KNOWLEDGE|
(1) |
Public Health Insurance.
Japan's public health insurance is based on the nationwide universal health insurance system (in Japanese “国民皆保険制度”), which requires that all citizens participate in and pay for public health insurance in order to reduce the burden on each other. By doing so, all Japanese citizens can enjoy a high level of medical services at a low price
Japan's public health insurance does not impose restrictions on its usage, therefore, patients in Japan can choose the appropriate medical institutions and doctors for treatment according to their needs. This system of free choice of medical institutions and doctors is called “free access” (in Japanese “フリーアクセス”) and is one of the most significant features of the Japanese public health insurance system.
Public health insurance is categorized into following categories (including but not limited to) based on the participants' works nature, age, and so on:
i. National Health Insurance (NHI) (in Japanese, “国民健康保険”), is a program mainly for self-employed individuals, retirees, non-regular workers, and the unemployed. ii. Health Insurance Administered by Japan Health Insurance Association, which is mainly enrolled by employees of small and medium-sized enterprises. iii. Health Insurance Administered by Societies, which is mainly enrolled by employees of large enterprises. iv. Mutual Aid Association, which is mainly enrolled by Civil servants, staff of certain independent administrative corporations, staff of the Japan Post Group, etc. v. Medical Care System for Elderly in the Latter Stage of Life, which is for elderly aged 75 or above. |
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(2) |
Private Health Insurance
Private health insurance in Japan exists as a subsidiary of public health insurance to cover the individual's contribution to medical or miscellaneous expenses such as inpatient beds, transportation, etc., as well as to compensate for the reduction in income due to sick leaves, etc.
Unlike public health insurance, which generally does not provide cash subsidies, most private health insurance policies provide “visiting fees” to participants based on their diagnosis, degree of injury, type of surgery, frequency of consultation, or number of days of hospitalization, etc. In addition, when certain conditions are met, the private health insurance premiums paid by the participants can be deducted from their taxable income for tax reduction purposes.
Japan's private health insurance industry was controlled by U.S. capital in the early years. In 2021, after negotiating with rh U.S., Japan's private insurance sector achieved to go into free-market in. As the private health insurance industry has been developed for a relatively short period of time, it has been experiencing problems, such as bad incentives from the insurers or defaults on payment of insurance premiums.
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(1) |
The participant pays the health insurance premiums to the health insurer on a regular basis. |
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The insured person visits an insured medical institution, such as a hospital or clinic, to receive medical treatment and pays to the medical institution the portion of the rate of the medical expenses he/she should bear. |
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The insured provider submits a claim for reimbursement of the cost of the visit to the medical fees review committee (i.e., National Health Insurance Medical Fees Review Committee) and provides a bill for the visit. |
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(4) |
The medical fees review committee will review the medical bill and provide it to the health insurer. |
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Health insurers pay billing amounts to the medical fees review committee. |
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The medical fees review committee reimburses the medical treatment and pays it to the insured provider. |
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Applicable groups |
Deductible Ratio |
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Below 6 years old (before enrolment of compulsory education) |
20% |
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Above 6 to below 70 years old |
30% |
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General income group aged 70 or above to below 75 |
20% |
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General income group aged 75 or above |
10% |
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Higher income group aged over 75 |
20% |
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Non-retired income group aged or above |
30% |
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Referenced from： |
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Disclaimer All information in this article is only for the purpose of information sharing, instead of professional suggestion. Kaizen will not assume any responsibility for loss or damage. |
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