Japan Society of Fairfield County
Culture Watch, Society Watch (13)
by Dr. Ikuko Anjo Jassey
At the beginning of August, my husband
was dehydrated and lost
consciousness on campus. His blood pressure was way too low and his
heart rate way too slow when he was taken to a nearby hospital by
ambulance. Consequently, he stayed at the hospital for two days for
tests: Angiogram; MRI; and EKG-that I always mix up with KGB. A month
later, the bill came. It amounted to $24,000. Twenty-four thousands
dollars is a fairly large amount of money for a majority of people.
Fortunately, this was covered with his primary and secondary
insurances. If you don't have insurance, needless to say, you have to
pay the full amount from your pocket, regardless of the cost. Despite
this fact, it is reported that about sixteen percent of Americans do
not have medical insurance, simply because they cannot afford to pay
the premium share. If my husband lived in Japan, what kind of insurance
would he be entitled to have and how much would he pay for his tests,
provided he took the tests that cost exactly the same amount? Or how
much would he have to pay as premium share? Keeping these questions in
mind, let me browse through some health insurance plans in Japan.
Perhaps it is better to start with
Japan's insurance plans in a simple
manner. Japan's health insurance plans are broadly classified into two
types: (1) Health Insurance (Occupation-based public health insurance);
and (2) National Health Insurance for the self-employed, farmers, the
unemployed, the retired, and others. Take my husband's case as an
example. He is still a private university employee in this country
where there is no retirement age. On the contrary, since seventy years
old is the retirement age for professors at most private universities
in Japan, he would be no longer a university employee. Thus the
insurance he would carry is National Health Insurance with which he, as
a patient, covers 30 percent of his medical fees, and the government
the remaining. However, being eligible for Health Insurance for the
Elderly that is provided to those over seventy-five years old, he is
required to cover 20 percent of the cost, instead of 30 percent.
Consequently, his payment amounts to $4,800. Still, compared to the
former medical insurance plan for the elderly practiced from 1973 to
1983, which provided free medical treatment if you were over seventy
years old, today's plan has been compelling for the elderly with a
financial burden. Let me take one more example: My mother's case. She,
a National Health Insurance holder, died in 1989 at sixty-three years
old after an eight-month hospitalization with an initial eight-hour
operation. Except for the last two weeks when staying at a private
room, she was placed in a room of six patients covered by the
insurance. The total medical cost was approximately $6,000. In terms of
National Health Insurance, it has not changed much for some time.
Then, how much premium share do Japanese
people pay yearly for their
medical insurance in order to receive medical services as an inpatient
or as an outpatient? In case of people who hold Health Insurance of
Public Schools in Funabashi City, Chiba Prefecture, they pay 3.7
percent of their income. The premium also differs among municipalities.
Regarding National Health Insurance, take households in the above City.
The average premium share per household for the year of 2006 was
approximately $1,500. The premium share for National Health Insurance
differs among local governments, and it is collected on the basis of
income, property, and number of insured within a household.
Thus Japan's medical plans once rated
"excellent" have tremendously
changed. No more senior citizens go to a hospital with a trifle reason,
such as a light cold or an itchy eye since their medical cost is not
free any more. The good old days when older people went to see a doctor
with the second (or maybe the primary) hidden reason of meeting with
their friends and of entertaining themselves at a hospital lounge were
gone. Or the days when anyone--a primary insurer of Health
Insurance--was treated just with the 1,000-yen (about $10) co-payment
also disappeared. With the rapid increase of the elderly population,
specifically one in every five people is over 65 years old in 2004 and
one in three by 2050, Japanese people are already gasping with a burden
of a high premium share. "Well, the only measure to avoid high medical
cost is," my friend's husband, who retired last March from a local
government, wrote in his e-mail, "to do our best not to become sick."
He is still sixty years "young" and has a fairly long way to go....
1) Non-Japanese citizens also receive the same health insurance
benefits as Japanese citizens do.
2) The public health insurance system provides almost universal
coverage. The occupation-based public health insurance (Health
Insurance)is further classified into three types of insurances:
Society-managed Health Insurance for large firm employees; Government-
managed Health Insurance for small and medium sized firm employees; and
Other Occupation-based Health Insurance for civil servants, private
school employees, day laborers, etc.
3) Regarding Health Insurance of the Elderly, if the patient's annual
income is more than 1,450,000 yen (about $14,500), he/she pays 20
percent of the cost. (This will be raised to 30 percent in October
2006.) Those whose annual income is less than the above amount pay 10
percent of the fees. If a patient is on welfare, all expenses are
covered by the government.
4) In both insurance plans-Health Insurance and National Health
Insurance, the co-pay is about $8.00.
5) Japanese insurance plans cover dental but does not cover vision.
6) Please note that the above description about the Japanese health
insurance system is simplified; the actual system is regulated in far
7) For your information, today's average premium share for
administrators and teachers at public schools in Connecticut are 15%
and 10%, respectively. With reference to the Norwalk public school
district, Connecticut, the premium share is 10% for both administrators
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