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Medical Care

I expect that all of you feel that the cost of living in Japan is extremely high. Medical care is also very expensive, and thus there are health insurance schemes to reduce the burden of medical costs. However whether or not these schemes are accessible by foreigners may depend on their immigration status.

It seems likely that many refugees refrain from going to hospital, even when their symptoms are serious, because they are fearful of high medical costs. However your health and your family's health are important. A failure to seek treatment promptly can lead to further deterioration in your condition. If you feel unwell, please seek a medical checkup or visit a hospital. There are some schemes and services that can be accessed comparatively cheaply. Below is a brief introduction to medical care in Japan. If you feel unsure about going to a hospital because of language problems, or you are unsure how much it will cost, please take advantage of the free foreign language medical advice telephone services that are introduced below, or visit the Japan Association for Refugees. We can help find solutions to your problems.

1）Medical Insurance

Japanese hospitals are very expensive. For example, for just a regular cold, the cost of the examination and medicine is likely to come to over 5,000 yen. More serious illnesses cost more money. Health insurance schemes are designed to reduce those costs.

National Health Insurance

National Health Insurance is a scheme that reduces the amount you pay for treatment at a hospital by 70 percent. To be entitled to this discount you must pay a monthly insurance levy. The amount you pay depends on your income. Those with higher incomes pay higher levies.

Under Japanese law, Japanese nationals who are not enrolled in an Employees' Health Insurance scheme (see below) must enrol in the National Health Insurance scheme. However there is no such legal requirement for non-nationals (including refugees). Local governments, which administer the National Health Insurance scheme, have their own conditions for the enrolment of foreign nationals in the National Health Insurance scheme, with the majority of them requiring that you hold an immigration permit of at least one year in duration. As an exception, enrolment is sometimes permitted for people with immigration permits of less than one year in duration, thus it is important to negotiate with the relevant authorities at the relevant local government body.

For further information on National Health Insurance refer to the NPO AMDA's International Medical Information Center Home Page on their website at http://homepage3.nifty.com/amdack/index.html. See in particular the document "National Health Insurance Scheme" in the section entitled "To Pay Medical Expenses in Japan" on the page entitled "Helpful page" (in Japanese, Spanish, Portuguese, English and Chinese).

Employees' Health Insurance

Aside from the National Health Insurance scheme, there is an insurance scheme known as Employees' Health Insurance. By law, companies which employ one or more full time employees must enrol in such an insurance scheme. Permanent company employees, and part-time workers who work at least 3/4 of the hours worked weekly by permanent company employees, are covered by this scheme (the beneficiaries). Employees' Health Insurance covers not just the beneficiaries, but also their non-working dependent family members who meet certain criteria. However, the beneficiaries' dependents annual income must be less than 1,300,000 yen (for those over 60 and those with disabilities the amount is 1,800,000 yen). Nationality and immigration status are not questioned when enrolling for Employee's Health Insurance - anyone who meets the above conditions may enrol. The insurance levy is paid fifty-fifty by the company and the employee.

For further details on the Employees' Health Insurance scheme, refer to the NPO AMDA's International Medical Information Center Home Page on their website at http://homepage3.nifty.com/amdack/index.html. See in particular the document "Employees' Health Insurance Scheme" in the section entitled "To Pay Medical Expenses in Japan" on the page entitled "Helpful page" (in Japanese, Spanish, Portuguese, English and Chinese).

Private health insurance

For foreigners who cannot enrol in a public health insurance scheme, the Minato Machi Health Group is a membership-based insurance scheme. Members can receive medical consultations at the medical institutions listed below, and pay just 30 percent of the cost. Please telephone before attending any of these medical institutions. None of these institutions have in-patient facilities.

To become a member of the Minato Machi Health Group, pay the first three months' membership fees of 6,000 yen (2,000 yen per month) at one of the medical institutions listed below, and you will be issued with a membership card. You must continue to pay the monthly fee to maintain your membership.

Minato Machi Clinic
  • Medical; orthopaedics; gynaecology (strictly appointment based); dermatology (Tuesday afternoons only)
  • Kowan Roudou Fukushi Centre, 7-6 Kaneminato-cho, Kanagawa-ku, Yokohama, Kanagawa
  • 045-453-3673
  • Languages spoken: English, Korean, Persian, Tagalog, Spanish
Minato Machi Dentist Clinic
  • Dentist
  • Kowan Roudou Fukushi Centre, 7-6 Kaneminato-cho, Kanagawa-ku, Yokohama, Kanagawa
  • 045-453-3858
Yokosuka Chuo Clinic
  • Medical; gynaecology; psychiatry; orthopaedics
  • Third floor, Suzuman Building, 1-16, Wakamatsu-cho, Yokosuka, Kanagawa
  • 046-823-8691
  • Languages spoken: English; Spanish (Saturday mornings only)
Jujo Dori Clinic
  • Obstetrics/Gynaecology
  • 8-23-8 Minami Rinkan, Yamato, Kanagawa
  • 046-274-5884
  • Languages spoken: English; Chinese; German; Persian
Isezaki Clinic
  • Medical; gynaecology; counselling
  • Second floor, K Biru-Isezaki, 3-107 Isezaki-cho, Naka-Ku, Yokosuka, Kanagawa
  • 045-251-8622
  • Languages spoken: English; Chinese; Taiwanese

Medical examinations for persons not enrolled in any health insurance scheme

For part-time workers who work less than three quarters of the weekly hours of permanent company employees and thus are not eligible to enrol in the Employees' Health Insurance scheme, or for people who are unable to enrol in National Health Insurance because of their immigration status, medical examinations are referred to as "unregulated treatment". Medical fees are set by law in the case of treatment covered by health insurance, however in the case of unregulated treatment fees can be as high as one and a half or twice the amount of regular medical fees. Some hospitals employ a social worker who can be consulted with respect to methods for payment of these medical fees, for example, payment by instalments.

2）Childbirth and children's health

Childbirth

Giving birth in hospital is not covered by health insurance, and so even a delivery without any complications will cost around 300,000 yen. If the mother or her husband (that is her legally married husband, not a de facto or common law partner) is enrolled in health insurance, an amount of approximately 300,000 yen may be reimbursed as a lump-sum allowance. Those enrolled in National Health Insurance can receive a lump sum allowance of 350,000 yen.

A Caesarean section, without insurance, will cost approximately 500,000 - 800,000 yen. For those without health insurance, or for those who have insurance but face economic hardship, it may be possible to use the "Hospital-Based Childbirth Scheme" available at designated institutions, whereby the cost of delivery is free or considerably reduced. It is simply required to prove that you face economic hardship (defined as paying income tax of less than 16,800 yen per year). Those without immigration permits may also use this scheme. Those who cannot afford to pay the costs of childbirth and wish to use the "Hospital-Based Childbirth Scheme" should contact their regional Welfare Office.

Medical services for children

Medical services for children vary according to each local government's policy. When you want to know what services are available, you should first contact the Health Office of the local government for the area you live in. For those who are concerned about language or other matters, you can use the foreign language telephone medical consultation service or contact Japan Association for Refugees for advice.

Medical check-ups for infants

Regular check-ups for infants to ensure they are developing satisfactorily are provided. These are conducted free of charge at public health centres for infants who are 3-4 months, 18 months, and 3 years old. Generally the public health centre will send notice that a medical check-up is due. If no notice is received, contact the public health centre. Some local governments offer advice on health care for infants in addition to these check-ups. For details contact your regional public health centre.

For premature babies, or those with disabilities, free medical services are available - contact your hospital for advice.

Immunisation

Once babies leave the womb, they gradually lose their natural immunity and become prone to infectious diseases. Children are immunised to protect them from such diseases. Local governments carry out immunisation free of cost, provided children have alien registration certificates.

3）Communicable diseases

Public coverage of medical costs for treatment for tuberculosis

For people without health insurance who have tuberculosis, the government will cover 95% of the costs of specified medical treatment, meaning that the patient is liable only for 5% of the costs of treatment. If the symptoms of tuberculosis develop and there is a risk it will be passed to other people, hospitalisation may be enforced, however in that case the costs of hospitalisation are covered by the government. However, where the gross income tax of the household exceeds 1,500,000 yen the patient is required to bear a share of the cost up to the amount of 20,000 yen per month.

AIDS

AIDS is the name given to a stage of a disease. The virus that causes this condition is called HIV - Human Immunodeficiency Virus. Infection with HIV can cause Acquired Immunodeficiency Syndrome (AIDS). The Ministry of Health and Welfare Study Group estimates that there were over 15,000 people with AIDS in Japan at the end of 2003. HIV is transferred through blood, semen and vaginal fluids. Infection mainly occurs through sexual intercourse without condoms, sharing hypodermic needles, sharing tooth brushes and razor blades, and through mothers to their babies. It is not transferred through sharing toilets, baths, cutlery or plates etc in everyday life situations or workplaces. Symptoms may not appear for a long time after infection with AIDS. To test if you have AIDS it is necessary to test whether you have the HIV antibodies. Because it takes some time for HIV antibodies to develop following infection, the test should not be taken until 3 months after possible infection.

HIV tests are available free of charge at health centres and the Tokyo South Shinjuku Testing and Consultation Centre. The test can be taken anonymously, and no questions as to your immigration status will be asked. The hours of the Tokyo South Shinjuku Testing and Consultation Centre are set out below. Before visiting, please telephone for an appointment.

Telephone number for appointments
03-3377-0811 (excluding public holidays)
 Telephone hoursTesting hours
Mondays to Fridays15:30 - 19:0015:00 - 20:00
Saturdays, Sundays13:00 - 16:3013:00 - 17:00

Further information on AIDS and other communicable diseases is available on the homepage of the Tokyo Metropolitan Health Bureau Medical Services Division, Communicable Diseases Section (http://www.kenkou.metro.tokyo.jp/kansen/index.html) (Japanese only)

4）Public coverage of medical expenses for mental illness, etc

Compulsory hospitalisation

Where it is determined that if a person with mental illness or suspected of having mental illness is not hospitalised there is a risk they will injure themselves or cause harm to others, they may be compulsorily hospitalised. People without health insurance need not be concerned as the cost of hospitalisation is generally covered by the government.

Routine hospital and medical care

People with mental illness are only responsible for 5% of the costs of their treatment at hospitals, clinics or pharmacies. This applies whether or not a person has health insurance.

5）Free health checks

Several NGOs in the Tokyo area operate free health checks in various languages for foreign residents, several times a year. Free health checks are available periodically (at least 6 times a year) in the Tokyo metropolitan area, Chiba prefecture, Saitama prefecture and Kanagawa prefecture. Although it is not free, in Gunma prefecture, once a year, a cheap health check (2000 yen per person) is available to foreigners. For further information on free and cheap health checks, contact SHARE (Services for Health in African and Asian Regions), telephone 03-5800-4778.

6）Emergency medical treatment

Where people who are not enrolled in health insurance because of their immigration status require emergency medical treatment, there are two potentially applicable medical treatment schemes.

Law Regarding Sick Travellers and the Death of Travellers

The Law Regarding Sick Travellers and the Death of Travellers (referred to below as the Traveller's Law) was enacted to aid travellers who fall ill, or for the burial of travellers who die during their stay. The Traveller's Law is applied by each local government. This scheme may apply when a person with no fixed address (for example a person who is staying in someone else's home), or a person for whom there is no-one else who will cover their medical expenses, is taken to hospital by ambulance etc. As the Law stipulates that, where necessary, the local government shall contact the embassy of the country of nationality of the traveller to whom it is applied, it may be important for refugee applicants to advise the local government of their situation, and ask that the embassy not be contacted.

Regional local government schemes to subsidise costs of emergency medical treatment for foreigners

Aside from the Traveller's Law, some local governments have schemes to partially cover the emergency medical treatment costs of foreigners who are unable to pay due to unavoidable circumstances. Application for these subsidies are made by the medical institution, rather than the patient. The main such local government schemes are set out below.

Gunma Prefecture - Foreigners' Unpaid Medical Expenses Policy
  • Persons covered: Foreigners who do not have medical insurance, with a residential address in the prefecture, or who work in the prefecture, or those who receive treatment in the prefecture for unavoidable reasons.
  • Conditions: Where urgent medical treatment was provided by a medical institution in Gunma prefecture, other than by a national or regional public institution, and where despite that medical institution$B!G(Bs efforts to recover the costs of that treatment , they remain unpaid for more than one year.
  • Amount of subsidy etc: The unpaid medical costs must exceed 10,000 yen. The subsidy is limited to 2,000,000 per person at any one medical institution, and will cover up to 70% of the unpaid medical costs.
* Application for the subsidy is made by the medical institution.
For further information: Gunma Prefecture International Exchange Association, International Section (Telephone 027-226-2184).
Kanagawa Prefecture - Foreign Residents' Emergency Medical Treatment Expenses Assistance Programme
  • Medical institutions covered: Primary, secondary and tertiary emergency medical institutions, excluding national and regional public hospitals.
  • Persons covered: Foreign residents not covered by the Traveller's Law.
  • Medical expenses covered: Remuneration for medical expenses incurred for emergency treatment within limits determined by health insurance at primary, secondary and tertiary emergency medical institutions.
* Application for the subsidy is made by the medical institution.
Saitama Prefecture - Foreigners' Unpaid Medical Expenses Programme
  • Persons covered: Foreigners with a residential address within the prefecture, who are not covered by National Health Insurance or any other public health insurance scheme or the Social Welfare Law.
  • Conditions: The treatment costs of those brought by ambulance etc where, despite efforts to recover the costs, they remain unpaid for more than one year.
  • Amount of subsidy etc: Based on calculations of the medical expenses according to an insurance assessment, after subtracting the amount paid by the patient, where the unpaid amount exceeds 100,000 yen, after subtracting 100,000 yen, the remaining amount rounded down to the nearest 10,000 yen. The subsidy will not exceed 2,000,000. Where hospitalisation is necessary, as a rule, coverage is limited to 14 days. The subsidy is covered in equal parts by the prefecture and the relevant local government.
* Application for the subsidy is made by the medical institution.
For further information: Saitama Prefecture Health and Welfare Division, Medical Section
Tokyo Metropolitan Area - Foreigners' Unpaid Medical Expenses Subsidy Programme
  • Medical institutions covered: Medical institutions in the metropolitan area, excluding national and metropolitan public institutions.
  • Persons covered: Foreigners who live or work within the metropolitan area who are not covered by a public health insurance scheme (National Health Insurance, Employer's Health Insurance etc) and are not eligible for public medical assistance (the Traveller's Law, social welfare etc.)
  • Medical expenses covered: Medical expenses incurred for treatment undertaken as a result of unforeseen injury, traffic accidents etc (in accordance with an insurance assessment), which remain unpaid despite efforts to recover expenses. For those with chronic diseases, coverage is limited to emergency situations.
  • Period of coverage: Up to 14 days in the case of hospitalisation; up to three days of outpatient treatment.
  • Amount of subsidy: Up to 70% of the medical costs, as calculated in accordance with an insurance assessment. However, there is a limit of 2,000,000 yen per patient per institution. Where the amount applied for exceeds the available budget, payments will be made according to a reduced uniform rate. The amount of the subsidy will equal 70% of the cost (as calculated in accordance with an insurance assessment), having subtracted the amount already recovered from the patient.
* Application for the subsidy is made by the medical institution.
Information from Tokyo Metropolitan Health and Medical Treatment Corporation: Procedures for Applying for Subsidies to Cover Unpaid Medical Expenses of Foreigners, 2002. Programmes for subsidies for unpaid medical expenses for foreigners are covered in detail on the homepage of the Tokyo Metropolitan Health and Medical Treatment Corporation, at http://www6.ocn.ne.jp/%7Eiryo-hp/ under (Programme contents) (Japanese only).
Chiba Prefecture - Foreigners' Emergency Medical Expenses Assistance Programme
  • Medical institutions covered: Medical institutions in the prefecture, excluding national, regional and Chiba city public institutions.
  • 対Persons covered: Foreign patients receiving emergency care.
  • Period of coverage: As a rule, 14 days from the beginning of treatment.
  • Amount of subsidy: Private medical institutions: 100% of unpaid medical expenses, up to 2,000,000 yen per case.
    Public medical institutions: 50% of unpaid medical expenses, up to 1,000,000 yen per case.

Outside of the Kanto region, the prefectures that have schemes to subsidise the costs of emergency medical treatment for foreigners are as follows:

  • Yamanashi Prefecture - Subsidy for Losses Incurred for Emergency Medical Treatment
  • Hyogo Prefecture - Subsidy Programme for Losses Incurred for Emergency Medical Treatment for Foreigners

For further information: Hyogo Prefecture Health Section, Medical Care Office
(From Brenda-Kai Homepage "Subsidy Schemes in Other Towns and Prefectures", http://www.geocities.co.jp/SweetHome-Ivory/9660/index.html) (Japanese only)

To understand the various emergency medical treatment schemes may be difficult. In practice it is not the person who receives medical treatment but the hospital that applies for assistance from the various local government schemes for subsidies for unpaid medical expenses for emergency treatment for foreigners. If there are aspects of the schemes that you do not understand, consult the social worker at the hospital. The most important thing is your health. If you are unwell, don't delay unnecessarily, and seek medical attention.

7）How to call an ambulance

For emergencies and serious illness, dial 119 for an ambulance. Transportation to the hospital is free (although you must pay for treatment). When you dial 119 you will be connected to the fire department. When your call is answered, stay calm, and clearly tell the operator the following information:

Is it a fire or a medical emergency?
A medical emergency (this conveys that it is an ambulance, rather than a fire engine, that you require).
What is the address of your current location?
Tell the address. Refer to any landmarks that will assist the ambulance to locate the address.
What happened?
Explain what happened. Explain the condition of the injured person.
What is your telephone number?
Give the number of the phone from which you are calling. If you are calling from a public phone and do not know the number, give its location.
What is your name?
Give your name (the caller).

8）Medical advice in foreign languages

There are several groups offering medical advice by telephone in different languages. Refugees who are unwell and want to go to the hospital but don$B!G(Bt know which hospital to go to, or are concerned they will not be able to communicate and want to know how to explain their symptoms, may use these services.

Himawari

Himawari is a service that gives guidance about medical institutions to refugees living in the Tokyo metropolitan area.

Guide to medical institutions by recorded message
  • Daily Available 24 hours
  • 03-5272-0303
  • Languages: Japanese
Medical advice
  • Daily 9:00 - 20:00
  • 03-5285-8181
  • Languages: English, Chinese, Korean, Spanish

Himawari also gives guidance about medical institutions, in English and Japanese, on the internet. On the internet, you can search and obtain information based on the address, closest station and medical specialities of medical institutions. The address of the homepage is as follows:

AMDA (Association of Medical Doctors of Asia) International Medical Information Center

AMDA offers information over the internet and by telephone. There are AMDA centres in Tokyo and Osaka.
The schedules for each of these centres are as follows:

Tokyo Centre: Telephone (for advice): 03-5285-8088
  • English, Thai, Chinese, Korean, Spanish: Monday-Friday 9:00 - 17:00
  • Portuguese: Monday, Wednesday, Friday 9:00 - 17:00
  • Philipino: Wednesday 13:00 - 17:00
Kansai Centre: 06-4395-0555
  • English, Spanish: Monday-Friday 9:00 - 17:00
  • Portuguese: Tuesday 11:00 - 15:00
  • Chinese: Tuesday 11:00 - 14:00

SHARE

SHARE provides medical advice by telephone as follows:

Medical advice
  • Wednesday: 10:00 - 16:00
  • 03-5800-4778
Thai and Japanese language advice about AIDS
  • Saturday: 17:30 - 20:30
  • 070-5207-0953

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