Are You Really Insured?

Text: Allan Jardine

I was called to a hospital recently to find one of my friends had suffered a serious health problem. I was duly signed in as his next of kin and experienced the intricacies of the Japanese healthcare system up-close and dirty.

All in all, the experience was not bad. He was very lucky, and will recover in about three months. He was initially misdiagnosed, a revolutionary drug available overseas was not available here, and we experienced racism when we had to change hospitals, but in the end he was admitted when I "negotiated a room." On the whole, the staff were kind and showed the sort of compassion and sympathy that had I experienced it in my native UK, I would have fallen over with shock and needed resuscitation myself.

But on to the main point - the hidden cost of medical care in Japan. Having previously worked in the Japanese medical industry, I was in a good position to understand what was going on. My friend was thankful that he had medical cover through his company. Nevertheless, I had to explain to him the financial issues that accompany a stay in hospital.

"I have medical insurance - right? I am covered" he said.
"Well yes ... and ... no."
"What do you mean?" he asked.
"Well you have insurance, but you are not fully covered" ... I went on ...

Let's clarify this - the Japanese national healthcare system (in this instance we include the so called "company provided" health insurance - through a healthcare union). These are schemes recognized by the Japanese government and for which a portion of your salary, say 9% is deducted.

Many foreigners in Japan believe they are covered by their medical insurance, well, ... not quite. Typically, the psychology is "But when I go to the doctor and he charges 5,000 yen, I pay say 1,000 yen (the co-payment) and the rest is covered, no problem!

Insurance is like a sports car, in normal traffic, it is difficult to judge the dynamics. If going to the doctor for some medicine at 5,000 yen is equivalent to rambling through traffic, it is when you are speeding along the highway at 200kph and a truck pulls out in front of you - that is when the handling and brakes get tested - but at that point, it is too late. The golden rule with insurance and medical insurance especially is you can never get it when you really need it.

Many foreigners do not know that hospital meals, laundry and "bed charges" are not considered "medical expenses" and are financially met 100% by the patient. With these add-ons plus the co-payment which is capped in high cost cases - EVEN if you are insured -treatment could cost around 300,000 yen cash per month depending on the room you request. So the full cost in my friend's case will be 800,000 yen paid in cash each month, and around 500,000 yen refunded three months later.

On this basis, if you have a six month stay in hospital it could cost 1,800,000 yen (300,000 yen x 6 months). What's more, the full amount needs to be cash-flowed for three months (2,400,000 yen = 800,000 yen x 3 months).

This figure only covers what I term 'direct and essential' hospital costs; it excludes other costs such as telephone, travel for relatives and friends as well as new clothing and equipment for recovery etc. And you thought you had medical insurance!

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