Japan investigating abuse of health insurance system by foreigners
Agency is looking into instances when foreigners joined public insurance by illegitimately obtaining residential status to skirt paying costly medical fees
The Japanese government has begun a nationwide inquiry into foreign residents exploiting the country’s public health insurance system, according to sources familiar with the matter.
The Health, Labour and Welfare Ministry is checking with municipalities to investigate cases involving foreigners who joined public insurance by illegitimately obtaining residential status partly to skirt paying costly medical fees, the sources said.
The ministry will compile the findings of the survey in the fall and discuss steps to prevent such abuse of the insurance system.
Japan had about 2.56 million foreign residents at the end of 2017, up for the fifth consecutive year, according to the Justice Ministry. Of the total, Chinese nationals accounted for the most, at 29 per cent, followed by South Koreans at 18 per cent, and Vietnamese and Filipinos, both at 10 per cent.
With the government planning to rely more on foreign labourers to compensate for the country’s shortage of manpower – anticipating more than 500,000 foreign workers by 2025 – foreign residents are expected to increase further.
In Japan, all residents including foreigners must enrol in a health insurance plan provided by their employers, which also covers their dependents, or enrol for national health insurance at their local municipal offices.
Even if they are not company employees, foreigners who stay in Japan for three months or longer for business or study purposes can apply for national health insurance coverage.
But there have been a string of occasions when foreigners have fraudulently obtained resident status, for example, by posing as students studying in Japan. In other cases, people whose family ties with foreign residents are questionable came from overseas to receive treatment in Japan.
Public health insurance coverage in Japan requires a policyholder to, in principle, shoulder 30 per cent of the cost at medical institutions, with the remaining amount covered by the policy, in exchange for paying the monthly premiums.
By taking advantage of the benefits of a high-cost medical expense plan, which puts a cap on the monthly burden, policyholders can bring down the cost of expensive treatment by several hundred dollars a month.
A Chinese man in his 60s was one such beneficiary of the scheme. Shortly after coming to Japan, he visited a hospital in Tokyo, accompanied by his son, who lives in the country. The man was listed as a dependent of the son, thus being entitled to health insurance benefits.
The total medical costs, including surgery and post-operative chemotherapy, for the man were 3 million yen (US$27,000), but he only paid 80,000 yen (US$712) himself and returned to China.
Yoneyuki Kobayashi, director of AMDA International Medical Information Center, said that the current system, which allows the high-cost medical expense plan to apply to foreigners who have just entered Japan, should be reviewed.
At the same time, Kobayashi said that foreigners should be able to receive standard medical services in the country.
“Discriminating against foreigners is out of the question, but the current insurance system can lead to reverse discrimination against Japanese people,” Kobayashi said.