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Tuesday, Nov. 9, 2004

THE ZEIT GIST

A primer on health care

In the first of a two-part series on the Japanese health insurance system, Tomoko Furukawa goes back to basics


There are two main types of Japanese Health Insurance: National Health Insurance and Employees' Health Insurance

News photo

Once you have joined the health insurance system, you will be issued with an insurance card ("hokensho"), which you must bring with you every time you pay a visit to a clinic or hospital or other medical facility. If you forget your card, you may have to pay the full amount for treatment, though this is refunded later.

National Health Insurance

All residents of Japan who are planning to stay in the country for at least one year and haven't joined another health insurance program are entitled, and expected, to join the National Health Insurance Program.

This includes part-time workers, the self-employed, and those without full-time status at a company they work for (this often includes teachers at English schools).

Under this system, both the policy holder and dependents enjoy equal coverage.

The amount you must pay into the National Health Insurance System is based on local resident tax (which, in turn, is based on income), your assets, the number of people benefiting from coverage and, often, the number of people living in your area that have joined the system (eg. ward, city, town etc.).

At present, regardless of income and assets, the highest amount payable annually is 530,000 yen, though this can rise to 610,000 yen depending on the number of people over age 40 in your household. Payments are not automatically deducted from wages, but must be paid in installments at a post office or health insurance office.

Foreign residents are often shocked when they see a massive jump in their premium from the first year of joining the system to the next.

The reason for this jump is that, for the first year, the premium is set at a minimum of around 2,500 yen.

For the second year, however, it is calculated based on income.

Under National Health Insurance, the policy holder and his/her dependents must pay 30 percent of inpatient and outpatient fees, with 70 percent covered by insurance.

Those enrolled in all health insurance schemes can avail of some free or very low-costs general check-ups (chest X-ray, urinalysis, blood test etc.). Also available are dental checks (for cavities, gum disease etc.), TB tests and treatment if sick.

Health exams and check-ups are generally not covered by insurance. Local authorities and companies arrange yearly or twice-yearly check-ups at designated times for local residents and employees.

However, while a preventative check-up may not be covered, there's nothing stopping the insured person from going to their doctor with a complaint (fictitious or otherwise) and having a check-up performed as part of diagnostic treatment.

The NHI reimburses amounts paid over 63,000 yen (35,400 yen for low-income families) for medical treatment in one month; amounts over 37,200 yen, starting from the fourth time, if a household receives high-cost medical care four or more times a year; amounts over 10,000 yen for treating long-term, government designated ailments such as diabetes. A list of these designated diseases and conditions is available from your local city/town office.

However, reimbursement details under national health insurance are decided by local governments, so specific details of benefits should be checked with your local insurance office.

You may also be reimbursed if you receive treatment at a facility that does not accept your insurance and consequently hits you with a hefty bill.

In order to qualify for the above, you must be able to show that you were forced, through an emergency or unavoidable situation, to go to that facility. However, applicants will not necessarily be reimbursed the full amount, but rather will receive repayment based on a government-fixed fee.

If you get prior permission from your local EHI office, you can be reimbursed for transportation costs to hospital.

The Japanese health insurance system does not cover costs incurred as a result of accident caused by a third-party, since in Japanese custom the third-party is expected to pay. However, if that person cannot pay, then the insurance system may reimburse your costs and bill the person involved themselves.

If you cause the accident you have no coverage under the health insurance system.

Employees Health Insurance

This plan is for company employees and their dependents. It covers those who work full-time or at least 3/4 of the hours that a full-time worker puts in for a company that has joined an EHI plan.

In order for your dependents (basically your extended family stretching back three generations) to benefit from your policy, they must rely on you for more than half of their livelihoods and have an annual income of less than half of yours -- or up to 1,200,000 yen per annum.

Under the national pension plan, employer and employee each pay half the premium, which is based on a percentage of income.

Unlike the national health insurance system, the EHI policyholder pays 10 percent of costs, while dependents pay 20 percent of inpatient care costs, and 30 percent of outpatient costs.

For high-cost medical care, the EHI will reimburse any high-cost medical expenses or extraordinary medical expenses along the same lines as National Health Insurance.

Reimbursement usually occurs within two months of payment, though interest-free loans are available for those in need of funds to tide them over until the cash arrives.

Benefits are the same as those under NHI with the exception of coverage amount.

Getting out

It is essentially impossible to leave the Japanese health insurance system once you have joined, unless you are leaving the country, moving somewhere else, or starting a new job.

If you move jobs and go from full-time to part-time status you may decide to opt out of the health insurance system altogether and get private health insurance.

If you shift from EHI to NHI, you will be charged from the date you left the EHI.

You can receive an exemption from paying premiums if you have trouble paying due to unemployment, bankruptcy issues etc.

Health resources

There are several good resources for information on health insurance and health care in general in Japan.

One of the best is the Japan Health Handbook, published by Kodansha.

The book contains sections ranging from alternative medicine and mental health to old-age care, with lots more in between. Though Kodansha no longer prints the book, it may be still possible to find copies in English-language bookstores in major Japanese cities, and the book can certainly be found on Amazon and other online book retailers.

On the Web, many embassy homepages provide information on English-speaking hospitals and clinics around Japan. One particularly comprehensive list can be found on the homepage of the U.S. Embassy in Japan at japan.usembassy.gov/e/acs/tacs-7119.htm

Another good resource is the AMDA International Mediscal Information Center homepage ( homepage3.nifty.com/amdack)

This provides telephone services to foreign residents in eight languages, explaining the health care system in Japan to foreign residents and pointing them in the direction of medical facilities with staff who speak their language.

What's not covered

Not covered under the two systems are normal childbirth; abortion for economic reasons; vaccinations; cosmetic surgery; orthodontics; alternative medicine. Also not covered are accidents that occur in or on the way to work.

Health resources

There are several good resources for information on health insurance and health care in general in Japan.

One of the best is the Japan Health Handbook, published by Kodansha.

The book contains sections ranging from alternative medicine and mental health to old-age care, with lots more in between. Though Kodansha no longer prints the book, it may be still possible to find copies in English-language bookstores in major Japanese cities, and the book can certainly be found on Amazon and other online book retailers.

On the Web, many embassy homepages provide information on English-speaking hospitals and clinics around Japan. One particularly comprehensive list can be found on the homepage of the U.S. Embassy in Japan at japan.usembassy.gov/e/acs/tacs-7119.htm

Another good resource is the AMDA International Mediscal Information Center homepage ( homepage3.nifty.com/amdack)

This provides telephone services to foreign residents in eight languages, explaining the health care system in Japan to foreign residents and pointing them in the direction of medical facilities with staff who speak their language.

Next week's column will cover the above issues, aswell as those of tax deductions, coverage, high medical expenses, specialist treatment, back payments and more. Send your questions and views, good and bad, on the Japanese health care system to community@japantimes.co.jp


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