As you might expect, the Japanese have a very well developed healthcare system provided through generally clean and modern clinics and hospitals. Though medical costs are not free, there are social and national health insurance schemes to ensure that nobody need ever pay more than 30% of the cost of qualifying medical and dental procedures and treatments.
In this article, we’ll take a look at the kinds of medical services that are available in Japan and how to get seen by a doctor/dentist. But to begin with, let’s consider that all important health insurance.
Employee Health Insurance (Shakai Kenko Hoken) is mandatory for everyone working in Japan, and also covers any dependents the employee has. Premiums are based on one’s income (typically around the 10% mark) and are shouldered equally between employee and employer. The employee’s contributions are deducted automatically from monthly salary and also include pension and welfare components, not unlike similar schemes common in Europe.
Employers are not legally obliged to provide Employee Health Insurance to those who work less than 30 hours a week; for them, National Health Insurance (Kokumin Kenko Hoken) is available. This is administered by municipal offices and is designed for the self-employed, casual and seasonal workers, and students – foreigners who will be resident in Japan for longer than 3 months and who are not covered by Employee Health Insurance are obliged to register for National Health Insurance. Monthly contributions vary according to one’s domicile, income and number of dependents, etc.
Unlike a truly socialised welfare system, Japan’s public health insurance schemes cover only 70% of medical and dental costs (90% for those over 75). Treatments not covered include: psychotherapy, cosmetic surgery and implants, certain expensive or experimental treatments, gold and porcelain dental work, etc. Always check to see if the treatment you’re offered is covered by your public insurance or not.
Some Japanese take out additional private insurance to cover some, if not all, of the 30% they would otherwise be obliged to pay for treatments under public health insurance. Whether this makes long term financial sense is debatable, depending on how much use one is likely to make of medical services in the future, and that premiums will reflect one’s general and past state of health. In addition, there are private insurance plans specifically covering dentistry… for those who’d prefer a porcelain denture to a plastic one!
Whether foreign or international insurance schemes will reimburse medical expenses incurred in Japan will depend on individual providers. Furthermore, private clinics that cater specifically to foreign residents don’t usually accept public insurance, so to use such services for one’s healthcare will require one to either pay a higher cost for treatments, or pay the higher premiums for private insurance.
We’ll come back to paying for services further on; for now, let’s consider the kinds of medical services that are available.
There are no GPs in Japan per se; doctors tend to specialise in one particular area of medicine whether they work alone, in group practice, or at a hospital. Of the two clinics closest to my locale, for example, one is a single practice primarily for young children and nursing mothers, whilst the other specialises in treating the elderly. At a push, myself and my teenage daughter could go to either clinic for basic general treatments, such as those not catered to by high street drug stores.
The other major difference between these two examples is that the latter offers in-patient care, and employs several doctors, as well as nursing, pharmacy, radiology and other staff. However, it is not classed as a hospital because the number of in-patient beds is limited to fewer than 20.
It’s a good idea to find out what kinds of clinics there are close to your home or place of work as they should always be the first place one turns to for non-emergency treatments. If a clinic is unable to treat you in the long term, they may refer you to the relevant department of a hospital or other facility; though such referrals involve an additional charge, this will be considerably less than the hefty fist-time consultation fee charged by hospitals without a referral letter.
If having 20 or more in-patient beds defines a medical facility as a hospital, then there must be an awful lot of small hospitals in Japan. But for most of us, if we ever have need to go to hospital, it will more likely be a much larger facility with hundreds of beds in dozens of wards; a wide variety of medical and surgical specialisations; sophisticated out-patient services; and an accident and emergency department.
In this way, general and teaching hospitals in Japan are pretty much the same as general hospitals the world over, though a lack of guidance in languages other than Japanese can make them difficult for foreigners to navigate. Some hospitals do offer direction in English, Korean, Chinese or other languages, but there’s no obligation for them to do so.
The hospital that I attend once a month has absolutely no printed non-Japanese guidance, or any English-speaking reception staff, yet it is an established major teaching hospital in a Tokyo ward with a considerable foreign population. However, it’s easy to overlook this possible deficiency because I’ve become accustomed to the hospital’s procedures, and because my consultant, who can speak a little English, is a leading expert in his field. There’s a lot to be said for having confidence in one’s physicians!
Many Japanese doctors and dentists understand some English, and there are various resources to help foreigners find appropriate medical services in their own languages. However, receptionists seldom have any foreign language ability, so it’s often the general procedures for arranging consultations and making payments that prove most difficult for newcomers to Japan.
It goes without saying that foreigners who can speak even a little Japanese will have a much easier time of it when seeking medical services, and those who can read and write Japanese will be laughing. Yet even for complete newcomers, dealing with clinic and hospital reception staff is a lot easier than it used to be; just install the Google Translate app and offline Japanese dictionary on your mobile device, translate a list of your symptoms or other information to show to the receptionist, and you’re good to go.
Yes, the receptionist is always your first hurdle, whether you’re going to a clinic for the first time, taking a referral letter to a hospital, or presenting yourself at the relevant specialist department of the hospital. And in each scenario, you’re likely to be asked to fill out a new patient’s form of one sort or another which is typically in Japanese only. However, receptionists are usually very helpful, so between the information on your resident’s card and the list of symptoms you translated on your iPhone, she will be able to help you fill out the form. You will also be given a patient’s card at some stage of your first visit that you will use for all subsequent visits.
An appointment is not usually required for initial consultations at clinics, but you might have to wait a while before being seen depending on how busy they are. Dentists are the exception to this, and appointments are almost always required to be made in advance by telephone.
When you eventually get to see a doctor, even if he/she claims to understand English, make use of your handy universal translator and be prepared to labour any points the doctor has problems grasping. Otherwise, seeing a doctor in Japan is pretty much the same as it is anywhere.
Finally, you can retrace your steps back to the reception and find out where to pay, presenting any papers or prescriptions issued by the doctor, along with your patient’s card and public insurance card (hokenshou) to the cashier. Medical bills, less the portion covered by insurance, are always settled at the end of every visit in cash or by credit card (though not all clinics accept credit cards). Whenever you visit a clinic or hospital, there’ll be a consultation fee, whether you received treatment or not. This will cost more for your first visit, but is subsequently much cheaper.
So that’s all there is to it; it’s quite simple really, in spite of the odd embarrassment or half-baked conversation with a receptionist along the way, but you’ll soon get used to that kind of thing while you’re learning the language. Of course, I could’ve advised you to take a Japanese person along to help you, but isn’t it better to learn to do these things for yourself?
Drugs and Stuff
Some clinics and hospitals have their own pharmacies dispensing a limited variety of medicines, but most prescriptions will need to be taken to a separate pharmacy. If that’s the case, it’s important to get directions to the right one (usually adjacent the hospital/clinic) and not take your prescription anywhere else – that ¥100 shop opposite your apartment might say ‘Drug Store’ over the door, but it will not be able to fill your prescription!
And as you’ll be a first time customer… you’ve guessed it… there’ll be a first-time patient form to fill out and a membership card for your future visits. Now all you have to do is get well and thank heaven for Google Translate.
If you’re looking for medical services in English or specific advice, the following resources are very useful and accessible:
- Japan Helpline – a 24 hour assistance line for emergencies or health related questions in English: 0570-000-911
- Himawari is my go-to resource for finding English-speaking doctors in Tokyo: http://www.himawari.metro.tokyo.jp/qq/qq13enmnlt.asp
- AMDA International Medical Information Center helps people to find medical service providers in their native language in Japan: http://eng.amda-imic.com/?ml_lang=en
- AMDA multilingual telephone information – 9am to 5pm, Mon-Fri: 03-5285-8088
- Japan Healthcare Info helps to locate English-speaking medical services in Japan: http://japanhealthinfo.com/
By Bill Ambler
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