The Japanese government has started a nationwide review to understand how foreign residents are using the country’s public health insurance system. This is the first time such an investigation has been carried out.
The Ministry of Health, Labor and Welfare is leading the study, which will look into how much foreign residents contribute to the National Health Insurance (NHI), and how much they benefit from it in return. Results of the study are expected by mid-2025. Depending on the findings, there could be changes to how the system works.
What is the National Health Insurance (NHI)?
In Japan, all residents—including foreigners—are required to have health insurance. Those who are not enrolled in company health plans (like self-employed workers or freelancers) must join the National Health Insurance program.
If a person has high medical costs in a single month, the NHI system can cover a large portion of the bill, based on the person’s income and age.
How Many Foreigners Use the NHI?
As of March 2024, about 970,000 foreign nationals were enrolled in the NHI system—around 4% of total members. Between March 2023 and February 2024, total insurance reimbursements under the program were about ¥980.3 billion. Of that, ¥11.8 billion (or 1.21%) went to foreigners.
Government officials said this percentage is in line with the number of foreigners using the system. However, some politicians have raised concerns. They worry that people could take advantage of the system by coming to Japan for a short time and receiving expensive treatments at a low personal cost.
Rising Healthcare Costs Across Asia
This discussion is happening at a time when many people in Asia are concerned about rising medical expenses. A 2024 survey by Manulife across several Asian countries (including Japan) showed that medical costs are the top financial worry for many people.
The survey found that:
- 39% of people said physical health is their top priority
- 32% said financial stability was next
- 29% ranked mental health as important
Insurance coverage also varied:
- 32% had inpatient or accident coverage
- 26% had outpatient coverage
- Only 18% had critical illness insurance
The biggest health concerns were heart disease, cancer, diabetes, and stroke. Many respondents noticed that healthcare costs—especially for medication and hospital care—have gone up by about 23% in just one year.
Even though most people had some kind of insurance, around 76% said they expect to need more savings or support beyond what they get from their employer’s pension.
