I’ve heard that in Japan you need to cover 30% of medical expenses out of pocket, is that true? Does it apply for every surgery even the most expensive one? What happens, for example, in the case of a young working man that goes through a particularly pricy surgery but his savings aren’t enough to cover his part?
https://www.reddit.com/r/japan/comments/16oodo5/healthcare_system_in_japan/
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There is upper limit based on your income.
56k yen per month if your annual income is below 3.7 million yen.
80k + (total cost ‐267k)*0.01 yen per month if your income is between 3.7 million and 7.7 million yen.
There are co-pays often around 30% but there is also a cap based on your income so you can’t pay more than your income adjusted limit. In this case if you were a single person without much savings your limit would be pretty low and hopefully not be more than you could pay.
Also, not every surgery is covered. Only ones that are medically necessary.
There are many social safety nets in Japan related to healthcare such as the previously mentioned monthly cap as well as the fact that medical expenses become a tax deduction at 100,000 yen total cost per year(About $700 USD) instead of the US where it’s somewhere around $10000 before you can start deducting.
But there is a much, much bigger impact on this. Medical care is inexpensive in Japan. For example, I have had to have a very similar surgery done both in the US and Japan. In the US, the surgery cost me somewhere around $2000 USD. In Japan, the cost to me was 13,000 yen or the equivalent of about $85 USD.
Even regular doctor appointments are very inexpensive. We rarely pay over 1000 yen (7 USD) in total to see a doctor, often it is much less than that. I’ve had several appointment that cost 290 yen for just a quick followup appointment.
So overall surgery and healthcare is less expensive in Japan.
It isn’t the US, surgery prices aren’t laughable exorbitant.
I broke my collarbone, and multiple hospital trips, an MRI, surgery with a two night stay, and post-surgery physical therapy cost under ¥100,000
It applies to everything unless it’s not an approved treatment.
It’s also capped monthly based on your income which for most is lower than 100k.
First of all, don’t worry, ambulances are free and major surgery and hospital stays are about 1/10 the price of the pre-insurance costs in the US. I had a major surgery where they cut open my bowels and a specialist was called in to do the surgery. I stayed 10 nights, and did physical therapy for months. The whole thing was laughably cheap. My out of pocket was negligible since I applied for the special high-med-cost rule to my city before the surgery.
Here’s some Japanese info about the rule (It translates well in google translate): https://www.kyoukaikenpo.or.jp/g3/sb3020/r151/
If you have any questions, or think that you might incur a large medical bill in the near future (ie. planned surgery etc.) (within a year) you can actually apply for the program without an actual bill/receipt in some cases. Talk to your city office.
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Basically, it’s 30% coinsurance payment up to a certain threshold based on income. And if your income is in a high enough bracket, they don’t actually cap it, but lower your portion from 30% to 1% for all medical fees over the “cap”.
There’s also another rule where “In the past 12 months prior to this current month, if 3 of those months saw you applying for the medical cost cap refund, then you get an even lower cap that even higher income earners are just a flat capped amount” called 多数該当
As long as you make less than 3.24 million yen per year before taxes, your medical payments will be capped at about 35k ~ 57k ish per month out of pocket, and if you hit that cap 3 months or more within the last year that goes down to 24k ~ 44k ish.
Yeah.. my sister had an operation and billed 400k yen, but only paid around 130k.
You could also apply other insurance after to lessen your bill if you work for a company.
It’s 10% but you can get an income cap through your employers health insurance. That’s what I did for cancer treatment in Japan. (Gendogaku tekiyo ninteisho). Good luck
What everyone else said: The base costs are reasonable, so the 30% isn’t a big problem, and the 30% is capped anyway if the costs get huge. It’s a good system. Not perfect, but I honestly haven’t heard of a better one.
Also to add, some cities supplement this for kids. In Yokohama, all copays are paid for by the city until the children hit elementary school age. My son had his cleft lip/palate surgery for free after the city supplement kicked in.
The system is great compared to what I paid for healthcare in the US. In addition to the insurance co-payment, the prices doctors can charge as well as the price of medication are capped under the insurance system. You can get treatment and medication that are not covered by NHI but you have to pay full price or use private supplemental insurance if you want those options.