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- The Payment Contect of Japanese Public Health Care Insurance
2025-12-15The Payment Contect of Japanese Public Health Care Insurance
January 20, 2020, Japan's former Prime Minister Mr. Abe pointed out that, in the, the densely populated generation (in Japanese “団塊の世代”) is moving towards the age of 75 in 2022, and the trend of ageing population is inevitable, which will bring a huge burden to the workforce, hence, the government is urgently looking into ways to prevent the increase of burdens.
January 18, 2021, the Japanese government announced that, by raising the ratio of healthcare expenses to be paid by those over 75 years of age, lowering the prices of 70% of medicines, and adjusting national budgets, the government had achieved a reduction of over 600 billion yen in the burden of healthcare on citizens through the 204th policy speech.
With the worsening labour shortage situation, it is expected that Japan's public health insurance benefits will continue to be adjusted downward in the future. According to the Japanese government's plan, it will continue to implement the policy of raising consumption tax rates to supplement healthcare budgets with a portion of the increase in national revenues. It is expected that by 2025, reforms of the public health insurance policy for elderly, especially those over 75 years of age, will be completed, including reduction of fixed commitments, modification of age-specific commitment ratios, regulation of the range and amounts of the public insurance coverage items, and to further implement medical product assessment and pricing programs, etc.
As of 2022, Japan's public health insurance payments are mainly categorized into medical payments and cash payments. Medical payments include a range of nursing expenses, while cash payments include lump-sum maternity and childcare benefits, funeral expenses, injury and illness allowances, and maternity subsidies.
In this passage, Kaizen will base on information from the Ministry of Health, Labour and Welfare and related regulations, briefly introduce the payment content of Japanese public health care insurance, for a reference to Kaizen’s existing and potential clients. Kaizen do provide services on enrolment of Japan insurance and calculation of payroll for Japan companies, please contact our consultants for further information.
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Home-Nursing Fees
The medical expenses for home-nursing (in Japanese “訪問看護療養費”) refers to the fees incurred by a person who receives nursing care from an eligible nursing service provider.
Insurance companies pay the expenses directly to the specified nursing service provider, and the insured person pays only the portion of the expenses that they are responsible for. Payment of the medical expenses for home-nursing is based on a ratio of contributions toward the expenses. For example, home-nursing patients aged 6 or older to under 70 years old should pay 30% of the expenses, and the remaining 70% will be covered by the home-nursing fee, as shown in the table below
Applicable groups
Deductible Ratio
Below 6 years old (before enrolment of compulsory education)
20%
Above 6 to below 70 years old
30%
General income group aged 70 or above to below 75
20%
General income group aged 75 or above
10%
Higher income group aged over 75
20%
Non-retired income group aged or above
30%
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Dietary Treatment Expenses for Inpatients
Dietary treatment expenses for inpatients (in Japanese “入院時食事療養費”) refers to a food expenses required for dietary treatment. From April 1, 2006, the standard changed from 1 day to 1 meal, the amount of dietary treatment expenses for inpatients is calculated by the standard amount specified by the Minister of Health, Labor and Welfare minus the average household budget and the average amount of expenses required to provide meals.
According to the Ministry of Health, Labor and Welfare, as of April 2022, the standard contribution for dietary care will be as shown in the table below, i.e., the portion below the following amount will be paid by the patients themselves, and the portion exceeding that amount will be paid by the dietary treatment expenses for inpatients.
Applicable groups
Standard Deductible Rate (Japan Yen)
General public
460 Per Meal
Low-income group
210 Per Meal
Low-income group with treatment over 90 days
160 Per Meal
Over 70 years old and extreme low-income group
100 Per Meal
In fact, the above standards may vary slightly depending on the insurer. For example, in the inpatient meal allowance policy implemented by the National Health Insurance Association has additionally set a standard of 260 yen per meal for patients with difficult and complicated illnesses, and for children with chronic and specific illnesses (excluding family members exempted from the resident tax)
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Living Support Expenses for Inpatients
Living support expenses for inpatients (in Japanese “入院時生活療養費”) is an allowance for aged 65 or above who are staying in a hospital for convalescence as a benefit to the enrollee's patients. If the participant is dependent, the cost of hospitalization will be paid as family care.
The above living convalescence refers to the convalescence that provides a suitable environment for convalescence in terms of temperature, lighting, food, water supply, and so on. The amount of fees to be paid is calculated by subtracting the standard cost for living during convalescence from the basis amount calculated from the average cost for living during convalescence.
The standard cost for living during convalescence is determined by the Minister of Health, Labor and Welfare based on the average household food and beverage expenses, utility bills, etc. The standard living infirmary care burden may be additionally adjusted downward in special cases stipulated by the Minister of Health, Labor and Welfare, such as those with low incomes, serious illnesses, or those who are undergoing multiple treatments. The standard costs for living during convalescence are shown in the table below (not applicable to specified patients with complicated illnesses or other persons specified by the Minister of Health, Labor and Welfare):
Applicable groups
Standard Deductible Rate (Japan Yen)
Dietary Expenses
Accommodation Fee
General public
460 Per Meal (420 Per Meal when specific conditions are met)
370 per day
Low-income group
(Remark 1)
210 Per Meal
370 per day
Very low-income group
(Remark 2)
130 Per Meal
370 per day
Old Age Welfare Pension Recipients
100 Per Meal
370 per day
Remark:
(1) Low-income group refers to exempted from the resident tax.
(2) Extreme low-income group refers to people whose annual pension income does not exceed 800 thousand yen.
Applicant who’s previously held general passenger vehicle transportation service
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High-Cost Medical Expenses
High-cost medical expenses (in Japanese “高額療養費”) refers to a reimbursement amount which the inpatients have paid a cost which has exceed the regulated cap limit of deductible rate. Inpatients can claim this high-cost medical expense from the insurer.
The regulated cap limit of deductible rate is determined by the age and income of the insured. According to the Ministry of Health, Labor and Welfare, as of 2022, the regulated cap limit of deductible rate applied from August 2018 is shown in the tables below:
Table 1 Cap Limit for Persons Aged 70 or Above
Applicable groups
Cap Limit for a Single Month (Japan Yen)
Non-Retired
Annual income of more than 11.6 million yen
252,600 + (Medical Expenses -842,000) ×1%
Annual income of 7.7 to 11.6 million yen
167,400＋Medical Expenses -558,000) ×1%
Annual income of 3.7 to 7.7 million yen
80,100＋ (Medical Expenses -267,000) ×1%
General persons (Annual income of 1.56 million to 3.7 million yen)
57,600
Person exempted from the resident tax
24,600
Person exempted from the resident tax (Annual income less than 800 thousand yen)
15,000
Remark：Individuals over the age of 70 and family members exempt from residential tax are eligible for the individual outpatient limit of ¥ 18,000 per month and 8,000 per month, respectively.
Table 2 Cap Limit for Persons Aged 69 or Below
Applicable groups
Cap Limit for a Single Month (Japan Yen)
Annual income of more than 11.6 million yen
252,600＋ (Medical Expenses -842,000) ×1%
Annual income of 7.7 to 11.6 million yen
167,400＋ (Medical Expenses -558,000) ×1%
Annual income of 3.7 to 7.7 million yen
80,100＋ (Medical Expenses -267,000) ×1%
Annual income of 3.7 million yen or below
57,600
Person exempted from the resident tax
35,400
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Lump-Sum Allowance for Childbirth
Lump-sum allowance for childbirth (in Japanese “出産育児一時金”) refers to an allowance target to reduce the financial burden of necessity arising from the birth of a child. The allowance payment is based on the Health Insurance Act (in Japanese "健康保険法") etc. Generally, Mothers who are eligible for the allowance and give birth after four months (85 days) of pregnancy are entitled to the lump-sum allowance for childbirth of 420,000 yen per newborn baby.
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Burial Charges
In the event of the death of a participant for reasons other than employment, an amount of 50,000 yen will be paid as funeral expenses (Japanese “埋葬料”) to a person who depended on the said participant for his/her livelihood and who carried out the burial work of the said participant. In addition, in the event of the death of a participant's dependent, the same amount of 50,000 yen will be given as family funeral expenses (“dependent's burial charges).
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Injury and Sickness Allowance
Injury and sickness allowance is an allowance that will be paid when the insured person is unable to receive adequate remuneration from the employer due to rest from sickness or injury. Only employees and their family members whose company have joined the Japan health insurance association (in Japanese “全国健康保険協会”), health insurance society administers insurance (in Japanese “健康保険組合”), and mutual aid association (in Japanese “共済組合”) are eligible for the injury and sickness allowance. Individuals who have joined the national health insurance (such as farmers, or unemployed persons, etc.) are not covered by the injury and sickness allowance.
Normally, the daily amount of the injury and sickness allowance is calculated by 1/ 30 of the average monthly standard remuneration, for the most recent 12 months, and multiplied by 2/3. The calculation criteria may be changed in some cases, please refer to the enrolled public health insurance schemes for the actual amount.
Members of the mutual aid association are entitled to a payment period of no more than 1 year and 6 months in total. For other members who are eligible for the allowance, the payment period is any duration within 1 year and 6 months from the starting date of the allowance, with no further allowance being paid for the same disease after 1 year and 6 months. At the time being, certain insurers are aligning the standard for everyone to the standard of the members of the mutual aid association.
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Childbirth Allowance
Childbirth allowance (in Japanese “出産手当金”) refers to an allowance which the insured person unable to receive wage from their employers due to maternity leave. Only employees and their family members whose company have joined the Japan health insurance association, health insurance society administers insurance and mutual aid association are eligible for the childbirth allowance. Individuals who have joined the national health insurance (such as farmers, or unemployed persons, etc.) are not covered by the childbirth allowance.
Generally, the daily amount of the Maternity Allowance is calculated by 1/ 30 of the average monthly standard remuneration, for the most recent 12 months, and multiplied by 2/3. The calculation criteria may be changed in some cases, please refer to the public health insurance policy in which enrolled.
Childbirth Allowance is payable from 42 days before the date of delivery until 56 days after the date of delivery. If the date of delivery is postponed, the payment of the allowance will be valid even if the expected date of delivery and the actual date of delivery has been postponed. In the case of multiple pregnancies, the starting date of payment is advanced to 98 days before the date of delivery.
Kaizen with experienced team of professionals, providing services of company formation, registration, and application for several types of permits/licenses and subsequent maintenance, tax planning and auditing services, please consult our consultants for more details.
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Disclaimer
All information in this article is only for the purpose of information sharing, instead of professional suggestion. Kaizen will not assume any responsibility for loss or damage.
WhatsApp/Line/Wechat: +852 5616 4140
All information in this article is only for the purpose of information sharing, instead of professional suggestion. Kaizen will not assume any responsibility for loss or damage.
WhatsApp/Line/Wechat: +852 5616 4140
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