Japan’s government has launched an inquiry into the public health insurance usage patterns of foreign nationals, as policymakers consider the financial implications of providing subsidised care to non-citizens.
The review, spearheaded by the Ministry of Health, Labor and Welfare, marks the first formal investigation of this kind.
According to a report from Kyodo News, the study will examine both the contributions made by foreign residents to the national health system and the extent of the benefits they receive.
Results are expected by mid-2025, and depending on the findings, the ministry may propose adjustments to the current framework.
In Japan, public health insurance coverage is mandatory for all residents. Foreign nationals who live in the country for more than three months and are not enrolled in employment-based plans must join the National Health Insurance (NHI) scheme, primarily used by the self-employed and those without formal employment.
The NHI includes provisions for reimbursing individuals whose medical expenses exceed a designated threshold within a single month. This cap varies based on income and age.
According to ministry data, as of the fiscal year ending in March 2024, roughly 970,000 foreign nationals were enrolled in the program, accounting for 4% of total NHI members.
From March 2023 to February 2024, total reimbursements under the program reached ¥980.3 billion, of which ¥11.8 billion – or 1.21% – was allocated to foreign beneficiaries.
A representative from the ministry noted that this proportion aligns with the percentage of foreign enrolment.
Still, some legislators have raised concerns about potential abuse of the system. Yuichiro Tamaki, leader of the Democratic Party for the People, stated via social media that individuals who stay in Japan for just 90 days could potentially access expensive medical treatments with minimal personal expense.
This debate occurs as healthcare affordability becomes a pressing issue across Asia. A 2024 Manulife survey spanning eight Asian markets, including Japan, found that escalating medical costs were the top financial worry among respondents – outranking general inflation.
The report found that physical health was the most important aspect of overall well-being, cited by 39% of participants. Financial well-being followed at 32%, with mental health trailing at 29%. Married individuals with children reported stronger financial footing than singles, who also showed lower engagement with investment and insurance products.
Health insurance coverage varied across types: 32% of respondents held inpatient or accident coverage, 26% had outpatient insurance, but only 18% were covered for critical illness. The survey identified heart disease, cancer, diabetes, and stroke as the primary health concerns.
Respondents perceived medical expenses to have increased by 23% year-over-year, particularly in prescription drugs, preventive services, and hospital care.
Although most participants owned some form of insurance, a significant portion – 76% – anticipated needing to supplement employer-provided pensions to maintain their standard of living in retirement. This sentiment was especially strong in Indonesia, Vietnam, and China.
