All Japanese citizens are required by law to be covered by public health insurance.
Because of this universal system, most medical treatment is covered and the costs are reasonable.
The first health insurance law took effect in 1927 to protect laborers, and in 1938 the umbrella was extended to farmers, according to the Health, Labor and Welfare Ministry.
After World War II, many organizations stopped providing health insurance. To make sure every citizen was covered, the government revised the national health insurance law in 1958.
Here is some basic information about how the system now works:
What types of public health insurance are available?
There are basically four types. Company employees are mostly under “kenko hoken” (health insurance), also known as Kenpo, managed by the national health insurance association or health insurance unions. Civil servants are covered by mutual aid insurance. Sailors and fishermen have seaman’s insurance, while farmers and other self-employed people must apply for the Kokuho national health insurance managed by local governments.
Can nonregular workers, including temporary employees and day laborers, also be insured by Kenpo?
Yes. If temporary workers have a contract exceeding two months and if they work at least 30 hours or four days a week, they can be covered by the insurance provided by temp staff dispatching agencies.
Day laborers with a contract of two months or less are covered by special insurance for day workers, according to the Social Insurance Agency.
Do people on welfare also have to pay into the health insurance program?
No. Their medical costs are fully covered by medical aid, which is a part of public assistance.
Are dependents of the insured also covered?
Yes. Relatives in the first, second and third degree benefit from the insurance if they are financially supported by the insured.
How about foreigners?
Foreigners whose length of stay is more than a year and who are not covered under Kenpo need to apply for the Kokuho coverage. Foreign students should be covered by Kokuho even if they stay in Japan for less than a year.
Foreign residents are required by law to join one of the health insurance schemes, but some opt out because they have their own insurance contracts with private firms or they do not want to pay the fees. [In many cases, employers refuse to enrol foreign employees in Kenpo.]
There is no penalty for not joining public insurance. But the Justice Ministry’s Immigration Bureau asks foreign residents to show their public health insurance cards when applying to renew their visas to urge them to join the health care system.
Are there people who are not under any public health insurance?
Yes. For example in Saitama Prefecture, 36.4 percent of 962 workers who answered a questionnaire from the prefecture in March were not covered by public health insurance because they didn’t apply for Kokuho for financial or other reasons.
In 2009, a survey by the city of Yokkaichi, Mie Prefecture, found 24 percent of 473 Brazilian residents in the city had not applied for health insurance because they couldn’t afford the fee. Yokkaichi is known for its high population of foreign factory workers.
How much are the individual monthly premiums?
They vary a great deal depending on the type of insurance. The monthly Kenpo fee is based on income. For example, in the case of Kenpo coverage managed by the national insurance association, the workers’ share of the burden — 50 percent of the total fee — in Tokyo ranges from about ¥2,700 to ¥56,000. The rest is paid by their employers.
How about for medical treatment?
Patients under 70 years old are required to pay 30 percent and those between 70 and 74 have to pay 10 percent of medical costs, including fees for checkups, treatment and medicine at a hospital or pharmacy.
People aged 75 and above also pay 10 percent of their medical costs, but the expenses are deducted from their pensions.
There are basically no medical charges for children whose parents pay into public health insurance, and each local government sets its own age limit. In Tokyo, children aged 15 or younger are eligible for free medical treatment in many municipalities, according to the metropolitan government.
What happens if people covered under Kokuho fall behind on their premiums?
According to the metropolitan government, local governments first send a reminder. If they still do not pay the fee, they will receive an insurance card valid only for several weeks to months. They will also be charged in arrears.
Does public health insurance cover all types of checkups, treatment and medicine?
No. Periodic health checks, vaccines for influenza, mumps, chickenpox and some infectious diseases, and advanced medical treatment conducted at authorized university hospitals, are not covered.
Health insurance also doesn’t cover the cost of birth control pills.
What if a person has really high medical costs?
If the actual medical cost exceeds the fixed upper limit patients have to pay, an insurance organization refunds the difference. In average, the monthly limit is ¥80,100 for patients under 70. If their income is particularly high, the limit is ¥150,000. Patients who are 70 or above have to pay up to ¥44,400.
How about births?
Regular checkups and the costs for childbirth must come out of pocket. However, local governments provide various ways to offset these costs. Prefectures offer ¥420,000 in childbirth assistance, and local governments have their own financial aid for checkups and births on top of this amount. In the event of a Caesarean section, the cost is covered by insurance.
Is it true relatives of the insured or their dependents can receive burial fees?
Yes. In the case of Kenpo, ¥50,000 is provided. For those under Kokuho, the amount of payment varies depending on the local administration.
The health ministry plans to make mental health checks mandatory in regular health examinations given at the workplace, health minister Akira Nagatsuma said Monday.
The step is aimed at preventing depression and suicide, problems that have been making headlines in recent years, he said.
A ministry task force, formed in January, is expected to propose adding mental health checkups in its interim report to be released soon.
The ministry will consider revising the Industrial Safety and Health Law or related ministry ordinances.
Businesses are required under the law to give their employees at least one health examination a year. Those violating the law are subject to a fine of up to 500,000 yen ($5,450).
Related rules require blood pressure, liver function and blood sugar checks to be included, but there is no clear stipulation about mental health examinations.
In fiscal 2008, 927 applications for workers’ compensation were filed for depression and other mental ailments, of which 269 were approved.
The number of applications was more than four times greater than in fiscal 2000 and that of approved cases was seven times greater than in the same period, according to the ministry.
At least 33 people died in 17 prefectures in 2009 after not visiting doctors because they lacked national health insurance, a private survey showed Thursday.
The 33 stopped being covered by the national health insurance scheme after failing to pay insurance premiums due to financial difficulties, the Japan Federation of Democratic Medical Institutions said, referring to its survey of member institutions across the country.
The 33 comprised 27 men and six women. Of them, 23 were uninsured, six had invalid health insurance certificates and four were required to pay a medical bill in full before applying for reimbursement minus the deductible. Eighteen of them were unemployed and nine were irregular workers.
In one case, a 39-year-old man in Nagano Prefecture who died of lung cancer refrained from visiting a hospital due to his lack of a health insurance certificate, belatedly visiting a hospital two months after becoming aware of his cancer symptoms.
“The data show the severe situation of low-income people who are facing difficulties in receiving medical services at a time when the economic slump has exacerbated poverty and income disparities,” a federation official said.
The survey also found another 10 people who possessed health insurance certificates had died in six prefectures after refraining from visiting a hospital because they were unable to pay the medical expenses required.
Hundreds of foreign and Japanese people staged a rally Sunday in Tokyo demanding better working conditions and employment benefits for foreign residents.
At the annual “March in March” event at Hibiya Park in Chiyoda Ward, Louis Carlet, deputy general secretary of the National Union of General Workers Tokyo Nambu, said foreign workers have a great need for job security and health care.
“It’s difficult to be a foreigner in any country. But it’s much more difficult when you don’t have job security, when you don’t have health care,” said Carlet, whose union jointly hosted the event with other groups lobbying for improved labor conditions.
One of the biggest problems is that most foreigners are being employed as nonregular workers, and more and more Japanese are being used the same way, he said.
Participants at the rally included people from many different ethnic backgrounds as well as various unions. Organizers said around 400 people took part.
Romsun Pramudito from Indonesia, who chairs the Tokyo-based nonprofit organization Indonesia Youth Association, said more job security should be given to foreigner workers.
“We are working very hard and really contributing to the country,” he said, adding he hopes foreigners receive better treatment. He also said foreigners and Japanese should collaborate to find a solution.
Buddhika Weerasinghe, a Fukui-based freelance photojournalist from Sri Lanka, came to the event because he is interested in the problems foreign workers face in Japan.
Weerasinghe said he has heard from foreign workers in the city of Fukui — many of them Chinese working in garment factories — that some received salary cuts without explanation and even experienced physical harassment. “I feel foreigners working in Japan are facing a lot of problems.”
While hopeful that improvement will accompany the change in government last September, little progress has been made, Carlet said.
“We want the new government to take this issue very seriously and make serious change,” he said.
The event also featured a live music by musicians from various countries, including Senegalese drum sessions and Ainu dancing from Hokkaido.
A march planned after the gathering, however, was called off because of the chilly rain, organizers said.
Health, Labor and Welfare Minister Akira Nagatsuma has announced cuts in national health insurance premiums for people who have lost their jobs.
Under a new system beginning in April, the yearly national health insurance premium will be decreased for people who lose their jobs, based on their yearly income. For a couple with one child and a yearly income of 5 million yen, the premium will fall from 347,000 yen a year to 148,000 yen a year — a decrease of nearly 200,000 yen.
Since national health insurance premiums are calculated based on the previous year’s income, there have been cases in which people found it impossible to pay high premiums after losing their jobs and source of income, resulting in a loss of health insurance coverage.
In order to lower the premiums for people who lose their jobs, the enforcement order for the National Health Insurance Law will be revised in March, and a bill to revise the Local Tax Law has been submitted at a regular session of the Diet. Under the changes, it will be possible to calculate insurance premiums based on an amount that is 30 percent of the person’s actual wages earned the previous year.
The measures will apply to people who have employment insurance, and who receive an unemployment benefit after losing work through no choice of their own. People can apply to have their premiums reduced at local government offices, and the measure will apply from the day after the person loses work until the end of the next fiscal year.
The reduction in premiums will remain in force for people who become self-employed after losing their jobs and stay in the national health insurance scheme, but if they sign up with national health insurance associations that employees of small- or medium-sized businesses belong to or with company health insurance programs, the reductions will not apply.
Under the measures, people with a yearly income of 10 million yen, for example, will have their premiums reduced from 590,000 yen a year to 283,000 yen. Those on a yearly income of 3 million yen will have their premiums lowered from 233,000 yen a year to 85,000 yen, while those with a yearly income of 1.5 million yen will have the premiums reduced from 134,000 yen a year to 48,000.
Reductions will also apply to people belonging to health insurance associations who move to the national health insurance program after losing their job. Some 870,000 people including the families of people who lose their jobs are expected to use the new system.
The Immigration Bureau announced Wednesday new guidelines for foreign residents, stating that joining the social insurance system is not a requirement for renewing or changing one’s visa status.
The bureau told The Japan Times on Feb. 1 that it had decided to change the wording of the new guidelines — which were originally drawn up last March and scheduled to take effect April 1 — to ease concerns that those without social insurance would be forced to choose between losing their visa and joining the insurance system.
The original version of the guidelines said foreign residents must present their health insurance card when reporting changes to or renewing their residential status.
The wording has now been revised to read:”In order to promote signing up for social insurance, we will ask (foreign residents) to present their health insurance card starting April 1. We will not reject renewal or change of visa status for failing to present the card.”
Immigration Bureau official Aiko Oumi said, “We just want to persuade foreigners to join the social insurance, but we heard from many people that the original version sounded like having social insurance is a requirement.”
In some cases, employers [violate the law by not enrolling] their foreign employees [in] the social insurance system to cut costs.
The Immigration Bureau has effectively scrapped a guideline that compelled foreign residents to present health insurance cards when applying to extend visa status, it has been learned.
The new guideline, due to be enforced on April 1, states it would have requested non-Japanese to enroll in the social insurance system and present health insurance cards at the application window when reporting changes in their status of residence or when renewing visas.
But the newly revised immigration guideline also states that failing to present health insurance cards would not adversely affect decisions by the bureau on the issues of changing residence status or renewing visas. [Japanese as well as] non-Japanese are required by law to enroll in the social insurance system.
Aim is to ease foreigners’ concerns
The Immigration Bureau is planning to change a new guideline for foreign residents to ease concerns that those without social insurance will be forced to choose between losing their visa and entering the insurance system, a bureau official said Monday.
But some foreigners warn the move won’t be enough to entirely free them of the risk of being forced to enter the insurance system.
The wording of the guideline, which is to be enforced April 1, currently stipulates that foreign residents must present their health insurance card when reporting changes to or renewing their residential status. It is the last of the guideline’s eight items.
“The bureau will delete item No. 8 by the end of March, and ‘lightly mention’ the need to present a health insurance card in the introductory passage of the guideline,” Immigration Bureau spokesman Yoshikazu Iimura told The Japan Times. “The wording will be in a manner to eliminate foreign residents’ concerns that their visas won’t be renewed if they don’t have insurance.”
The bureau will try to persuade foreigners who don’t have the card to enter the social insurance system by giving out brochures, but not having the insurance won’t affect the bureau’s decision whether to grant a visa, he said.
The Democratic Party of Japan (DPJ)-led administration has called for a “shift from concrete to people” — spending taxpayers’ money on people’s livelihoods, rather than public works projects. This is reflected in the fiscal 2010 budget draft, but it suggests that the government desperately secured financial resources to carry out its election campaign pledges, rather than show a clear vision on how Japan should be reformed. What will threaten people’s livelihoods are problems with medical and nursing care services in the short term, and raising children in the longer term.
Japan’s failure to find a way out of the child-care, medical and nursing-care crises is attributable largely to Japan’s traditional social security philosophy, in which fathers are the traditional breadwinners, and insurance and pension programs at the companies they work for support their entire families’ livelihood. In other words, Japanese people tend to believe that families should be responsible for raising children and nursing care, and that the national government should supplement such practices only in exceptional cases, such as those in which the fathers have lost their jobs or fallen ill.
However, single-parent families and households comprised of only elderly members are common now, while a growing number of people do not marry, forcing traditional family values to adapt.
Moreover, part-time and temporary workers now account for one-third of the entire workforce. If the government continues to address problems involving the outdated system only with deficit-covering bonds and reserve funds, taxpayers will be forced to pay for that in the end. The social security and employment systems should be reformed in response to changes in family values and Japan’s society.
Japan Pension Service, an organization set up to succeed the scandal-plagued Social Insurance Agency, started full operations Monday with a pledge to restore public trust in the public pension system.
The names of 312 social insurance offices nationwide have been changed to pension service offices.
The entity has drawn up 10 pledges to improve customer service and restore public trust, including “Pick up the phone within three rings,” and “Don’t make visitors wait more than 30 minutes.”
Handouts listing the pledges were distributed to everybody at the opening ceremony.