Japan Healthcare System

The public healthcare system in Japan, known as Social Health Insurance or Shakai Hoken (SHI), is available to all residents and citizens, including expats who work full-time. Those who are self-employed, work part-time or are not covered by SHI are instead covered by the National Health Insurance or Kokumin Kenko Hoken (NHI). Both are funded through government subsidies, premium contributions and co-payments. They offer all eligible residents a wide range of services, including emergency care and surgeries at subsidised rates. For households earning below a certain threshold, a public assistance programme is available, exempting the household from insurance or public healthcare payments.

The quality of care within the Japanese public healthcare sector is very good, and unlike many other countries, the universal coverage extends to dental and optical care. Facilities are of a high standard, but expats may encounter language barriers, especially outside major cities.

Enrollment in the public system is mandatory for eligible residents and ensures that 70% of medical expenses are covered for most treatments, including doctor visits, hospital stays, surgery and some preventative care. The remaining 30% is then covered out of pocket or via a private health insurance plan. How you enroll depends on whether you are eligible for NHI or SHI. The SHI scheme, also referred to as an EHI or employment-based health insurance, will normally be handled by your employer the moment you start work. You can also register your dependents for coverage with the same scheme.

It gets a little more complicated if you qualify for NHI. You’ll need to register at your local municipal office within two weeks of arriving in Japan and bring:

After enrolling, you’ll receive a Hoken Sho (health insurance card), which must be taken to all appointments.

Private healthcare in Japan is somewhat different to the private healthcare found in many other countries. The majority of healthcare providers in Japan operate as private sector businesses but remain accessible through the public system. Figures indicate that approximately 70% of hospitals in Japan are private, with the rest being public sector or non-profit. 

Private healthcare facilities in Japan are, in fact, small, often family-run organisations offering routine care with just some specialities. Equipment is normally of industry standard, and the level of care quality is good. The facilities that mirror “private” as we view it in the UK and the USA, for example, are in fact found in International Hospitals. Many of these also operate as part of the national system, where 70% of costs are covered. However, some smaller international facilities do not participate in the public insurance scheme and therefore require patients to pay for treatment themselves or use a private health insurance plan.

Due to the public sector covering such a wide range of treatments, the unique treatments offered by the private sector in Japan are fewer than those found elsewhere. That being said, specialist treatments, mental health support, some optical and dental care and cosmetic surgeries are often only found in private facilities.

The costs of private healthcare in Japan can vary, but thanks to government regulation, they are heavily monitored. A visit to a clinic can cost approximately ¥5,000 to ¥10,000 (£25/$35 to £50/$68) with insurance, whilst a visit to the emergency room could cost around three times this amount. Long-term hospital stays cost considerably more, and in some cases, reservation charges may be applied. Should a stay at an international hospital be required, the costs can be even higher and may not be covered with public insurance.

Japan is home to some high-quality private hospitals, including the JCI-accredited St Luke’s International Hospital and the NTT Medical Centre. Both are in Tokyo and provide English-speaking patient support and a wide range of services. Outside of Tokyo, Nagoya University Hospital and Kyoto University Hospital cater to international patients.

Private healthcare is recommended for expats in Japan, even if eligible for the public healthcare system. With only 70% of medical expenses covered, the insurance bridges the gap and ensures little to no out-of-pocket expense.

Health insurance is mandatory for expats living in Japan. This contribution is made through deductions from the salary (approximately 5% with the same amount matched by the employer). If you are on NHI, the deduction is based on your income. With only a percentage of medical expenses covered, a private health insurance plan ensures you can cover any outstanding amounts and access high-quality care without the added financial stress.

Expats must enrol in the public system once they are registered as Japanese residents and can top it up with supplemental private coverage if they prefer. There is no obligation to do this, but for many, it offers an extra degree of coverage and more suitable facilities. Before being granted residency, a standalone private healthcare plan will be required. A local plan is often chosen in the interim, but it limits coverage to Japan only, and for some expats, this isn’t sufficient. As a result, international plans are the most popular option. They cost a little more than local plans but offer more comprehensive coverage and allow for repatriation or overseas care if required.

Exclusions often apply to private plans. These could range from pre-existing conditions to cosmetic treatments, but as each policy can differ, it is worth checking before taking out a plan. Premiums for a private plan in Japan can vary significantly, and take into account your age, medical history, level of coverage and the insurer. Basic coverage, used to fill the 30% co-pay, can cost between ¥3,000 and ¥5,000 per month, whereas an international plan offering direct billing, no co-pays and global coverage could cost as much as ¥40,000 per month.

The quality of hospitals across Japan is generally good, especially in the public sector. Many public and international private hospitals hold JCI or JMIP accreditation. The NTT Medical Centre in Tokyo and St Luke’s International both hold the prestigious JCI endorsement, whereas Hiroo Hospital, a well-known public facility, holds JMIP accreditation and is celebrated for its multilingual staff alongside its high standards of care.

English-speaking staff can be found in many Japanese public and international hospitals. Private facilities may have fewer English-speaking staff, and in clinics, it can be even rarer. Much will depend on the location of the private hospital or clinic. Those located in areas popular with expats are likely to have some English-speaking staff, but this is not a guarantee.

Across all major cities in Japan, you can find many excellent public and private hospitals. Tokyo, Kyoto, Nagoya and Aichi, among others, are all home to well-known and well-respected hospitals.

The services offered in Japanese hospitals are wide-ranging. Public hospitals offer the most comprehensive services, along with private international facilities. Clinics and private hospitals, on the other hand, are much more limited. The public hospitals offer many specialist treatments such as cardiology, oncology and orthopaedics, whereas private facilities offer more general care with limited specialisms available.

In Japan, not all medical facilities provide emergency care; however, you will find emergency medical centres within large private and public hospitals. In some smaller hospitals and clinics, emergency services are sometimes available, but only during working hours.

The admissions process in Japan varies depending on the facility required. Clinics, which are often the first point of care for many, will accept walk-ins and appointments. Upon assessment, they may refer you to a hospital, although this isn’t strictly required, as patients can choose any hospital that accepts NHI. Some facilities may require referral, and if a patient attends without one, a fee of up to ¥11,000 may be added to their hospital fees.

Costs of healthcare in Japanese hospitals are set by the Ministry of Health, Labour and Welfare through a fee schedule known as Shinryō hōshū tensūhyō. This means that prices in both public and private hospitals are the same, unless using an international facility that may be outside the national insurance system. The costs for a basic doctor’s appointment can cost ¥5,000 to ¥6,000, and a hospital stay can cost up to ¥50,000. With 70% covered by the national insurance scheme, the remaining 30% is covered by you or a private health insurance plan.

What should be noted is that room upgrades are not covered by insurance and need full payment from the patient.

Facilities are generally excellent in public facilities and international hospitals. Private hospitals tend to be small with a limited number of beds. For expats wanting similar facilities and comfort to what they may have experienced elsewhere, an international hospital may be preferable. With private rooms and added features such as a bath, shower, and sofa, they provide a higher level of comfort and are perhaps more in line with expectations. Most large public hospitals also provide rooms like this, but upgrading comes at a cost to the patient that cannot be covered by insurance.

Many hospitals in Japan accept private international health insurance, but this is not universal. In most cases, payments are made upfront with reimbursement claimed afterwards. A few hospitals and clinics offer direct billing, but this should be checked in advance.

Before travelling to Japan, expats are recommended to ensure all routine vaccinations, such as MMR and DTP, are up to date. Hepatitis B and Japanese Encephalitis vaccinations may also be advised, especially for those staying in rural areas.

Approximately 6-8 weeks before travel, you should consult your GP for the latest guidance and follow their advice on vaccinations and general healthcare in Japan.

Japan is a very healthy country, but some risks remain. Some areas of the country can get exceptionally hot during the summer months, leading to potential dehydration, heatstroke and sunburn. Seasonal influenza and cedar-pollen allergies are common, and, whilst rare, Dengue outbreaks are possible.

Expats should reduce their exposure to the sun and use protective measures to reduce the harmful effects of UV rays. Furthermore, insect repellent and long sleeves are recommended to help reduce the risk of mosquito bites.