Recent years have seen a remarkable increase in the number of foreigners living in Japan. There have also been an increasing number of reports of problems occurring between Japanese medical facilities and foreign patients, such as unpaid medical bills and delays in seeking medical help. One important cause of these problems is insufficient information concerning the Japanese medical system. Thus, we hope to give you a helpful overview of the system in this article.
An outline of the Japanese Public Health Care System
The Japanese health care system is fundamentally a public system that is based on public insurance, welfare and services. The following is a list of the types of public health insurance available:
Employee's Health Insurance (where employees of companies and institutes are automatically enrolled),
the National Health Insurance,
a public Health Insurance System for the Elderly,
public Financial Assistance Programs for the disable and the poor, and
services through public health centers.
It is very different from health care systems in countries such as the United States, where most people participate in private health insurance programs on a voluntary basis and where government programs are limited. In Japan, every resident is required to join one of the public health insurance programs. Foreign residents must enroll too, though that depends on certain requirements being met. Foreigners may also be eligible for public financial assistance and services at public health centers.
Medical institutions (iryo shisetsu) in Japan may differ from those in one's home country. They are generally categorized according to the type of establishment: national, public (prefectural, city, etc.) and private. If one does not use public health insurance, the cost of the care tends to be higher at private than at national or public facilities (though either way, you have to pay full price and not just the deductible). Some institutions provide both outpatient (gairai) and inpatient (nyuin) care; others operate only on an outpatient basis. Appointment systems are becoming more common, but at many facilities you can expect to wait one or two hours to see a doctor (so bring something good to read!). Continuity of care is rare at large hospitals, and so to insure seeing a particular doctor, time your visits according to the doctor's outpatient hours. Sometimes a letter of introduction is needed. Careful selection of a facility and physician can be important in getting the appropriate care.
Fees for Medical Care
When public health insurance is used:
Medical fees under the two main types of public health insurance are the same and are fixed by the Ministry of Health and Welfare. No matter where you are in Japan, here in Tsukuba or anywhere else, at a public hospital or private clinic or even at home, the fee for the same medical treatment is identical. The timing, however, can increase the cost as a surcharge is added for the same care at night, on public holidays and Sundays (yakan kyujitsu shinryo). These surcharges are also fixes by the Ministry. You may also be charged extra for a home visit (oshin) as well, as the doctor's transportation expenses are not covered by the insurance and so may be added to the bill. The Ministry revises medical fees once every two years.
When public health insurance is not used:
When medical care is not covered by public health insurance (hoken-gai shinryo), each facility can charge whatever fee it considers appropriate. This is true for all uncovered costs under the public health insurance programs, as well as for fees charged to persons not enrolled in one of these programs. In these cases, the fee charged by different hospitals or clinics for the same treatment may vary considerably, even up to four times as much. Thus, many people in Japan who expect to receive medical care not covered by public insurance take out private insurance to cover these costs.
When public health insurance cannot be used in spite of enrollment:
Public health insurance covers only treatments and medications which have been approved by the Ministry of Health and Welfare. This means that some very new technologies and medications may not yet be approved for coverage. Likewise, many non-conventional treatments such as acupuncture, acupressure and moxibustion are also not usually covered. You may be able to get reimbursement, however, at a later date if you have received a particular non-covered treatment on the advice of a doctor and submit the necessary documentation. The same is true for hiring a personal nurse and for special apparatus such as corsets.
Treatment for conditions not considered as illness or injury:
Public health insurance can be used only for treatment of an actual or suspected illness or injury. It will not cover, for instance, induced abortions, immunizations, cosmetic surgery, orthodontic work or voluntary health checkups without any symptoms of illness. It also does not cover normal pregnancy and childbirth, although it will help pay for the treatment and hospitalization resulting from complication which may arise during pregnancy and delivery. Public health insurance can also be used for induced abortions if the operation is performed for recognized medical reasons. Likewise, it does apply for some kinds of dental care, including the treatment of tooth decay.
Treatment of injuries when the liable party is known:
Medical costs for injuries in which the liable party is known are not generally covered by public health insurance. The reason is that the liable party's accident insurance usually will pay these costs. If you are injured in a traffic accident, for instance, the liability insurance of the cars involved will normally take care of the medical expenses based on a percentage of liability as is worked out by the police and insurance companies.
Luxury or Consumable Items:
Public health insurance does not cover the costs of what are considered luxury or consumable (disposable) items used in medical care. As a result, the fees for these items vary greatly among medical institutions. For example, most hospitals or clinics with inpatient facilities have premium beds and special hospital rooms (private rooms) which, if used, can raise the fee anywhere from 2000 yen to 100,000 yen per day. For this reason, many Japanese take out additional private medical insurance to help pay for such items.
Treatment at facilities not approved for public health insurance coverage:
In most cases, medical facilities which do not utilize public health insurance have elected to do so voluntarily. Usually this choice is made because the facility specialized in care which is not covered by public health insurance. Some medical and dental clinics which cater to the foreign community in Japan fall into this category. Thus, before visiting a clinic for the first time, check to see if the care you will receive can be covered by your insurance.
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