Japan's gold standard health insurance system at politicization risk

Japan's health insurance system... ensures medical care remains affordable for all residents

Um, no it doesn't. My insurance premiums are my highest expense after housing. When my wife worked in a restaurant, her co-workers would ask for overtime in order to pay off their health insurance bills. Japan residents pay for healthcare three times: through steep insurance premiums, out of pocket, and through income tax payments. The system is designed to look less expensive than it actually is.

Introduced in 1973, the high-cost medical expense benefit system, which has few parallels abroad, was designed to ensure economic equality in health care. Despite its obvious benefits, younger people, who contribute equally despite not requiring medical services as much as their older compatriots, are often skeptical of the framework.

I've often wondered about that. If healthy people don't require medical treatment so much, what happens to all the money that they pay for healthcare insurance?

Gold standard? affordable?

No, it's not.

let's not forget the fairly recent introduction of 'kaigo hoken'.... don't know about others, but as a pensioner, I pay roughy twice what the 'kenko hoken' costs annually. (unlikely I'll ever need 'care', as I'm 78 and genki as anything). the former is a good deal for me, the latter....????? Hmmmm.....

...younger people, who contribute equally despite not requiring medical services as much as their older compatriots, are often skeptical of the framework.

They will learn. I used to complain about healthcare taxes until I had children and they broke bones and stuff. Then my wife came down with cancer and was cared for at home until her death. All of this was affordable to me on a teacher's salary.

Always thought that the Healthcare system here was next level. One of the big positive factors about choosing to settle in Japan and especially after retirement. The demographic cliff is very real though. Someone has to pay. Have talked with numerous public servants though over the years and some actually quit out of disgust at the chronic amounts of systematic waste ( 税金まだ使い) by those working (for?) the system , so I’d like to see that cleaned up before they go for healthcare.

Japan desperately needs its own version of a DOGE, ( calm down folks, just breathe ) do politicians here ever dare to suggest such a thing though?

Save us AI, you’re our only hope. ;p

Ricky Kaminski13Today  06:57 am JST

Have talked with numerous public servants though over the years and some actually quit out of disgust at the chronic amounts of systematic waste ( 税金まだ使い) by those working (for?) the system , so I’d like to see that cleaned up before they go for healthcare.

That's not surprising. I often wonder if private clinics and hospitals aren't milking the system a bit too much by seeing people who really don't need all that treatment, e.g. anyone who thinks they have a cold.

Japan desperately needs its own version of a DOGE, ( calm down folks, just breathe )

Sure, if it works properly.

do politicians here ever dare to suggest such a thing though?

I don't think so, especially not if they're in the LDP. I'm sure it wouldn't go down at all well with their generous supporters in the Japan Medical Association.

I've often wondered about that. If healthy people don't require medical treatment so much, what happens to all the money that they pay for healthcare insurance?

Usually it goes into a communal govt pot to aid paying for people who do require medical care. Which is how Japan's health care is still affordable now.

Currently Japan faces a problem of fewer healthy young people (paying their taxes and stuff) than people using the medical system.

In a perfect system, society would have enough people paying into the system, yet not using it, to sustain the cost of use for those who need it.

Despite its obvious benefits, younger people, who contribute equally despite not requiring medical services as much as their older compatriots, are often skeptical of the framework.

Is this young Japanese people thinking( which I have never heard about), or the writer, Peter Masheter, assertion ?

The system, common in most European countries for example, is the best.

Better to pay a bit for nothing and support the system then having no money for cure when a sudden disease happens

The system is designed to look less expensive than it actually is.

yes. exactly.

Gold standard? affordable?

No, it's not.

I agree

That's not surprising. I often wonder if private clinics and hospitals aren't milking the system a bit too much by seeing people who really don't need all that treatment, e.g. anyone who thinks they have a cold.

Simon that’s a great point actually. The cold-fear factor here is off the scale. They definitely overdo it. Maybe something about living on a small island with so many people. Not for long though ay! The masks never coming off does my head in though! Hehe

Currently, 60 percent of the medical bills are paid by the health insurance premiums. The government pays the rest by issuing bonds, which will be refinanced by simply issuing new bonds.. So the system can never run out of money regardless of demographic changes.

The cold-fear factor here is off the scale. They definitely overdo it.

man, turn up 30 minutes before the clinic opens to ensure a short wait time, and the car park and waiting room are already full. Is it that the pharmaceutical companies stoked fear in order to move more units, or is it a cultural thing? The slightest sniffle, “you should go to the hospital” (!!!)

It should be paid for with our taxes, not 'subsidised'.

The mere fact that Chronic condition meds (insulin, inhalers etc.) and cancer drugs are CHARGED is an absolute disgrace.

Paying premiums may feel painful, but if you ever have a serious medical issue requiring surgeries and weeks of hospitalization you'll probably be impressed. At least compared with the US, where a health problem can bankrupt you.

No, it's not.

Well, compared to the American system....

The life expectancy is quite higher too.

let's not forget the fairly recent introduction of 'kaigo hoken'...

Recent? Let me guess, new to Japan. Kaigo hoken started in 2000.

 My insurance premiums are my highest expense after housing.

First off, your "premiums" are taxes and include not only health insurance, but pension and unemployment as well. Yes, together they take a chunk of change from your pay, but health insurance alone is relatively cheap.

With socialized medicine there are problems, but at least there is universal care here.

That's not surprising. I often wonder if private clinics and hospitals aren't milking the system a bit too much by seeing people who really don't need all that treatment, e.g. anyone who thinks they have a cold.

I do think some clinics do milk the system. I quit seeing my dentist of 10 years because I felt he was taking advantage of me. He used to be so good, but for some reason changed, and I began to feel uncomfortable in his care. Switched to a new one, and I've had nothing but good experiences and care. That said, I can just imagine how much everything would cost if I didn't have health insurance.

To keep the status quo,short-term, a good starting point would be would be for the government and corporations to stop spending money on white elephant projects like expos and pointless infrastructure. Then cut military spending and bring manufacturing home.

But long term, the only way is to get the population pyramid back looking like a pyramid again.

I've always felt that the health insurance premiums we pay every month should take into account whether the payee lives a healthy lifestyle or not. People who don't smoke, exercise often, aren't obese and don't drink alcohol should pay less. When you pay for car insurance, factors such as whether you drive carefully are considered, right? The human body is a vehicle just like a car.

YubaruToday  08:12 am JST

 "My insurance premiums are my highest expense after housing."

First off, your "premiums" are taxes and include not only health insurance, but pension and unemployment as well. 

That's only the case for full-time employees, isn't it? I know the government has been expanding the scope of the social insurance, but employers have to pay half of all that for anyone who works over a certain amount of hours so I think a lot of part-timers only get the National Health Insurance, and no pensions or unemployment insurance.

IMadeAnAccountJustForThisToday  07:24 am JST

"I've often wondered about that. If healthy people don't require medical treatment so much, what happens to all the money that they pay for healthcare insurance?"

Usually it goes into a communal govt pot to aid paying for people who do require medical care. Which is how Japan's health care is still affordable now.

Sounds nice but it doesn't exactly incentivise people to stay healthy, which is what employees are always being told to do so that they don't cause any "trouble" by getting sick.

Politics and healthcare should be kept as far away as possible from each other.

Politics and national defence? Sure. Tax? Fine. Diplomacy and international relations? Absolutely.

Outside of the USA, pretty much every developed country has worked this out. Everyone contributes, so that even if they personally don't need the service, it's there for those who do. And a workforce is more effective when it's in good condition. Simple logic.

I keep hearing that the government doesn't have the funds but I keep reading that they have no shortage of money for defence spending and silly Expos etc .

There is money but it's not prioritised for the good of the people !!

I agree, Some dude-san,

Healthcare is a basic requirement for any nation. There is no question about it. The vast majority of us are going to need it some time in our lives. Even if only at the end.

Before people complain about costs... it is based on a percentage of your income like national and local taxes so fair the better off contribute more. It is not a 'get what you pay for' system. In the UK debate about assisted dying pointed out that most of the healthcare costs are in the last 6 months of life, but you do not expect people to pay for that at the end of their life - it is paid for over decades based on earnings. It is a much better system that in the UK where GPs are gate keepers to most specialist consultants where referral is needed. In Japan you can just go an see a specialist rather than wait 1 or 2 years in a queue like in the UK. Almost no national health dentists now in the UK and costs in Japan are much much cheaper.

It's generally a good system in Japan and affordable costs - x-rays a few dollars, MRI scan 70$.

I know for a fact that many people are abusing the system so badly to the point that it make you sick.

People are running to doctor's for the slightest symptoms or events in their lives and the doctors just keeps on telling them to come back for more check ups and updates as if both sides are benefiting!!???

Many mentally ill citizens are abusing the system by not wanting to go to work or for getting financial support, it is sickening to watch how they manipulate the system and many so called doctors go along with it.

Japanese life expectancy was about 10 years shorter than Western countries before World War II. Healthcare is a major reason why Japan is now world-leading on this metric.

The pre-WWII number suggests there is nothing "traditional" about Japanese being healthier than others. This only happened when prosperity and healthcare were added to the mix. Most Japanese were poor pre-WWII.

People are running to doctor's for the slightest symptoms or events in their lives and the doctors just keeps on telling them to come back for more check ups and updates as if both sides are benefiting!!???

While this is getting downvoted, I think there's a kernel of truth to it, or part of it.

I have to see an ENT guy every now and then to get some gunk cleared out of my ears. Takes no time at all and (thanks to the system) costs next to nothing. But almost every time I go to the clinic, it's packed. Absolutely packed. It's a "take a number and wait" system, and it's not uncommon to be hanging around for an hour or more, for a process which usually takes about two to three minutes.

I sometimes think that "going to the clinic" is as much a social thing for some people as it is an actual medical thing.

Yeah, some good aspects of the NHI especially the affordable medications and operations. But we all pay a very high cost each month for it, the myth that it's 'cheap' is just that. It's especially hard for income earners where the tax paying threshold starts to around 3.5 million yen a year salary.

Left English teaching years ago but know people still doing it and the 30,000 yen or so they're paying per month for health insurance wouldn't be payable in most western countries on national health systems. Very expensive for the income level.

The UK, Australia, NZ are only 3 of the countries where public health systems are way cheaper and don't charge a monthly fee. And Japanese average incomes are lower in most areas yet people here pay much more for national health. Private health cover in countries like Australia is around the same price as the J national health. And pays for private beds etc.

It's also a myth that 'poor/low income people can't get healthcare in the US'. People who can't pay still get treated for medical operations, it's just that a lot of them never pay it back. Just ask health staff at hospitals in cities with a lot of gang activity and shootings. People who shoot up each other still get treated, operated on and take up bed space.

With the older demographic increasing, we can all expect to pay more to the NHI. It's still worth it but the price per month is steep relative to income.

I sometimes think that "going to the clinic" is as much a social thing for some people as it is an actual medical thing.

Is like the famous story where two patients are chatting at the waiting room of a clinic and discuss about a third one that has not been there in the last few days, so one of the patients comments to the other "maybe he is sick?"

Japan desperately needs its own version of a DOGE, ( calm down folks, just breathe ). Sure, if it works properly.

Agree completely.

That's only the case for full-time employees, isn't it? I know the government has been expanding the scope of the social insurance, but employers have to pay half of all that for anyone who works over a certain amount of hours so I think a lot of part-timers only get the National Health Insurance, and no pensions or unemployment insurance.

Everyone who lives here is required to carry health insurance AND they are also supposed to be paying into the pension system as well, which is also a tax. Kokumin Nenkin (pension) and Kokumin Kenko Hoken (health insurance) Unemployment insurance is a different thing.

People dont automatically "get" NIH, they must apply for it, and nearly all elderly fall under it as well, particularly after they quit working.

Having seen the doctor several times in my life here, I notice drugs are quickly, frequently prescribed and follow up visits have never been a thing.

For some reason tests to identify the cause of the problem seem to to be sparse.

A quick check and it’s usually out the door…

Bit of an advertorial piece methinks. But that aside, welcome to the NHS of thirty years ago

Having seen the doctor several times in my life here, I notice drugs are quickly, frequently prescribed and follow up visits have never been a thing.

I can tell you from experience of working in Japanese hospitals for nearly a decade, your experience described here, is extremely rare and without a doubt an exception to the rule.

Japanese doctors and hospitals push for repeated visits. Doctors typically will prescribe the "weakest" medication available to treat a problem, and will have the patient return numerous times before declaring them "cured". I could share countless examples of "illnesses" that literally could be treated in one stop, but the doctors dont give the right medicine that would fix what ails the patient.

This happens because of fixed pricing, and doctors make money on repeat patients.

Ricky Kaminski13 ... systematic waste ( 税金まだ使い)

That should be むだ使い mudad(z)ukai

“Facing politicization” is a fancy way of saying “facing economic reality,” which in turn is a fancy way of saying “is going broke.”

Systems that funnel a high percentage of resources to the elderly inevitably fail over time. The elderly need care, but when elder care depresses savings and economic opportunities for young families, society has sacrificed its future.

Blacksamurai...in Australia, come Tax time, a Medicare Levy is added onto your tax burden , around 2% of your taxable income , and Govt. sometimes ups the amount when circumstances, unrelated to health mostly, like say, floods or fires, demand an extra kick into Government coffers for a year or so.

Never been really sick in Australia and cant remember the last time a GP took my blood pressure.

The other extreme here in Japan, little bit of overservicing and have to renew scripts more frequently, but overall level of care higher than Australia from my perspective.

Politics and healthcare should be kept as far away as possible from each other.

This is to claim essentially that government should have no role in providing, paying for, or regulating health care. Whenever the government taxes, decides how to spend those taxes, or makes rules about what people can and cannot do, these are fundamentally political actions.

With health care, as with all things, resources are finite. Society must decide how to apply those resources. Politics is the process for making these decisions.

The government pays the rest by issuing bonds, which will be refinanced by simply issuing new bonds.. So the system can never run out of money regardless of demographic changes.

Do you not grasp how bonds work? Someone uses their own money to buy those bonds at an agreed interest rate. “Can never run out of money” is economic ignorance. When no one is willing or able to purchase the bonds anymore, the bond issuer very quickly runs out of money.

And this is exactly the scenario that Japan faces. The “demographic cliff” is not merely the problem that there are more elderly people and not enough young people. It’s also that today’s youth earn and save less. Japan’s government has borrowed shamelessly from people’s postal savings accounts, but this pool of savings shrinks every year in Japan. The government will not be able to keep issuing bonds that Japan Post will just buy. The money available to buy bonds will run out.

Japan's health insurance system, praised globally

You have to be an American to write such BS. Nobody coming from most of the European countries is impressed by Japanese hearth insurance system.

BlacksamuraiToday  10:23 am JST

Left English teaching years ago but know people still doing it and the 30,000 yen or so they're paying per month for health insurance wouldn't be payable in most western countries on national health systems. Very expensive for the income level. 

The UK, Australia, NZ are only 3 of the countries where public health systems are way cheaper and don't charge a monthly fee. And Japanese average incomes are lower in most areas yet people here pay much more for national health. Private health cover in countries like Australia is around the same price as the J national health. And pays for private beds etc.

You’re right up to a certain point. Compare getting a NHS dentist to Japans system. The. When you can’t get an NHS dentist compared the out of pocket costs. Take into account, it is not based on earnings, so if you can’t pay, you’re basically out of luck.

no compare the ability to get any GP you want in Japan. Compared to the UK? You are told where to go based on your address. If you are on a waiting list you’ll be triaged, and placed on the list appropriately but many can’t wait and are forced to pay for their operations in the UK. At the full 100% plus profits. Take into account that the very same surgeon who did you private op is the very same doctor doing the NHS list.(however due to creation of the NHS and to get doctors on board, they were allowed to maintain private work) . compare that to the costs in Japan for a hip operation, yes you’ll pay something based on your earnings, where as the UK you’ll get the op based on your ability to PAY. A big n difference.

All the tax is put into a. Single pot, sales tax 20% in the UK. We all pay national insurance. The bottoms line is, you get what you pay for, and the UK public think they can have European or Japanese levels of care, but at low income tax rates. The uk wants everything free at the point of delivery but don’t want to pay more tax, or pay for it out of their pockets. Motorways are just one example, NHS dentists are another.

There is one good thing from a patients perspective here. Doctors have a financial incentive to do more tests offer more treatment. Compared to the UK it is incentivized to Reduce treatment or slow it down, cause the doc /GP has one eye on a budget.So I wonder if(only an if) that’s one reason Japan has a good survival rate for cancer. Compared to the UK. A two week delay to see a GP, for the GP, to rule a diagnosis IN. Compared to Japan that wants to RULE A DIAGNOSIS OUT. Eg you got stress, , see you in a month or two, nope! Ok it’s probably hemorrhoids. Nope! Well you don’t fit the profile for bowel cancer. Maybe you’re constipated and straining. See you in another few months. Oh. Yeah. You do need to see someone, I’ll send a letter, (and people complain about Japan using faxes) so you get a letter, to see the consultant in 3 months. And time is still ticking. Go to Japanese GP, yeah booked your apppointment online. Go next week. Or here is a written letter, take it physically to the hospital and your in the system. Ofcourse as a patient we have to pay at the front desk for that here. In the UK… your just waiting for letters.

This article sounds like a complete propaganda piece.

The Japanese healthcare system is great if:

You have a common illness that is easily diagnosed

You like to go to the clinic all the time

You have an illness that requires some very expensive drug

On the other side, the Japanese healthcare system sucks if:

You have cancer. If you have cancer, specially any form of rare cancer, you can just asume you are dead.

You have some non common disease that requires a complex diagnosis. I mean, you get at most 2 minutes with the doctor, who usually will just say "you are fine" without even looking at the results.

You want a second opinion. Most of the results of a test are not even properly disclosed to the patient, and asking a disclosure of the medical history a hospital or clinic has, is a extremely bureaucratic process that can take weeks or months.

A loved one was hospitalized and you want to know why. I had this situation with my partner's father, who was sent to the hospital after he was found collapsed in the bathroom. After an initial test, he was found to be fine, but for some reason he was still hospitalized, and no one knew what was his problem, and when asking the hospital, apparently no one knew either, and they wanted us to wait for 3 days until the doctor in charge of his case, who was on vacation, came back.

You want to visit your dying family member. Even in 2025 most hospitals still have covid-time restrictions on visitations, which means that most people cannot visit family members, even if dying, for more than a couple of minutes, and only one at a time.

If you have a mental illness. The reality of the mental health in Japan is jarring. It seems that mental health doctors in Japan believe in the "just give them more medication" approach to mental health. I have a friend who has a Major depressive disorder and for over half a year he has been experiencing horrible depresive episodes. This guy has a history of suicide attempts, including one in which he almost succeeded, and has been telling the doctor that the medicine he is receiving are doing absolutely nothing, only to get ignored time after time. It wasn't until recently in which his doctor admitted defeat saying that his case "was beyond his abilities" and sent him a recommendation to go to a big hospital for treatment, possibly to receive electroshock therapy, but "there are not opening available", and has been waiting for months now to get an appointment, while struggling with suicidal thoughts.

I've had quite a lot of medical treatment and dental work in Japan and am very satisfied with the service. Certainly, you have to pick and choose your doctors, but I'm glad to be able to do that. You sometimes have to wait for a while, but that's inevitable with the "take a card and wait your turn system."

My wife is a nurse with experience in both a Japanese hospital and as a home nurse. At the hospitals, working conditions are not great, long hours, very few paid holidays, night shift (12 hour shifts), staff shortages, and other stress related issues. As a home nurse, she would see around 5 patients per day on average including on-call work on weekends. She doesn't receive commuting pay, only the company pays fuel costs. Sometimes she has to drive 1-2 hours to see a patient. Its tough work and the pay is dirt cheap compared to what the nurses get in Canada. Seriously thinking about moving.

I've always felt that the health insurance premiums we pay every month should take into account whether the payee lives a healthy lifestyle or not. People who don't smoke, exercise often, aren't obese and don't drink alcohol should pay less.

I've heard an opposing argument. People who smoke and drink alcohol pay extra taxes and die younger, putting less strain on the health system. And I guess fat people buy more food and therefore pay more tax. As one comedian said, "These people are the heroes in this mess."

Lifestyle choice illnesses should NOT be subsidized by the general population.

Obese people with an obesity related illness should be charged extra.

Smokers with a smoking related illness should be charged extra.

 Certainly, you have to pick and choose your doctors, but I'm glad to be able to do that. You sometimes have to wait for a while, but that's inevitable with the "take a card and wait your turn system."

You only get to "pick and choose" when you are going to the smaller clinics, which are used to keep minor cases from over crowding the larger "sogo" hospitals. Which you can typically NOT get seen without an introduction from the smaller "local" clinic which you get to pick and choose.

The specialists work in the larger sogo hospitals and you dont get to "pick" them as odds (close to 100%) the average patient has no idea who that particular doctor is.

diagonalslipToday  06:46 am JST

let's not forget the fairly recent introduction of 'kaigo hoken'.... don't know about others, but as a pensioner, I pay roughy twice what the 'kenko hoken' costs annually.

Yeah, the same thing happened to me. I was paying about 25,000 yen a month but once I entered the 40-60 age range, they added "kaigo hoken" so my payment doubled to 50,000 yen. Then over the past few years my payments have crept up to 59,000 yen a month. It's a very big chunk of my monthly salary. I really don't want to see this go up any more than it already has.

Japan's health insurance system, praised globally

You have to be an American to write such BS. Nobody coming from most of the European countries is impressed by Japanese health insurance system.

Haha! Exactly what I thought. Comparatively high health insurance premiums here, and you still get saddled with 30 percent of the bill.

Spoken to a Brit recently? Post-Brexit? Don't think so. Here's something to tamp in your pipe to smoke:

Foreign friend, Japanese spouse, tween-aged daughter required spinal fusion surgery. Japanese university hospital performed the operation, daughter spent 3 weeks total in hospital, out of pocket was 50,000 yen, out of a total of 5.2 million.

It's also a myth that 'poor/low income people can't get healthcare in the US'. People who can't pay still get treated for medical operations, it's just that a lot of them never pay it back.

Referring to emergency treatment, mate. It is true that the poor cannot afford healthcare in the US, even with Obamacare (how you hate that term). Obviously not paying attention to (or not caring about) the tens of millions, including children, who require prescription drugs that AMA does not cover.

Despite its obvious benefits, younger people, who contribute equally despite not requiring medical services as much as their older compatriots,

Actually, Peter, no. Younger (age range, please) people do not contribute equally ( contributions assessed progressively). Do you're homework.

Better to pay a bit for nothing and support the system then having no money for cure when a sudden disease happens

Indeed. Pretty simple.

The specialists work in the larger sogo hospitals and you dont get to "pick" them as odds (close to 100%) the average patient has no idea who that particular doctor

My son's a brain surgeon here, born in Japan, raised in public schools and university, currently working at a general hospital in Hokuriku. Specialists are of many stripes: not a few prefer to remain at university to conduct research but treat patients as part of their calling. , Those who are not interested, and want to earn more money, can pursue the private route.

If quality healthcare is the order of the day, then be prepared to pay for it.

I have had number operations on both hips, knees, due to my carelessness riding motorbike a decade or so back.

The care I received here in Japan has provided me with a quality of life.

I was unable to receive such a healthcare in the UK, not in the timely manner I wanted  

However, I had to pay for it, for the hospitalisation, and the aftercare.

I think the question is should this form/quality of healthcare be universal at the point of demand to all, and how/who should pay.

Personally, I would gladly contribute/ pay tax for others less fortunate to receive the same quality treatment

Mr KiplingToday  06:27 pm JST

Lifestyle choice illnesses should NOT be subsidized by the general population.

Obese people with an obesity related illness should be charged extra.

Smokers with a smoking related illness should be charged extra.

Well, yes, up to a certain point, because you could ask people who drink alcohol to pay extra, people who eat chocolate and get diabetes, how about people who like to sunbathe, or suntan, shall we charge them more if they get skin cancer? How about people who drive? Should they pay more just because they drive and have an accident? Should motorists pay more, because they increase asthma attacks? Which conditions would you include or exclude?

Some people do have a true medical condition that makes a person appear obese.

But conversely, would you hold an anorexic to the same extra costs as, say, a person who is bulimic?

And why should the consumer be held accountable, and not the factories churning out addictive food, and denying it causes any harm? Not to mention the government receives all the extra tax revenue.( I refer to tobacco, and now the food industry. I refer you to ultra-processed people. The research is coming out. That the governments were happy to allow companies to push sugar, fat, and cheaper high-calorie food, for profits, shareholders, and dump the consequences on the health services. Now the government have cottoned on. There really is no free lunch. There will always be consequences down the road. In our case 40 years down the road. Cheap food means factory food. This wasn't a problem in the 60s '70s. It's only since cheap, factory food was produced, and mothers were forced to go out to work full time. And so many parents don't have time to cook healthy meals, so buy a cheap pie, sausage roll from the supermarket and slam it in the oven. Maybe that's why Japan doesn't have that massive obesity problem like the UK, USA,

On top of that, try taking 100 mg of prednisolone, and see how much weight you balloon up to. Some medications also have massive side effects, increasing patients' weights, stimulating their appetite, and sometimes we want that side effect. We can't just lay this at the patient's doorstep. It's a whole industrial problem. Advertising, buy 2 get 1 free, it's the additives, flavours, the emulsifiers, the sugars, the fats, the packaging, the placements. I know we want an easy answer, but that's what the industry wants us to believe. It's the same playbook the tobacco companies used for decades.

I have had number operations on both hips, knees, due to my carelessness riding motorbike a decade or so back.

The care I received here in Japan has provided me with a quality of life.

I was unable to receive such a healthcare in the UK, not in the timely manner I wanted  

I had a salivary stone in my salivary track that made it so that every time I eat it would hurt, and I couldn't enjoy at all any food.

For about 6 months I went to different doctors, hospitals, multiple letters of invitation to big hospitals, and spend a good amount of money, time and effort trying to get this solved, and I wasn't able to even get a proper diagnosis.

Basically at the end of the day, every doctor would tell me that it was all in my head, and that it was a psychosomatic illness, and I was even given anti depression medication.

Then, when I went to Mexico to see family and friends, I went to the first specialist I found, and this doctor not only properly listened to what I said, and believed me, but that same day, he was able to diagnose it, and take out the stone, as it was small enough to do it with a small incision.

In other words, supposedly horrible healthcare system Mexico was able to fix a health problem I had in a couple of hours, which supposedly great healthcare system Japan wasn't able to even properly diagnose after half a year.

Maybe the problem isn't that the Japanese system is great, but that the UK system is even worse.

Though Japan's LDP government had explained as if consumer tax is all used for social security, what had been used for social security is just small portion of it. Actually they are exploited consumer tax as subsidy for the large corporations, not for social security.

Besides, immense taxes are snatched by intermediate exploitation before reaching to people, necessarily shortage.

There are obscure forces behind these actions, like the breakup of Japan Post Inc.

YubaruMay 12  10:33 am JST

Everyone who lives here is required to carry health insurance AND they are also supposed to be paying into the pension system as well, which is also a tax. Kokumin Nenkin (pension) and Kokumin Kenko Hoken (health insurance) Unemployment insurance is a different thing.

I'd forgotten about the pensions, but I understand it's not exactly the same system for part-time employees and that their employers don't contribute anything towards it.

People dont automatically "get" NIH, they must apply for it, and nearly all elderly fall under it as well, particularly after they quit working.

Perhaps "entitled to receive" would have been more accurate.

Abe...

Well, yes, up to a certain point, because you could ask people who drink alcohol to pay extra, people who eat chocolate and get diabetes, how about people who like to sunbathe, or suntan, shall we charge them more if they get skin cancer? How about people who drive? Should they pay more just because they drive and have an accident? Should motorists pay more, because they increase asthma attacks? Which conditions would you include or exclude?

Alcoholics? Sure, its a lifestyle choice. There is no link between eating chocolate and diabetes. The Japanese health system does not cover road accidents. But I get your point, there is a point that individuals should be responsible for their own health. Those who don't should not be sponsored by those who do.

But conversely, would you hold an anorexic to the same extra costs as, say, a person who is bulimic?

Yes, another 1st world lifestyle illness of choice.

A lot of good perspectives here and I voted up a no. of them including Abe's and Guru Mick's. The Japanese NHI manages to get it right most of the time even with the shortcomings. Somebody made a good point that we can see a specialist without the ring fencing of having to go thru a GP first to get a recommendation. The dental is superior, Japan does us a favor by including it in the public system because that's not the case in a lot of other countries.

By an interesting coincidence had a message from a friend living in Australia, they had a dentist scale down a tooth where the filling had come out and the tooth looks like it will too. Dental isn't included in the public health system there and they paid what would be around 10,000 yen for that. Expensive but they don't have dental in their private health converage, probably wanted to avoid paying more for the cover.

No complaints from him there, the dentist was cool and they told him that the tooth needed to be removed and he'd need a replacement which was true. But they had to recommend a dental specialist, this dentist couldn't do it herself. She wrote the exact code for the procedure and other details for him to give the dental specialist and a copy for himself. This dentist said looking at the state of his remainng tooth it would be a simple procedure for the specialist to take the tooth out. The replacement tooth of course would take another appointment.

Seemed reasonable but when he called the specialist and told them the procedure info, he was told that the first appointment would 'only be a consultation'. The specialist would NOT be doing any work on it despite knowing exactly what it was. He asked if they could make enough time on his appointment day to take the tooth out but that was just dismissed.

They sent my friend the usual forms to fill out but it was the equivalent of some Big Bro paperwork with questions requiring him to list all his family members - he' s single but they wanted all iinfo about his siblings and parents, what health conditions they had etc.

He was prepared to state if he had any allergies, blood conditions etc that might make a dental procedure complicated but not all of this horse$ He phoned and said he was busy, couldn't come and decided to get his dental work done as a tourist when he visits Sth Korea later this year. I appreciate the Japanese system more when I hear true stories like that.

Then over the past few years my payments have crept up to 59,000 yen a month

Considering that health insurance premiums in Japan, for shakai hoken are roughly 5% of the persons salary, costs split between the employer and employee, meaning your cost would be roughly 2.5%, your income is far beyond the average here.

Even if you are including pension, health insurance, and unemployment insurance, in the total, your income per month, is close to, or more than likely, over 1,000,000 per month.

The Japanese health system does not cover road accidents.

I really wonder where people get MIS-information like this here. Yes road accidents are covered by health insurance.