In order to use the discounts the Japanese health insurance offers, you need to first register for it.
Do this as soon as you arrive in Japan as it is not only recommended to have it, but it is in fact compulsory. According to the law, anyone staying in Japan for over three months should be covered by a Japanese health insurance. For more about insurance, see our Taxes, Pensions and Health Insurance section.
If you are employed
Your company will typically apply for health insurance on your behalf and deduct a monthly sum from your salary for it. This type of insurance is simply called kenko hoken (健康保険).
After your employer completes all the necessary procedures for applying for a health insurance, you will receive a health insurance card called a kenko hokensho (健康保険証), which you should keep with you at all times.
If you are not employed
If you are not employed full time, your employer does not provide health insurance for some reason, or you are unemployed, you will have to apply for Japan’s National Health Insurance (kokumin kenkou hoken, 国民健康保険) at your local city hall at the health insurance department.
To apply for the national health insurance, you will need:
- Passport
- A valid Japanese ID (residence card with your postal address written on it)
- Hanko (Japanese seal or stamp)
- My Number card if you have one issued (if not, you may be required to issue one simultaneously)
Once you apply for a national health insurance, your application is typically accepted right away and you will be issued a health insurance card typically on the same day. Again, carry this card with you at all times. If you have this type of insurance, you will have to pay monthly premiums by yourself. These premiums are based on each individual’s age and income and you will receive a slip indicating how much you should pay. You can pay at your local convenience store or through online banking.
If you are in Japan on a spouse visa and you are unemployed, your partner can apply for your health insurance through his/her employer.
In all cases, whenever you visit a Japanese hospital or clinic, be ready to present your health insurance or you will have to pay the full cost.
Hospitals vs clinics
The easiest way to differentiate between these two different types of medical institutions is size and severity of your condition.
If you have an idea of what is wrong, you can select the specialist clinic that is best suited to your needs. However, most people will go to a general clinic for what’s called “Internal Medicine” (naika,内科) which acts kind of like a General Practitioner. To find a clinic near you, simply search クリニック or “clinic” in English, and your area. The majority of clinics will have an Internal Medicine department, unless otherwise stated.
If you have a mild condition, go to a clinic first. They will be able to tell you whether your condition is indeed mild or you need to consult a more specialized doctor at a larger hospital. Refrain from going to a larger hospital if you have a cold or other mild conditions — you won’t necessarily be turned down, but you will be requested to pay an extra fee for their service due to the case not being serious enough.
If your condition is more serious or it is an emergency, you should go straight to a larger hospital.
Visiting a doctor in Japan
At a clinic
It depends on the actual clinic you visit, but typically you don’t need a reservation for your first time visit. You can call in advance if you wish, but you will not be turned down in case you just show up at the clinic.
Once inside, stop at the front reception (uketsuke, 受付) and give them your health insurance card.
If it’s your first visit, tell them:
- “初めてです。= Hajimete desu.
You will then be given a medical questionnaire form which you will have to fill in. It’s called monshinhyou (問診票) and contains general information about yourself: your name, address, sex, age, past conditions and an inquiry about the purpose of your visit at the clinic. If you need language support, simply let the staff members know that you need help.
Once you have filled the questionnaire, return it to the reception desk staff and wait for your name to be called. At some point you will be called to enter the doctor’s examination room, where you will once again be asked to answer questions about your condition.
Once the doctor has established what the problem is, he/she will explain it to you and tell you what the next step is. When you’re done, once again go back to the waiting area at the reception desk and wait until you are called to pay.
If you are given a prescription, you will be guided to a nearby pharmacy (usually attached to the clinic or nearby).
Once there, you will once again be asked to fill in a medical questionnaire listing any allergies you have. Pass it on to the pharmacist in charge together with your health insurance and wait until your turn comes. Once you’ve received your medicines, pay and you’re ready to go home.
At a hospital
If you’re in a hospital you’re either there because of an emergency or a more serious condition, or you’ve been referred to by a clinic you have visiter earlier.
Hospitals typically operate per reservation only usually for the initial visit and always from your second visit on. If you have a referral letter (shokaijo, 紹介状) from a clinic, show this to the person in charge at the reception desk along with your health insurance. You will then be guided to the department you should be checked at. Once there, wait at the waiting area until you are called.
Once inside, your doctor will guide you through the examinations, typically asking more detailed questions. Be prepared to wait longer if you are visiting a larger hospital. From your next visit, you will also be given a medical card for the hospital, usually with your next appointment written on the back of it. It is called shinsatsuken (診察券 ). Carry this with you every time you visit the hospital.
Dentists
Visiting a dentist, called haisha (歯医者), in Japan is like visiting any other clinics, but the only difference is that dentists are by appointment only.
Call the dentist (or book online) before you go and show up for your appointment with your health insurance. Like in other clinics, you will be asked to first fill in a questionnaire and then proceed to your check up. On your first visit, the dentist will usually take an X-ray even if it’s just a regular check up, so have at least ¥5,000 with you when you visit.
The dental procedure will typically not end on a single visit, even in the case of a regular cavity. You can speed the process, however, by stating clearly that you would like everything done as fast as possible. Your procedure will typically also end with a general teeth cleaning.
An important thing to keep in mind is that not all cavity fillings are covered by your Japanese health insurance. During your treatment, the dentist will explain the offers they have, letting you choose the filling your prefer.
The most common types available in Japan are:
- amalgam fillings (metallic = kinzoku, 金属)
- composite fillings (white, plastic = purasuchikku, プラスチック)
- ceramic fillings (seramikku, セラミック)
Amalgam fillings are the cheapest and always covered by health insurance, though depending on the place, they may be bothering you due to their clear visibility. Composite fillings are also covered by health insurance (though slightly more expensive than amalgam) and are typically the most preferred option. Ceramic fillings are not covered by the health insurance and can get very expensive. Teeth whitening is also not covered by health insurance.
Before you leave the dentist, make sure you have collected your health insurance and your medical card for your next visit. You may also receive a letter from your dentist three to six months later, inviting you to have another regular check up.
Mental health
Depression is a very serious issue that affects every nation. As a foreigner in Japan, however, the adjustment to a new lifestyle, the culture shock, the long working hours and work and society-related stress can easily pile up. If you live alone here, it is beyond frightening.
If you are feeling the symptoms of depression, there could be many causes. It could be something wrong with your diet, a lack of sleep or exercise, and numerous other, easily resolved health issues. Or, it can be more serious.
If you have tried everything possible and nothing seems to work, visit a psychiatric doctor as soon as possible. Search for the nearest seishinka (精神科) clinic or hospital to your house.
Upon your visit, talk to the doctor openly about everything that happens and how you feel. Depression is a long battle and one key factor in beating it successfully is to be able to speak to your doctor openly. If you don’t think this is possible, change your doctor until you find one whom you can trust.
If you are diagnosed with depression, you will most likely be given medicines depending on your condition. It is crucial to follow your doctor’s advice and take the medicines in the exact way that your doctor has advised. If you don’t feel any progress, however, talk to your doctor. They will most probably prescribe a different type or set of medicines.
If you have been diagnosed with depression, you are entitled to medical leave from your work. With an official letter from your doctor, you can legally take at least two months off from work. Depending on your condition, you may be advised to take a break from work, typically, if the cause of your depression is work-related. Return to work with your doctor’s agreement.
Resources
- TELL (Tokyo English Lifeline) has a variety of resources available to help you at a time of crisis. Give them a call on 03-5774-0992. Their chat services also help you to speak about your condition online if you feel uncomfortable calling them.
- Tokyo Counseling Services, provides individual counseling, couples counseling, marriage and family counseling, group therapy and psychotherapy services. Counseling and therapy services are available in English, French, German, Korean, Chinese, Japanese and Portuguese for all residents living in the Tokyo Metropolis and Kanto region. Tel: (03) 5431-3096. Email: tokyocounselingservices@gmail.com.
- There’s also general mental health information on Japan Health Care Info’s website.
- The Japan Helpline has info and resources for areas across the country for everything from medical help to other emergencies.
- Tokyo Meguro Counseling Center: English speaking psychiatrists provide psychological counseling, psychotherapy including insight-oriented psychodynamic therapy, CBT (cognitive behavioral therapy), supportive psychotherapy, life coaching, marital/divorce, family, child & adolescent counseling, and psychopharmacology-integrated psychotherapy.
- Tokyo Psychiatry Clinic: Native English psychiatry services: from consultations in English to a distinctively Western treatment approach. Consultations by appointment only. Not covered by Japanese Health Insurance.
Gynecology, birth control, pregnancy and women’s health
Women’s clinics usually run a practice of drop-in appointments at various points throughout the week, so call in advance, register on entry and take a seat in the waiting room.
On your first visit, present your health insurance, but be warned that a number of female-specific conditions may not be covered by it. Those include getting a birth-control pill or even a voluntary mammography or cervical cancer screenings for precaution. Even if you’re visiting the gynecologist for a regular check up, it is a common practice to tell them that you’re following up on a previous condition or have been feeling a slight pain.
Once with your doctor, you will be guided into a changing room (or a private space covered by a curtain), asked to take off your underwear and sit on the gynecology chair. Be aware that the chair moves. In a matter of a few moments, the chair will be adjusted, transporting you — legs wide open — to where your doctor is. Typically there will be a curtain between you and your doctor, so you will not see his or her face.
The doctor will then examine you and will usually end the procedure with a chitsusenjou (膣洗浄, vaginal cleaning), which feels like a jet spray into your vagina. When the procedure is completed, you will be invited to change and wait to pay at the waiting room.
Birth Control
Birth control (unless for a specific medical condition) is not covered by Japanese health insurance. Finding the right doctor is key, as regular blood tests are part of the package of obtaining the pill and many contraceptive prescriptions require monthly renewals. Birth control pills are known as keikou hinin yaku (経口避妊薬) but more commonly referred to as “piru” (ピル). The pill can be picked up at your regular gynecologist and usually cost around ¥2,000-¥3,000 at the cheapest for a month, depending on your doctor and brand.
Other birth control methods available in Japan:
- condoms (kondoumu,コンドーム)
The most widely practiced and available at every convenience store and drugstores
- Intrauterine devices (IUDs) such as coils (shikyunai kigu,子宮内器具) or vaginal rings (hininringu, 避妊リング)
- Temperature control
You can buy a women’s thermometer (fujin tai-on kei, 婦人体温計) at any drugstore
- Morning after pill (afutaa piru, アフターピル)
The morning after pill is not covered by the Japanese health insurance. They can typically cost around ¥10,000 and can be obtained at any women’s clinic. To find a clinic that does offer it, search for モーニングアフターピル (morning after pill) and your area.
Pregnancy
For expats living in Japan, aside from the realization that you are expecting, the fear may be compounded even further by having to figure out prenatal care, doctors, official registration and the like in a foreign language and on foreign grounds.
The first thing you have to do is confirm your pregnancy. If you suspect you may be pregnant, home pregnancy tests (ninshin kensayaku, 妊娠検査薬) can typically be found at any drugstore for a few hundred yen.
To confirm your pregnancy head to your local hospital or ladies’ clinic for a checkup. Your doctor will confirm your pregnancy via transvaginal ultrasound. Once your doctor spies a heartbeat, you will be issued with a certificate declaring the pregnancy confirmed (ninshin todoke, 妊娠届).
After confirmation, take the ninshin todoke and your foreign residence card to your local health center to register the pregnancy. Upon registration you will receive a pregnancy goodie bag which includes:
- Boshi kenkou techou (母子健康手帳, mother and child health handbook)
- Ninshin kenkou shinsa jushin hyou (妊娠健康診査受診票, pregnancy health checkup coupon book)
- Mataniti maaku (マタニティーマーク, maternity mark, or pregnancy badge)
- Plus lots of booklets and other goodies
Your prenatal checkup schedule will look something like this:
- First and third trimesters—appointments every other week
- Second trimester—monthly appointments
- Beyond 40 weeks/10 months—appointments every two days
This corresponds to around 15 checkups total — more compared to that in other countries. Ultrasounds are performed each time. While it’s nice to have the constant reassurance, it also adds to the cost and can be inconvenient if you are working. If you find it too much, you may be able to request to space the appointments out more.
Maternity leave and notifying your workplace
According to Japan’s Labor Standards Act, employers are required to allow mothers maternity leave from six weeks (for one baby and from 14 weeks for twins and more) prior to the due date until eight weeks after delivery. In addition, the Act on Childcare Leave provides for childcare leave until the child turns one (and until the child reaches one year and six months of age, if the parents take turns). During this time, labor and social insurance will cover up to 66 percent of the mother’s base salary, but every company will have their own regulations, so please confirm all details with your employer.
Cost of giving birth in Japan
It is expensive to give birth in Japan, but much of these costs will later be reimbursed through your health insurance in the form of a childbirth and childcare lump-sum grant of up to ¥420,000, payable per child to help families with the costs of the birth.
The basic birth fee for an uncomplicated natural birth, including a five-day stay (which is typical) ranges between ¥500,000 to ¥700,000 on average. This fee includes the daily hospital-stay rate with three meals a day. Many hospitals provide the option for a private room, the cost of which vary depending on whether you opt for one with a bathroom, couch, TV and other equipment.
The extra daily cost for a private room can range from ¥10,000 to ¥70,000 and beyond. Medical expenses (including birth costs and prenatal care) meeting a certain threshold (usually, a minimum of ¥100,000) over the tax year are able to be deducted from your income tax liability. As such, you will likely be able to receive a tax rebate by filing a return (kakutei shinkoku, 確定申告) by March 15th of the following year. For more information, please consult your local municipality.
Abortion
Abortion is not covered by the Japanese health insurance, but is legal in Japan. To find a clinic where abortion is practiced, search for jinko chuuzetsu (人工中絶) and your local area. To have an abortion, make an appointment at the clinic or hospital first. On the day of the abortion you will be required to bring a certificate stamped by the father of the baby and money in cash.
The certificate can technically be signed by any man, so if the father of the baby is not reachable or refuses to cooperate, ask a male friend to sign. This person will not be contacted. It typically costs around ¥100,000 to have an abortion and it can be done in one day without staying over at a hospital.
Recommended English-speaking gynecologists
Tokyo
- Toho Women’s Clinic: Located in Kiba. Female, English-speaking gynocologist who has experience working with the Western patients. 5-3-10 Kiba, Koto-ku, Tokyo
- Azuma Clinic: Village Sasazuka III 4F., 1-30-3, Sasazuka, Shibuya-ku, Tokyo
- Ginza Clinic Femina: Village Sasazuka III 4F., 1-30-3, Sasazuka, Shibuya-ku, Tokyo
- Tokyo Midtown Medical Center: Midtown Tower 6F, Akasaka 9-7-1, Minato-ku, Tokyo,
- Primary Care Tokyo: (Birth control (oral contraceptives, morning after pill), STD testing and treatment. No pre-natal or obstetric care.)
- Urbanity Shimokitazawa 3F, 2-1-16 Kitazawa, Setagaya-ku, Tokyo Japan
- Primary Care Tokyo: Dr. Joe Kurosu is Stanford-trained general practitioner with training in women’s healthcare. He’s experienced in serving the foreign community and offers online appointment booking.
Kansai
- Ueda Hospital (Kobe): Has female, English-speaking gynecologists. Accepts NHI.
- Nishikawa Clinic (Osaka): The website focuses on obstetrics, but this clinic does have gynecologists who speak English.
Buying medicines in Japan
You can buy medicines in Japan either at a drugstore (ドラッグストア) or a pharmacy (yakkyoku, 薬局). Drugstores are places that typically sell everything from daily supplies to cosmetics and even food. Pharmacies sell only medicines and are typically adjunct to a clinic or a hospital and you will need a doctor’s prescription to buy medicines there.
Medicines in Japan are classified in three main categories:
- Class 1 (第１類医薬品): These require a consultation with a pharmacist, as they might have impairing side effects. You may find empty boxes of medicines in this class in drugstores, which you will have to take to the counter. Your empty box will be replaced with the medicines by a licenced pharmacist.
- Class 2 (第２類医薬品): These don’t require a consultation. These are the category many OTC allergy and cold meds fall under. You can buy these online or at your local drugstore.
- Class 3 (第３類医薬品): These don’t have known side effects. Buy at any drugstore.
For regular cold medicine, sore throat lozenges, cough syrup, eyedrops, painkillers, hay fever medicines, bandaids etc., stop at your local drugstore. If your condition doesn’t improve though, see a doctor and get stronger medicines at a pharmacy.
Treatments covered and not covered by Japan’s health insurance
The rule is simple: if you’re visiting a doctor just to check without actually having any symptoms nor pain, or if your condition is deemed “unnecessary” or “a choice” from a survival point of view, then in most cases you won’t be able to use the health insurance.
Any conditions you have symptoms or pain for, injuries, regular dental treatments, allergies, abnormalities or complications caused during or as a result of treatment are covered by Japanese health insurance.
The following is a list of common treatments that are not covered by the Japanese health insurance and you will have to pay the full fee of any medical treatments.
Clinical departments
For a list of major hospitals throughout Japan, see here.
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