolled in a Japanese insurance plan are generally required to pay 30% of the costs of treatment and any prescribed medicines, with the remaining 70% covered by insurance. Medical fees are strictly regulated by the government to keep them affordable, so the cost of treatment is relatively low by international standards, and there is a limit on the amount a person can be asked to pay for medical expenses in a given month, with the calculation for this based on the person’s income.
In general, there are plentiful options for medical treatment, at least in urban areas, and the level of treatment provided is high. The long waiting times for treatment that are common in other countries are almost entirely absent. However, the profit motive is evident in the liberal way that medicines, including antibiotics, are prescribed. Those visiting a doctor with symptoms of a common cold will frequently be given a prescription for four or five different types of medicine, one for each symptom, which can come as quite a surprise to those coming from countries where doctors prescribe medicine sparingly.
Phronimoi, CC BY-SA 4.0, via Wikimedia Commons
