NHI or private insurance?

#1
Another non-cycling query...

For those that have been living in Japan long-term I'm curious to know what you may have done regarding health insurance. Have you used the National Health Insurance scheme, gone private or risked it with no cover? What have your experiences been, any complications or recommendations?
 
Jan 14, 2007
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#4
Will be getting my knee operation on NHI in January.
Besides Japanese hospitals being relatively cheap anyway...NHI is enough I think.
I'll pay 30% of the operation about 80,000. The 20,000 yen MRI only cost me 6000.
The same operation in Australia without insurance would run close to $20,000 with the doctor charging about $7000.

I also have the cycling insurance which I've never had a chance to use in 8 years of having it.

With a family of four the NHI has been costly over the years but I feel safe with it.
Private insurance doesn't put anything back into the system, (unless the insurance company hedges it's risk by buying hospitals) at least the payments to NHI go towards building hospitals, buying equipment etc. Private insurance profits end up in the pockets of investors and do nothing to help bring down the cost of health care.
 

kiwisimon

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Dec 14, 2006
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#5
I don't like the fact that I would pay taxes to supposedly support a system that is already bloated and wasteful. NHI is upsidedown already and it will only further add to the internal debt in years to come.So premiums will rise on a lesser number of young working folk and the coverage will gradually lessen. As I can't vote this is the best I can do to tell the government "up yours you morons" If they were in private business they would all get the sack at 08:01 on Monday for being inefectual.
Oh boy that felt good.


Private life and health for me. I pay more each month but get 100% coverage.

Depends how long you want to stay here I guess.
 

kiwisimon

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Dec 14, 2006
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#6
. Private insurance profits end up in the pockets of investors and do nothing to help bring down the cost of health care.
I prefer to let markets determine the cost of health care. All those repitive visits by old people to get a shippu changed everyday (which are charged as full consultations by the hospital) also do nothing to bring the cost of health care down.
 
Sep 2, 2009
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#7
So yeah, got out of hospital this morning after suffering a savage double Aura Migraine that was so bad the ambulance staff thought I was having a cerebral hemorrhage. They carried me out of my kitchen and got me to the hospital (don't remember that bit).

MRIs, blood work, all sorts of machines that go ping, painkillers, etc.

And let me tell you this; I am bloody glad I had NHI.
 

joewein

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Oct 25, 2011
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#8
Private life and health for me. I pay more each month but get 100% coverage.

Depends how long you want to stay here I guess.
Legally you don't have a choice if you live here: If you're not a company employee covered by some company employee scheme, you are required to join 'kokumin kenko hoken', even if you already have private medical insurance coverage that you signed up for in your home country. At least that is what I was told.
 
Sep 2, 2009
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#9
Yeah, I think it is something like that.

Loads of shady agencies don't pay into it for employees (saves them money, as they are liable for half the contribution) and get around that by claiming their employees are not working full time hours (over 29.5 hours per week).

That is set as the threshold of investigation by the tax guys, and they generally will not investigate anything up to this point with companies not enrolling their employees on the insurance package. The reality is, there are millions here working what are essentially full time hours, who are not enrolled as they should be because their employers are money grabbers with shite business models.

Very shady, and causes a lot of heartache (sometimes literally) for a lot of people.
 

kiwisimon

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#10
Legally you don't have a choice if you live here: If you're not a company employee covered by some company employee scheme, you are required to join 'kokumin kenko hoken', even if you already have private medical insurance coverage that you signed up for in your home country. At least that is what I was told.
no not true, legally you are required to be insured, the rest about NHI is BS. or was last time I asked a senior health official.
 

kiwisimon

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#11
Yeah, I think it is something like that.

Loads of shady agencies don't pay into it for employees (saves them money, as they are liable for half the contribution) and get around that by claiming their employees are not working full time hours (over 29.5 hours per week).

That is set as the threshold of investigation by the tax guys, and they generally will not investigate anything up to this point with companies not enrolling their employees on the insurance package. The reality is, there are millions here working what are essentially full time hours, who are not enrolled as they should be because their employers are money grabbers with shite business models.

Very shady, and causes a lot of heartache (sometimes literally) for a lot of people.
and then there are small businesses struggling that (a) want to keep their employees employed (b) cant afford the co=pay. You think they should just close up and sack everyone?
Of course businesses want healthy employees but first they want to be a business.

Your brushes are very broad and very black and white, we live in a multi colored world my friend.
 

joewein

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Oct 25, 2011
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#12
Yes, you are required to be insured, but only certain insurances are recognized, and all of these happen to be Japanese. As far as Japanese law is concerned foreign insurance does *not* count even if it covers you internationally, according to what I (and my wife) were told by the social security department of my city at the time.

One of our "experts" obviously was not telling truth, or one of us misunderstood or perhaps even the law changed at some point. I sure sure would like to know.
 

jdd

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#13
I've been "a member" of the private school mutual aid association for about 25 years (an alternative the NHI). No choice really, but it has served me very well a few different times. Kids have never had anything serious, but it's always been there, in case. (wife works so she's health-insured on her own, and hers covered two child-births) On two hospitalizations (one of which was a bike crash) I've had the cap on the monthly max co-pay kick in.

I also tick the options for some extra coverage for a private room, and to tack on some life insurance for me, and a bit for the wife, and kids.

Not sure about NHI, but on my system I get a yearly physical, too. At 61, the value of that is little more than it was at 35.
 

Phil

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#14
As I'm self-employed, I pay for the kokumin kenko hoken for myself and the family. It's my largest single tax bill (I consider it tax as that's what it is back in Canada), but money worth spent. We haven't had anything major yet, but as Pete points out health care bills are low here anyway and 30% rarely amounts to anything significant. You can get supplemental private 入院 (hospital stay) insurance, but as far as I can tell it really isn't worth it for anyone who has at least a few man-en in the bank for emergencies.
 
Sep 2, 2009
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#15
and then there are small businesses struggling that (a) want to keep their employees employed (b) cant afford the co=pay.
Oh boo hoo! It is not as if this system has suddenly been forced upon them; they will have known before they set up their business that this was the way things work. Also there are a load of small businesses who DO make the payments as well. The system may indeed be restrictive, but that is the society we are living in, and those are the rules.

And for the record, I agree that it is not perfect.
 

theDude

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#16
Yes, you are required to be insured, but only certain insurances are recognized, and all of these happen to be Japanese. As far as Japanese law is concerned foreign insurance does *not* count even if it covers you internationally, according to what I (and my wife) were told by the social security department of my city at the time.

One of our "experts" obviously was not telling truth, or one of us misunderstood or perhaps even the law changed at some point. I sure sure would like to know.

Yup, that's right. Unless it has changed in the last couple of years (I don't think so), you are obliged to be part of the National Health Insurance scheme. There is a list of reasons why you would not need to (like being a diplomat, part time student, and some others i don't remember).

Of course you can get away without it, many do. Probably not a big deal for you. However, it can cause trouble for some things, as in, the Health ID card is an ID here, and not having one may make it difficult with people/organizations that would like to see it.

A couple years ago there was a bill to require showing national health in order to renew a visa. That didn't pass, but I think they are starting to figure out many don't have it and should according to the laws here.

From a cash flow perspective, the private health stuff I am familiar with operates on a reimbursement schedule, as in, you pay full price at the hospital and claim it back later.
 

jdd

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#17
Yup, that's right. Unless it has changed in the last couple of years (I don't think so), you are obliged to be part of the National Health Insurance scheme {or some alternative legally authorized option}. There is a list of reasons why you would not need to (like being a diplomat, part time student, and some others i don't remember).
...
Another positive thing is that the system here is blind to pre-existing conditions. Someone with a condition, or a condition in the past (e.g. past colon polyps, or "successfully" treated cancer) (or a smoker, something I personally would object to), is treated just like the next person before or after them in line.

Additionally, I know of a retiree or two who have come here recently, and without having to show that they've worked/lived/resided/paid in for some minimum number of years, they can get health coverage.

I know of two people with conditions, which would be pre-existing conditions if they returned to the states, who stay here simply because those conditions would kind of bankrupt them in the US market, while here, they're treated as equals. I'm completely cool with that.

Even someone who has gone years here without paying into the system, can join and begin receiving benefits.

Finally, even those who decline NHI or some legal alternative, are benefiting from the system, since insurers here (and the gov't) control the cost of drugs and treatment on your behalf. You are getting that cheaper health care since costs are controlled by the insurers that you are opting not to pay into.

Go figure.

You may not be insured, and think you may not need it because costs here are low, but the costs here are low because most everyone is insured, and because there is some serious negotiation by insurers to control those costs.

***

Sure, my insurance rates are based on my salary, and I think they are high. Also, I think it's odd that since my wife works full time, she has to pay according to her salary, and we are not classified as a family unit. Yep, we're paying "more than we should"--call me dumb, but I think that's as it should be. We're not rich, but we're comparatively well off, and the wife has never mentioned or worried about this at all.

And that's the way it works here, and I'm of the opinion that it works pretty well. If you don't like it, try Korea, or China, or the U.S., and see how well you do there.
 

Phil

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#18
Another positive thing is that the system here is blind to pre-existing conditions...try Korea, or China, or the U.S., and see how well you do there.
Yeah, nicely said. Maybe I'm biased, but after living in three countries with (different forms of) universal health coverage, it boggles my mind that anyone would want to live anywhere that doesn't. I'll take "inefficient" over non-existent any day.