National health insurance a basic universal safety net


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.