The Japanese government has initiated its first formal investigation into how foreign nationals utilize the country’s public health insurance system, amid growing debate over the financial sustainability of subsidized healthcare for non-citizens.
The Ministry of Health, Labor and Welfare is spearheading the review, which aims to assess both the contributions made by foreign residents to Japan’s National Health Insurance (NHI) program and the healthcare benefits they receive. The findings are expected by mid-2025 and could lead to reforms in the current insurance framework.
In Japan, public health insurance is mandatory for all residents. Foreign nationals who stay in the country for more than three months and are not covered by employer-sponsored insurance are required to enroll in the NHI scheme. This system primarily serves the self-employed and those not formally employed. It includes reimbursement provisions for individuals whose monthly medical expenses exceed an income- and age-based threshold.
According to health ministry data, approximately 970,000 foreign nationals were enrolled in the NHI program as of the fiscal year ending March 2024, representing about 4% of the total membership. Between March 2023 and February 2024, total reimbursements under the program reached ¥980.3 billion, with ¥11.8 billion—roughly 1.21%—allocated to foreign enrollees. Ministry officials stated that this share is in line with foreign representation in the program.
However, concerns have been raised over the potential misuse of the system. Yuichiro Tamaki, leader of the Democratic Party for the People, argued on social media that short-term visitors could exploit the insurance scheme by accessing high-cost medical treatments at a minimal out-of-pocket cost.
The review comes at a time when healthcare affordability is emerging as a critical concern across Asia. A 2024 Manulife survey of eight Asian markets, including Japan, found that rising medical expenses ranked as the top financial concern among respondents—surpassing even general inflation.
According to the survey, 39% of participants identified physical health as the most important aspect of overall well-being, followed by financial health (32%) and mental health (29%). Married individuals with children reported greater financial stability than their single counterparts, who were also less likely to invest in insurance or savings products.
The study also revealed gaps in insurance coverage: 32% of respondents held inpatient or accident insurance, 26% had outpatient coverage, and only 18% were insured for critical illnesses. Key health concerns included heart disease, cancer, diabetes, and stroke. On average, respondents perceived a 23% year-on-year increase in medical expenses, particularly in areas such as prescription drugs, preventive care, and hospital treatment.
Despite widespread insurance ownership, 76% of respondents expressed concern that employer-provided pensions alone would be insufficient for retirement. This sentiment was especially prevalent in Indonesia, Vietnam, and China.
As Japan grapples with a rapidly aging population and growing healthcare costs, the outcome of the health ministry’s review may play a pivotal role in shaping future policy around foreign residents and access to public health benefits.
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