It’s no secret that Japan is struggling economically. Instead of addressing these issues head-on, however, some politicians here are electing to focus on benefits “unfairly” given to Japan’s foreign residents.
In the latest example, one popular politician’s agitating against foreigners having access to high-cost medical coverage. However, an analysis shows that this problem isn’t really a problem at all.
The high-cost medical care reimbursement system
At issue is the system for reimbursement of high-cost medical care (高額療養費制度; kougaku ryouyouhi seido). The system, part of Japan’s national health care insurance program, reimburses patients whose medical care exceeds the country’s out-of-pocket maximum.
As outlined on this English-language web page, the cap differs based on one’s income. For someone of average income, this will be around 80,100 yen (USD $538) a month. If monthly accumulated charges exceed that amount, the government either reimburses the payee that amount or the payee can apply in advance for a Certificate of Application of Maximum Copayment Amount.
All of Japan’s residents – including foreign residents – must pay into the country’s health care program. The source of the current outrage is that foreign residents can qualify for coverage of high-cost healthcare after only three months in the country. Japan’s monthly medical insurance payment scales from 9,564 yen ($64) to 86,667 yen ($582) based on income and age. That means, theoretically, that a foreign resident with massive medical expenses can get more back from medical care than they pay into the system.
As noted approvingly by the right-wing Sankei Shimbun, Democratic Party for the People (DPFP) party chairman Tamaki Yuichiro first raised this issue on his X account on February 15th. “Under the current system, people can get tens of millions of yen in health care after a mere 90 days here – we ought to fix that and make it more rigorous.”
The DPFP is an up-and-coming political party that made large strides in the October Lower House election. While leaning conservative, according to the website Japan Choice, it’s tended to be positive or neutral on issues regarding foreigners in Japan. The party favors anti-hate legislation as well as strengthening multilingual support. It also, as I’ve written about before, seems to be keen on defending the rights of sex workers, particularly in Japan’s adult video industry.
Old xenophobia in new packaging
Such claims of foreign malfeasance aren’t new. For example, some on Japan’s right-wing claim that foreigners commit a disproportionate number of crimes in Japan (they don’t). Others have claimed foreigners absorb a majority of the country’s social welfare benefits (they don’t).
While some posters agreed with Tamaki, others shot back. “It’s not foreigners’ fault that Japanese citizens are suffering,” one wrote, blaming Japan’s current economic woes on politicians – and blaming politicians like Tamaki for stoking the flames of prejudice.
On his YouTube channel, Takami denied he was championing anti-foreigner sentiment or trying to drive foreigners away. He says he’s trying to crack down on residents who come to Japan to get loads of free health care.
The question is: are foreigners actually doing that?
The reality: Foreigners account for 1% of high-cost healthcare usage
Writing for Asahi Shimbun, reporter Otegawa Taro dug into the numbers. It’s true, theoretically, that even people with one-year work or student visas paying into Japan’s health care system can take advantage of the country’s high-cost health care premium coverage.
However, in reality, the number of foreigners who take advantage of the high-cost healthcare system is a tiny fraction of overall usage. Japan pays out 960.9 billion yen ($6.4B) in high-cost healthcare coverage every year. However, the amount used by foreign residents is 11.1 billion ($74M). That’s a mere 1.15% of the total.
Looking at this another way: There are, according to the Ministry of Justice, currently 3,311,292 foreigners living in Japan. Of those, according to the Ministry of Health, Labour and Welfare, 880,000 don’t qualify for healthcare. That leaves 2,431,292 paying health insurance premiums.
Based on 2023 data, foreigners in Japan make an average of 318,300 yen a month, or 3,819,000 yen yearly ($25,676). That means most owe 360,893 yen ($2,425) a year in health insurance premiums.
That means foreigners pay around 877.4 billion yen annually – or $5.8B – into the national health care system. Even if that number’s off by as much as 25%, it’s more than enough to cover the 11.1 billion yen in high-cost health care – and then some. Add to this that there are likely many cases where foreign residents pay into the program and leave without ever fully utilizing their benefits.
In other words, viewed as a whole, Japan’s foreign population is covering its healthcare costs just fine, thank you very much.
Additionally, Otegawa concludes that Japan already has a system to report and investigate healthcare fraud – i.e., people who came to Japan specifically to receive healthcare services for cheap. It’s investigated 34 cases between 2018, when the system was introduced, until May 2023. Of those, it’s revoked visas or demanded money back from people in precisely zero cases.
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