Shield Medical Care System from Abusive Short-stay Foreigners

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Concerns are increasingly being voiced about Japan's high-cost medical care system. Generously, it aims to reduce the out-of-pocket expenses of patients facing high medical expenses. However, one particular gripe is whether it should be applied to foreigners who are in Japan for only a short stay.

Foreigners who reside in Japan for more than three months for study or work are covered by the National Health Insurance (NHI) system. These individuals are required to pay 30% of their medical expenses themselves. They may also apply for a reduction of medical expenses under the High-Cost Medical Treatment System.

A problem arises, however, when people who know they have an illness come to Japan under the pretext of studying or working. Many of these people then receive the benefits of Japan's medical system during their brief stay.

In short, a person coming to stay in Japan for medical purposes is not eligible to join the National Health Insurance scheme. Cases in which unqualified individuals take advantage of the system must be thoroughly rooted out.

Japan's Diet Takes a Look

Yuichiro Tamaki, leader of the Democratic Party for the People (DPFP), has commented on this on social media. He notes, "The current system allows people to receive high-cost medical care benefits worth tens of millions of yen while here for a 90-day stay." Then he adds, "It should be revised so that it is applied more strictly."

Meanwhile, in the Diet, the Japan Restoration Party (Nippon Ishin no Kai) has called for closing loopholes that allow fraudulent use. Responding, Health, Labor and Welfare Minister Takamaro Fukuoka said, "We want to grasp the actual situation while working to ensure proper use."

Who is Eligible

When the revised Residential Basic Book Act (Residential Registration Act) took effect in 2012, the alien registration system was abolished. Since then, foreigners staying in Japan for more than three months have been required to register as residents. And if their stays have passed three months, they are now eligible to join the NHI scheme. Previously they had to reside in Japan for at least one year to be eligible.

The time has come for the Ministry of Justice, the Ministry of Health, Labor and Welfare, local governments and other relevant parties to work closely together to strictly manage residence status. At the same time, we should consider tightening enrollment requirements.

*Juntendo University Hospital in Tokyo.*

How the NHI System Works

Japan's NHI system was launched in 1961. Even if you get seriously ill or have a serious accident, you can receive treatment without incurring excessive out-of-pocket expenses. That is the way it is supposed to work. And it does, thanks to the mutual support of fellow enrollees in the NHI system who paid insurance premiums while they were healthy.

Universal health insurance is an asset that Japan can display with pride to the world. And one of the pillars that supports it is the National Health Insurance scheme.

We must not tolerate "free riders" who try to reap the benefits without having paid insurance premiums in the past.

Medical expenses are forecast to continue to rise in Japan due to declining births and an aging population. If the misuse of high-cost medical care benefits goes unchecked, it will undermine trust in the public health insurance system. That could also poison the debate over the burden of medical expenses.

Author: Editorial Board, The Sankei Shimbun

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