More on the mysteries of the Japanese Health System

Health - July 3rd, 1998

Staying Healthy in Japan

by Elyse Rogers

Japanese National Health Insurance (Kenko Hoken)

Japan has a National Health Insurance system, and everyone is covered—or should have coverage either through a business or through the local government office. Payment for all types of medical care is made by the government directly to the provider, with a co-pay of 20 or 30 percent (just raised from 10 or 20 percent on Sept. 1,1997) by the patient. This is true of prescription medicines as well.

In the case of clinics or hospitals, it makes little differ­ence whether they are private or public institutions as the payment rules (and rules for paper work, types of treatment and payment schedules) are the same. Which is why pubic and private thrive side by side.

Many expats, particularly those who are trans­ferred to Japan with a large international company, do not have Japanese National Health Insurance— rather, they keep the private insurance that the com­pany provides. This can present a payment challenge, as most hospitals and clinics in Japan expect that patients will either present a national health insur­ance card (and pay the small co-payment fee) or pay the entire bill in cash.

This can be especially traumatic if emergency care is needed and the bill is significant. The more interna­tional hospitals will often submit claims to private insurance companies for you, but don’t count on it. Best bet is to make arrangements before treatment (if the treatment is elective) or carry extra cash (at least ¥30,000) with you, just in case.

If you are an expat who arrived in Japan without any health insurance at all, inquire at your local ward office. Take a Japanese friend with you if at all pos­sible, if you don’t speak Japanese, as getting through the system and filling out forms is pretty complicated.

Private Medical Care/Insurance/Specialists

To serve expat community members who have pri­vate health insurance, there are a cadre of physicians and clinics (and dentists) set up to serve that commu­nity. There are several clinics, such as Dr. Fujii’s To­kyo Medical Surgical Clinic, one of the largest that many of you are familiar with.

His clinic is staffed by foreign physicians, all of whom speak English and are trained in Western medi­cine—many of them having studied in the U.S. or the U.K. The clinic also provides another valuable and unusual service in Japan: it has specialists who will see referred patients (referred by the clinic’s primary care doctors) at the clinic by appointment.

Since it is not always easy (or even possible) to be referred to a specialist of your choice in Japan—the Japanese system works more on the principle of “you get the doctor on duty”—this is a very useful service, particularly for specialist-loving folks like Americans.

If you use your private insurance with the usual Japanese hospitals and clinics that are set up under the national health system, your care will often be billed at a higher rate than the same care for your nation­ally insured counterparts. Out-patient service costs may be comparable, but if you become an in-patient, it’s often more expensive. This is because such hospitals and clinics feel that the set pay rate from the government is really a “discounted rate” (after all, they certainly are the major paying client!).

Even patients with national insurance, however, are required to pay extra for additional services in hospitals that might be considered routine by U.S. or European standards. For inpatients, there is a sur­charge for a private or semi-private room, and in rural hospitals some of the linens and food must be provided by the patient or his family. Don’t panic, though, as the larger hospitals in Tokyo provide hos­pital care that is pretty close to the all-inclusive type we know and expect in our home countries.

Within the Japanese medical system, if a specialist is called in (or requested by the patient and/or his family), a “gift” to the specialist to reward him for his extra time and attention, is expected. Dr. Fujii told the “Tokyo: Here & Now” group that a gift could be “home-made cookies” or such, but that’s not what I’ve been told by other Japanese physicians. Senior specialists or honored “sensei” often get cash in an envelope, I understand, and that “donation” can be as high as ¥100,000. Fortunately, Japanese specialists are usually resigned to the fact that foreigners live in Japan under a different system and, therefore, don’t expect such “voluntary gifts.”

For a list of other hospitals and clinics that have English-speaking doctors and (hopefully) staff, a good reference is the Japan Health Handbook, published by Kodansha International and available for ¥2,233 at most bookstores. The book is a wonderfully useful source of information for foreigners living in Japan, and will be a valuable resource for you during your Japan stay, even if you already selected a doctor and hospital.