Japan's Healthcare System - A Personal Guide for Expats

You need to understand Japan's healthcare system, whether you are working full-time, looking for a new job in Japan via our job-board, are self-employed, a student, or just staying temporarily. And here’s why.

A few weeks ago, I faced an unexpected challenge as I had to accompany my non-Japanese girlfriend to a clinic due to sudden illness. Neither of us knew which clinic to choose, nor how our respective health insurances worked in Tokyo. As a public health insurance holder myself, and my girlfriend being covered by her Japanese employer's insurance, this was our first ever encounter with the Japanese healthcare system. 

So, with this comprehensive guide I want to break down Japan’s healthcare system, explain how to enroll in health insurance, and offer tips on accessing medical services as an expat. You can be working full-time in Japan, self-employed, or just visiting. I did the research, and hope to give you the knowledge you need to handle your healthcare needs with confidence and ease.

Japan boasts one of the most robust healthcare systems in the world (Japan Times). It provides excellent medical care with a strong emphasis on preventative health. Japan’s Ministry of Health and Welfare (MHW) has recently even launched a campaign aiming to create a value-driven, personalized, and globally engaged healthcare system (MHW).

However, navigating this system as a foreigner can be confusing, especially if you’re unfamiliar with the language and procedures. For many expats, healthcare will make or break the deal.

The basics – General overview

In Japan, all residents, including non-citizens who live in the country for more than three months, are legally required to have health insurance (JHPN). This system lets everyone have access to healthcare services, with the Japanese government subsidizing 70% of healthcare costs for individuals under the age of 70. For retired and older people, the subsidy can go up to 80%.

Generally, residents are expected to cover 30% of medical expenses out of pocket, allowing for continued access to a wide range of treatments and medications. This makes healthcare both affordable and high quality for all. Also, there are over 8,000 hospitals and nearly 200,000 clinics, spread across both urban and rural areas. So, no matter where you are, you'll be fine.  

Shakai Hoken and Kokumin Kenko Hoken

When it comes to public health insurance, there are two main options in Japan (SAMMU):

Employee Health Insurance (Shakai Hoken)

Shakai Hoken is designed for full-time employees working at Japanese companies. It covers both medical care and pensions, with costs split between the employee and employer. Each contributes around 5% of the employee’s salary toward the insurance premium.

One major advantage of Shakai Hoken is that it covers not only the individual but also their dependents—including spouses and children. This provides extensive protection, especially for international families living in Japan.

A key feature of Shakai Hoken is its emphasis on preventative care, regular check-ups, hospital stays, and surgeries. The Japanese government actively promotes preventive measures, helping to catch illnesses early and reduce the need for more expensive treatments later.

National Health Insurance (Kokumin Kenko Hoken)

Kokumin Kenko Hoken is for those not covered by Shakai Hoken, such as freelancers, part-time workers, students, and the unemployed. Similar to Shakai Hoken, the government subsidizes 70% of medical costs, and participants pay the remaining 30%.

Premiums for Kokumin Kenko Hoken are based on annual income and are recalculated each year. This can be both a benefit and a challenge. For example, in my first year, premiums were often lower due to limited earnings history, but they rose significantly in my second year as my income also rose as a freelancer.

The good part is, residents can reduce their insurance premiums for the following year by submitting the form to their respective ward office between January and March each year (Minato City) Just simply go to the ward office, fill out the ‘reduction form’ (Keigen Shinsei; 軽減申請) and you’re good to go.

How to enroll?

If you are not covered by Shakai Hoken, you'll need to sign up for Kokumin Kenko Hoken at your local city hall. It requires a bit more legwork, but it's still totally manageable! 😉 Make sure you bring your essential documents, such as your residence card and MyNumber card, and head to your ward office.

By the way, if your employment status changes—like if you leave a job that previously provided Shakai Hoken—you’ll need to switch to Kokumin Kenko Hoken within 14 days. This ensures there's no gap in your health coverage, which is essential when living in Japan.

Once at the ward office, there will be someone guiding you to the relevant counter, depending on what you need. Don’t worry, everything is structured in Japan. You’ll be fine.

Bring the following documents:

• Residence card (Zairyu card)

• Passport

• Proof of income from the previous year (if applicable)

• MyNumber card (if applicable) – I did not have mine back then

• You’ll be asked to fill out an application form that includes your personal information, address, and income details.

After processing your application, you’ll receive your health insurance card (hokensho) on the spot. Be sure to keep this card handy, as you’ll need to present it at clinics, hospitals, and pharmacies whenever you seek medical care. Think of your healthcare card like an emergency survival kit for Japan.

This process may take a bit of time, but it’s pretty straightforward.

Good to know: Before heading back to your home country and leaving Japan, make sure to stop by your local ward office to officially cancel your health insurance. If you’ve overpaid your premiums, you could get a refund. You can do this about a month before you leave. Don’t forget to bring proof of your departure (like a copy of your airline ticket or e-ticket).

If you skip this step, you’ll keep getting billed for insurance premiums, even after you’ve left Japan. So, be sure to take care of this at the same time you submit your moving-out notice.

What now? – Clinics and hospitals

Now that we’ve got our health insurance settled, how do we figure out where to go when we need care? Japan has a lot of options, but it’s important to know the differences.

Clinics and international clinics

First, let’s talk about clinics (kurinikku, クリニック). These are small, local spots where you can get basic check-ups or handle minor health issues. Many clinics focus on specific things, like dermatology or pediatrics. If you’re feeling under the weather but it’s nothing too serious, a clinic is usually the first stop.

Now, if you’re like me and not fluent in medical Japanese, international clinics might be your best bet. These clinics cater to foreigners, especially in places like Tokyo, Osaka, and Kyoto. They usually have English-speaking staff, which is a lifesaver (no pun intended) when you’re trying to explain how you feel. Tokyo Metropolitan Government offers some guidance, too.

General and Specialized Hospitals

Next up, we have general hospitals. These are much bigger and handle more serious stuff—surgeries, emergency care, and more complex treatments. If you’ve got something more than a cold, this is where you’ll likely end up.

Hospitals here can be super busy, but the quality of care makes up for it. You get access to a ton of different departments under one roof, from cardiology to oncology. Luckily, I never had to be hospitalized myself, I only went for a visit and talked with a friend who just had a surgery.

And then there are specialized hospitals. These are the places you go if you need something more specific, like cancer treatment or heart surgery. If you’ve got a chronic condition or need long-term treatment, you might get referred here. They’re serious about what they do, but you’ll probably need a referral from a clinic or general hospital first.

How to find an English-speaking doctor in Tokyo?

In our case, because we decided on a clinic to get a first health check to see what’s wrong, we wanted to look for an English-speaking clinic. Minato-area has some of the best English-speaking clinics and hospitals.

In fact, we first walked into a clinic with English speaking staff and they only accepted foreign health insurance, not Japanese ones. They were specializing in treating tourists and short-term visitors. So, that might be something you’d want to look out for if you’re in Tokyo on a short-term visa, or don’t have health insurance yet.

Thankfully, the internet makes this process much easier. In fact, I’m convinced that Google Maps is the best tool for finding English speaking clinics and hospitals. By typing in ‘kurinikku’ in Katakana, Google shows nearby locations and, even better, the reviews often include whether the clinic can communicate in English.

For example, my girlfriend lives between Azabu-Juban and Hiroo, so we simply entered the term on Google Maps and quickly found English speaking clinics and hospitals in the area. Another helpful tip is to check your local embassy’s website—many embassies provide lists of recommended doctors and healthcare facilities, including those that offer services in English, such as Japan Healthcare Info (JHI).

Appointments, walk-ins, and what to expect

Okay, so booking medical appointments (at least in Tokyo) can vary depending on where you go.

Clinics

At most clinics, you can usually just walk in, especially for general consultations. But honestly, it’s always a good idea to call ahead or book an appointment via call. It’s the easiest way.

Similar to other countries, even if you have an appointment, you’ll most likely still have to wait in the waiting room. But less than if you were to go without an appointment.

If the clinic is specialized in something specific, like dermatology or internal medicine, you might definitely need to set up an appointment.

Hospitals

For hospital visits, especially when you’re seeing a specialist, booking an appointment is a must. Also, here’s something I didn’t know at first—many hospitals work on a referral system. This means if you don’t have a referral from a general doctor, you might end up paying extra fees for your first visit.

What to bring?

Always, always, always bring your health insurance card (hokensho) and some form of ID (like your residence card) when you visit a clinic or hospital! If you're heading to an international clinic, I’d also suggest bringing your passport.

While many places do accept credit cards, it’s still a good idea to carry some cash just in case.

You will have a really hard time and expensive visit without a health insurance card if you live in Tokyo.

After the doctor sees you (and yes, we really did walk out with candy once), you’ll head back to the front desk. There, you’ll hand in your health insurance card and ID. If you need any medicine, they’ll give it to you right away.

You’ll also get a paper slip with a quick summary of your visit, plus a receipt (called a ryoushuusho). And that’s it—you’re good to go! It’s simple and easy.

Good to know: Emergency services

In the event of a medical emergency, dial 119 for an ambulance. The emergency operators may speak some English, especially in major cities like Tokyo, Osaka or Fukuoka. Ambulance services in Japan are free of charge, but you will still be responsible for the medical treatment costs once you arrive at the hospital.

Tokyo’s Fire Department has some important-to-know vocabulary, and the most important emergency numbers listed on their website (TFD). Again – always carry your health insurance card and some cash.

Important things to note

Prescription Medications

Getting prescription meds in Japan is pretty straightforward. Most of them are covered under public health insurance, which is super helpful. After your doctor gives you a prescription, you can head to a local pharmacy (they’re called kusuriya or yakkyoku).

Sometimes, like in our case, they will hand in your meds right at the clinic counter. If not, pharmacies are everywhere, especially in the cities. You can even grab some over-the-counter stuff while you’re there, if needed.

When you fill your prescription, your health insurance covers 70% of the cost, and you’ll just pay the remaining 30%. But, keep in mind, not every medication—especially ones imported from abroad—will be available here. So, if you need something specific, make sure to talk to your doctor about it in advance.

Reimbursement procedures

Now, if you ever end up at a clinic or hospital that doesn’t take your insurance, you might have to pay the full amount upfront. Don’t stress—you can still get reimbursed. Here’s what you need to do:

• Keep all your receipts and paperwork from your visit, including invoices, medical records, and your prescription details.

• Reach out to your insurance provider and ask them for the right reimbursement form.

• Submit the form along with all your receipts and documents. Be patient—it can take a few weeks for the claim to process, so don’t forget to follow up if needed.

• The same applies to the HR department of your company, if you need to hand in proof that you visited the clinic.

Just keep track of everything as per usual, and you’ll be fine

Some more relevant info

While Japan’s healthcare system is efficient, us expats may face certain challenges:

Language barrier

For many of us, the language barrier is the biggest challenge when seeking medical care. To overcome this, you can simply:

• Use a translation app (such as deepL) to communicate basic medical needs – it works. People in Japan can understand English.

• Bring a Japanese-speaking friend to help with communication.

• Look for hospitals and clinics with interpreters, many of which are listed on international healthcare websites.

Cultural differences that I personally observed

Japanese medical culture is more formal than in some Western countries. When we visited, our doctor-patient interaction was brief, and we were not given detailed explanations of our condition unless we had asked.

It’s important to be proactive in asking questions and making sure you understand your diagnosis and treatment options. It is your health.

Another difference is the focus on preventative care. Japan’s healthcare system emphasizes regular check-ups and early detection of illnesses. For example, full-time employees will receive an annual health check (kenko shindan) as part of your employer’s health insurance plan, which covers various screenings and tests.

Final tips

• Stay organized: Always keep your health insurance card and identification on you. You never know when you might need medical care.

• Research local clinics: Before you need medical care, research local clinics and hospitals that offer English-speaking services. It’s much easier to have a plan in place than to scramble during an emergency.

• Understand your coverage: Know what your health insurance covers, including co-pays, hospital stays, and specialist consultations. If you anticipate needing specialized care, consider getting private insurance to supplement your public plan.

• Prepare for emergencies: Keep a list of emergency contacts in Japan, including the nearest hospital and embassy, and know how to access emergency services (e.g., by calling 119).

• Get regular check-ups: Take advantage of Japan’s preventative healthcare focus by scheduling regular check-ups and screenings

Conclusion

I admit - getting healthcare in Tokyo as an expat might seem overwhelming at first, but with the right knowledge and your health insurance card, it becomes much easier, I promise. From understanding your health insurance options to finding the right English-speaking clinic or hospital, this guide helps you get familiar with the essentials. Just make sure to have your health insurance card always with you.