As an American, I had little experience with medical care before living in Japan for two years. Like many people in the States, my health insurance situation had often been spotty, which meant I found myself in Japan with 23 years of long-standing health issues to address. Luckily, under Japan's National Health Insurance, or Kokumin Kenkō Hoken (国民健康保険), I could finally end my cycle of total bodily neglect and take affordable steps toward a healthier life.
Since I come from the viewpoint of a previously uninsured American, the beginning and end of this article will focus on the emotional side of taking care of your health in Japan. However, the bulk of my advice is for anyone who's looking to dip their toes into the Japanese healthcare system in their (perhaps limited) time in Japan. I'll break everything down step by step, from deciding where to go, to paying for treatment, to tackling the language barrier with Japanese physicians.
After reading about my experiences, I hope you'll feel more empowered to swing by a doctor while you're a resident of Japan!
Table of Contents
- Encountering Japanese Healthcare as an Uninsured American
- Cost of National Health Insurance
- Things to Know Before Going to the Doctor
- Where Should I Go?
- Tips for Going to the…
- Cultural Differences Between Japanese and American Healthcare
- Maintaining Your Health in Japan
- How to Stay Healthy When You Return to the US
Encountering Japanese Healthcare as an Uninsured American
To foreigners from countries with a less predatory healthcare system than the US, Japan's national health insurance might not seem like such a big deal. But to the approximately 30 million uninsured Americans who avoid the doctor like the plague, having access to affordable medical care in Japan is nothing less than life-changing. And on top of those who are uninsured, millions more under insured Americans suffer from high premiums, inadequate coverage, and unreliable insurance tied to their job that they could lose at any time. Unfortunately, this leads to a fair number of Americans landing in Japan less healthy than they could be.
When I first arrived in Japan, I was so used to shrugging off health problems that getting them fixed didn't even cross my mind. In fact, the idea of using my Japanese health insurance to address my chronic medical issues didn't occur to me until I'd already lived there for a year and a half. My conditioning may be on the extreme side, but many Americans grow up learning to weather their ailments and simply "power through" to avoid medical expenses. I explained this to many Japanese doctors and was always met with astonishment and pity.
Japanese healthcare is generally so cheap and easy to access that almost everyone does it, a lot.
So to any traumatized Americans, if you need someone to tell you it's okay to go to the doctor instead of sitting around hoping that giant knife wound magically heals itself, here it is. Your health matters, and you are allowed to get help. In fact, no one will blink an eye at you seeking medical assistance in Japan, even for minor issues. Japanese healthcare is generally so cheap and easy to access that almost everyone does it, a lot.
If you're worried about dealing with doctors in a foreign country and language, I understand — it's an intimidating task. And as a person predisposed to medical anxiety with a lifetime of avoidance to overcome, I know how hard it can be emotionally as well as logistically. But you deserve a healthier life than our country has often allowed us. So if you can set down any baggage you're carrying and summon the courage to trust the Japanese healthcare system, I think you and your body will be glad you did, for years or even decades to come.
Cost of National Health Insurance
Okay, now that I've encouraged you to hightail it to the doctor, you'll need to know how to get a medical issue checked out using Japanese health insurance. If you're wondering about the difference between National Health Insurance (Kokumin Kenkō Hoken) and Employees' Health Insurance (Kenkō Hoken), check out Verity's Tofugu article on Surviving Japan's Medical System. Here, I'll explain how to use that handy dandy insurance card to get some medical visits done in Japan.
Paying the Monthly Bill
Of course, there are quite a few logistics to work out at your local ward office once you get to Japan, and health insurance is one of them. Not to worry — if you've successfully conveyed that you're there because you're new to the country, you'll eventually be ushered to the health insurance window.
Every foreigner who has a residence visa that lasts over three months is legally required to have health insurance in Japan. Both national and employees' health insurance covers roughly 70% of your medical expenses, leaving you with the other 30%. That extra 30% is occasionally subsidized or covered by your employer's accident insurance, but otherwise you'll shell it out yourself.
Every foreigner who has a residence visa that lasts over three months is legally required to have health insurance in Japan.
After you receive your little paper health insurance card at the ward office, you'll receive a monthly bill in the mail. You can pay this bill at any convenience store or sign up for automatic withdrawal from your bank account at the ward office. Sometimes, in addition to the regular monthly bill, you'll get a whole wad of bills that you can use to pay for six months' worth of insurance at once. As a student with only part-time jobs, I handed over a measly 1,300 yen a month, so I often paid for half a year at a time (with glee!).
How much you pay in premiums per month is made up of two parts: a base fee and an income-based fee. The base fee is about 10,000-40,000 yen per year. The income-based fee scales up or down depending on your previous year's salary. But good news — If you've just landed, your previous year's income in Japan is zero, so you'll only pay the minimum amount possible. That's approximately 10,000-15,000 yen annually for your first year in Japan. Congrats, patient!
The Point System
Now that you've paid your bills, how much will it actually cost at the doctor's office to get your eleventh toe looked at? Well, it's all based on a magical standardized point system devised to make sure medical procedures typically cost the same amount, no matter where you go in Japan. Before I knew this, I naively sent an email asking how much a test would cost at a particular clinic. The secretary's answer was, kindly, "the same as anywhere else!"
It's all based on a magical standardized point system devised to make sure medical procedures typically cost the same amount, no matter where you go in Japan.
So although what's covered by insurance occasionally varies between places — especially among dentists, I've found — you can generally look up how much things cost beforehand. If you can read and/or muddle through Japanese, you can look up the name of what you want done on a medical website called Shirobon Net to find out its point value.
Under the point system, every medical procedure is assigned a point value. One point equals 10 yen, so if a certain test or exam is 85 points, that means it's 850 yen total. But by presenting your health insurance card, you'll only have to worry about 30% of that, or 255 yen. As an American, do you see how I often walked out of clinics feeling like I robbed them? The cost will depend on your specific medical needs, of course, but less intensive visits will generally be extremely affordable.
Cost of Seeing a Doctor
The biggest expense of seeing a doctor in Japan is often just that: the fee to see the doctor at all. You'll have to dish out a "first-time exam fee," or shoshinryō (初診料), every time you go to a new medical facility. This can range anywhere from 1,000 to 3,000 yen or a bit more, especially if it's a highly specialized clinic. Next time you come back, though, the "returning exam fee," or saishinryō (再診料), will probably be around 1,000 yen or less.
Because of this system, there's an incentive for you to keep coming back to the same place. That's why I recommend you get cozy with any clinics you end up liking or small hospitals without a sentei ryōyōhi (more on that later). This way, you'll only pay the first-time fee once. All in all, the shoshinryō is unavoidable, but since the cost of treatment itself tends to be low, it usually isn't too big of a pill to swallow… no pun intended.
Cost of Treatment and/or Medication
But just how low is low? Once you've dumped your first-time fee on the counter, now comes the time to pay for your actual treatment. Naturally, surgery and more intensive procedures will cost more. My most expensive trip to the doctor had me shelling out about 13,000 yen, but that was because I had some tests done using big fancy machines.
This repeated cheapness gave me such a level of trust that I eventually stopped looking up prices for low-level exams.
However, less invasive procedures are typically much cheaper than that. Most items on my medical receipts are below 100 points, or less than 1,000 yen total. This repeated cheapness gave me such a level of trust that I eventually stopped looking up prices for low-level exams, because they were rarely above the few thousand yen burning a hole in my wallet.
On top of treatment, you'll also have to buy whatever drugs they dealt you to cure your recurring athlete's foot. Again, the cost of medication will vary, but it is typically quite affordable. I never paid more than 800 yen for a month's worth of basic anti-inflammatory pills — often less, around 300-400 yen, if I bought several months' worth at a time.
Further lessening drug costs, generic medications tend to be pushed over brand names in Japan as of late, so the pharmacist will likely ask whether you're okay with generics. Drug prices themselves are also set by the government in Japan, meaning that no matter what pharmacy you go to, you shouldn't have to worry about getting bamboozled.
Things to Know Before Going to the Doctor
Now that you know how much going to the doctor is (or rather, isn't) going to ruin you yen-wise, you're ready to just stride on into the hospital, right? Wrong! Before you do that, you should know what documents to bring, what you're going to say, how to fill out the intake questionnaire, and a little about how prescriptions work in Japan.
What to Bring
You'll want to bring some essential documents to every appointment, regardless of whether it's your first time there. These include your beloved health insurance card, residence card, and if you have one, your plastic registration card, or shinsatsuken (診察券), for that particular medical facility. Shinsatsuken are used to keep track of your appointment history at each doctor's office.
Your kusuri techō holds stickers from the pharmacy with information about every medication you take, or have taken, in Japan.
Also, be sure to keep your little paper notebook of medication records, or kusuri techō (薬手帳), handy if you're taking any prescription drugs. If you don't have one yet, your first trip to a Japanese pharmacy will likely fix that for you. Your kusuri techō holds stickers from the pharmacy with information about every medication you take, or have taken, in Japan. Often doctors and nurses will ask to see it, so I suggest carrying it with you all the time.
But keep in mind that you can't refill prescriptions with your trusty booklet alone. Each time, you'll need a fresh prescription document, or shohōsen (処方箋), before they'll hand over the good stuff. More on that in the Filling Your Prescriptions section.
Overcoming the Language Barrier
Alright, you've got your cash and IDs in hand and are itching, perhaps literally, to get out the door. But wait — how do you say "hemorrhoids" in Japanese?
Scrambling over the language barrier to get your creams can understandably be a daunting prospect, especially in any kind of medical crisis. You can look up English-speaking doctors, especially in or around Tokyo and the Kansai area, which can be a good option. Just know that some are known to charge more than regular Japanese-only doctors, and they may be hard to find outside of urban centers.
Japanese doctors often know advanced medical terms in English even if they don't speak much or any other English.
So if you do go with someone who may not speak English, here's my advice: Write out and practice what you're going to say beforehand. Assuming you have at least a beginner's grasp on Japanese, start by looking up what your medical conditions and symptoms are called in Japanese. Then, string together any amount of sentences you can to explain your issue.
For example, asthma is zensoku (喘息), breath is iki (息), and dizziness is memai (めまい or 目眩). After looking those words up, you could use some simple Japanese to say, Iki ga tsurai desu. Memai shimashita. Zensoku desu ka? or "It's hard to breathe. I got dizzy. Is it asthma?" Don't worry too much about wowing them with perfect grammar or syntax. Your health comes first, and even broken Japanese will probably do the job.
Even if you barely speak the emperor's nihongo,1 this strategy can get you surprisingly far. In fact, if you know basic to intermediate Japanese, you'll probably be able to rely on your own skills, preparation, and Google Translate alone. Plus, Japanese doctors often know advanced medical terms in English even if they don't speak much or any other English, so that may put your mind at ease.
And if all else fails, you can always show the doctor a phone note with your typed-out Japanese explanation, or a Japanese webpage about what you think is wrong with you. If you're really having trouble communicating, the doctors and nurses may even edit their speech down to baby talk. Don't be afraid to break out your miming skills, either. As long as everyone gets their point across somehow, you should be okay.
But if you're already bleeding out and have no time for research, I suggest calling a mentor, supervisor, or friend to help you in any way possible. Maybe they can tell you what to say on the phone, steer you to the nearest medical facility, or even show up in person to interpret. I've been that person, and trust that in an emergency, you'll likely be able to find someone who doesn't mind lending a hand.
That said, try not to overuse your friends for their free interpreting services. It's definitely worth checking whether there's someone from your school, dorm, or workplace whose job it is to help you. And who knows? Maybe you can take the opportunity to brush up on your medical Japanese.
Speaking of the language barrier, there's another potentially tricky hurdle to clear. The first time you show up at a new doctor's office, you'll have to fill out a medical history questionnaire, or monshinhyō (問診票). Typically, this form just asks you standard questions about why you came to the doctor, what your symptoms are, and whether you have any preexisting conditions or are taking any medications.
The first time you show up at a new doctor's office, you'll have to fill out a medical history questionnaire, or monshinhyō (問診票).
If you're at an intermediate-advanced N2-ish level of Japanese, you'll probably be fine with a little Googling. However, if you'd prefer not to sweat over large kanji medical terms at the doctor's office, sometimes an English form is available. In fact, if the secretary clocks you as a foreigner, they may outright ask you if you want the English version. And if they don't offer it, you can always ask.
But if you can't read Japanese, you haven't brought anyone who can, and there's no English questionnaire, I recommend just taking the form up to the desk wearing your best "confused foreigner" expression. Throw in a polite Sumimasen, yomenai desu. Tasukete kudasai, or "Sorry, I can't read this. Please help me," for good measure. The receptionist will likely take pity on you and ask you the questions in simpler Japanese or English to basically fill it out for you. Either way, don't let this scare you away from going to the doctor in Japan. The forms tend to be pretty similar, so once you get used to it, you'll be churning out questionnaires (or sheepishly asking for assistance) like you were born to do it.
Additionally, here's a great resource: Multilingual Medical Questionnaires written in Japanese and many other languages, including English. I've never tried using one of these forms, but filling one out and taking it to the doctor certainly can't hurt. It's also a great study resource to use before you break every bone in your body in a foreign country.
Filling Your Prescriptions
I've covered what to bring to the doctor and how to make yourself at least somewhat understood. But after you've done that, how do you get your paws on that sweet, sweet medical-grade ointment they prescribed you?
Well, it can be a little complicated. Here's another surprise that Japanese healthcare had in store for me: Prescriptions aren't refilled automatically. Every prescription expires in four days under the national healthcare system, so the vast majority of prescriptions are filled the same day, usually at the pharmacy next to the hospital or clinic. For better or worse, this means you have to show your mug to the doctor and get a new shohōsen (処方箋) every single time you want medication.
Here's another surprise that Japanese healthcare had in store for me: Prescriptions aren't refilled automatically.
How did I find this out, you ask? Shamefully, I once tried to present my kusuri techō (薬手帳) with the information sticker about my medication to the pharmacist, as if that was enough. Fool! Without a fresh prescription hot off the press, I wasn't getting any of my curative elixirs.
This rule holds true even if you're treating a chronic condition, so go ahead and get chummy with your physicians, because you'll be seeing a lot of them. Such frequent visits can be inconvenient, so it's worth asking for the longest prescription you can get at a time. Otherwise, hopefully you don't mind catching up with your doctor regularly in order to get your hands on your usual suppositories.
Where Should I Go?
You're now armed with some general knowledge of how things will probably shake out when you first go to a doctor in Japan. But where exactly should you go? Depending on the severity of your ailment and the equipment required to test for or treat it, you've got some options.
If you go to a hospital that you randomly found, you may find yourself paying an extra fee, so be sure to learn more to avoid that. Or at least remember this handy rule of thumb — go to a clinic or a small hospital first, especially for mild symptoms.
In the US, your family physician is often the first person to see for non-urgent medical situations, like a skin rash or a cough. But in Japan, you can have that kind of relationship with multiple doctors, narrowing down who you want to see depending on what type of care you need. At first, your go-to doctors will usually be the ones at clinics or small hospitals.
Clinics tend to include the speciality and words like 診療所, クリニック, or 医院, which basically all mean "clinic."
Clinics are smaller than hospitals, in terms of inpatient beds and medical staff. Japanese clinics can have up to nineteen inpatient beds, but many small local clinics don't have any at all. They are often family-owned or run by a single doctor and specialize in a certain type of care, such as naika (内科, or internal medicine) or jibika (耳鼻科, or ENT).
Usually you can tell by the name which facilities are clinics and which are hospitals. Clinics tend to include the speciality and words like 診療所, クリニック, or 医院, which basically all mean "clinic." Look for these words, and you can't go wrong.
As mentioned, going to a clinic first is usually a good option, especially for mild symptoms and non-severe injuries. If the doctor at the clinic decides you need to get tested or treated at a hospital, they'll write you a referral letter, like the ailing VIP you are.
Japanese hospitals can have more inpatient beds than clinics (twenty or more), though hospitals come in different sizes. You'll find everything from tiny hospitals in your neighborhood to massive hospitals. However, in general, they consist of various departments of specialty and have more advanced equipment compared to clinics.
The sentei ryōyōhi is a fee that was created to encourage people to go to a clinic or small hospital first for mild symptoms or assessment.
So why don't you just skip a clinic and go straight to a hospital for more high-tech treatments? Technically, you could do that, but you may want to be careful to avoid extra fees — sentei ryōyōhi (選定療養費), especially when going to a large hospital that has 200+ inpatient beds.2 The sentei ryōyōhi is a fee that was created to encourage people to go to a clinic or small hospital first for mild symptoms or assessment. This keeps people from overcrowding large hospitals, which are usually busy providing special care to patients with severe conditions who really need it. So if you visit a large hospital without a referral, you may have to pay this fee, which is 5,500 yen or more. It is a bit costly compared to other medical costs in Japan, which are usually generously affordable. I've also found that some hospitals charge double — 11,000 yen, so it can easily be more than what you are paying for treatment! And more importantly, you can help out larger hospitals by not going without a referral, so I highly recommend avoiding it when you can.
However, this doesn't mean you shouldn't go to a hospital without a referral at all. It's actually worth considering going to a small hospital. See if your local hospital provides 外来診療 (outpatient care), and also whether they welcome patients who don't have a referral. Check their website to see if there's a disclaimer about the sentei ryōyōhi fee or a warning to bring a referral letter on their website. You can consider this a sign of being not-so-friendly to patients without a referral. Otherwise, it's worth stopping by to see if this hospital could be your new convenient stomping (or limping) ground.
The biggest reason to check out your local hospital? This is case-by-case, but some small hospitals function as a hub of different kinds of clinics.
The biggest reason to check out your local hospital? This is case-by-case, but some small hospitals function as a sort of hub of different kinds of clinics. For me, it actually worked out perfectly — a local tiny hospital offered varied outpatient care without a referral, and it became my go-to place for medical care. So if you can, check whether there are any small hospitals like this near you. If there are, you might be able to use it for most of your medical needs and kill two birds with one kidney stone.
And if you do decide to give a small hospital a shot, do some research first. Many of them offer outpatient care between certain hours of the day, rotating doctors of different specialties throughout the week. For example, at the hospital I went to, on Mondays the orthopedic surgeon and mental health specialist showed up, Tuesdays were the neurologist and dermatologist's time to shine, and so on. So be sure to check the outpatient care schedule online, or try calling the hospital beforehand to make sure the doctor you want will actually be there.
Whether you hit up a hospital or a clinic or both, you'll almost certainly find yourself in a Japanese pharmacy, or yakkyoku (薬局), at some point. Medical facilities tend to have their own pharmacy parked right next door — probably so patients can fill their prescriptions before they rapidly expire in four days. And though these pharmacies are often small, I've never had a problem with medications being out of stock. That said, drugstores like Matsumoto Kiyoshi and Sundrug can also have pharmacists on staff. Just don't forget your fresh prescription, or you'll be out of luck.
Though these pharmacies are often small, I've never had a problem with medications being out of stock.
The pharmacist will take your shohōsen prescription, kusuri techō booklet, and health insurance card. Then, they'll supply you with your healing potions, explain the wizardry they do in your body, and tell you when to take them.
If you space out and miss some of the explanation, consult the paper envelope the drugs came in. It should say something helpful like ichinichi ikkai, nerumae (１日１回 寝る前), or "once per day, before bed." Also, the envelope will say how long the prescription is and how much you should take at a time (e.g. １錠 ２８日分, or "1 pill a day for 28 days"). When in doubt, Google Translate is your friend.
Speaking of confusion, here are a few extra tidbits that stood out to me as a foreigner about Japanese pharmacies. For one thing, they often carry a variety of special snacks and nonperishables, if you fancy buying your apple juice and Lexapro at the same time. Another surprise was how talkative the pharmacists were with me, often asking a lot of questions about what I needed the meds for, as well as striking up conversations about my hobbies and ethnic background.
Admittedly, this may simply be what happens when a foreigner enters a building in Japan. But also, due to how frequently people access medicine in Japan, perhaps patients tend to have closer relationships with Japanese doctors and pharmacists on the whole. Maybe I just happened to encounter a lot of chatty Chihiros, but it's definitely something to be prepared for.
Tips for Going to the…
At this point, you've been briefed on the basics of going to Japanese medical establishments without making too much of a baboon out of yourself. Now, I'll offer some guidance on dealing with various types of specialists based on my own adventures with seeking medical care in Japan.
I've only included the kinds of doctors I have specific advice on, so this isn't an exhaustive list. Also, keep in mind that my perspective is one of a cisgender Asian-American woman who speaks Japanese and has not experienced any body type discrimination in Japan. Thus, I'd like to point out that other foreigners may have different experiences from mine, and any negative tidbits I mention shouldn't deter you from seeking help in your own area.
And with those disclaimers out of the way, now for some hot tips!
General Practitioner of Internal Medicine (内科)
If you're looking for a direct equivalent to a Western general practitioner, you can try to find a sōgō shinryōka (総合診療科). Doctors of internal medicine, or naika (内科), also serve a similar purpose. You can find these doctors at your nearest hospital or general clinic who will ask you the typical questions about what's wrong with you, give your heartbeat a listen, and direct you to a specialist if needed. For primary care, regular check-ups, and refilling some chronic prescriptions, a general doctor may be your first stop.
The first time you meet a naika doctor, they may take interest in who you are, where you come from, and any other factoids you can offer about the interesting foreign creature you've deposited in their office. Like my pharmacists, my general doctor was endlessly curious about how I got interested in Japanese and the details of my ethnicity, all of which he took meticulous notes on. Then, any other doctor I saw at that hospital could access those notes and comment on my hobbies or recommend nearby Southeast Asian restaurants to me as well. It caught me off guard at first, but after a while I found the rapport oddly nice, and often rather amusing.
I know other foreigners who have buddy-buddy relationships with their naika doctors too, so it may be a pattern. This makes sense; your local doctors probably don't get to interact with foreigners every day, especially if you live outside of Tokyo. So be prepared for a conversation about where the heck you came from while you're getting your fingers sewn back on. And if you find a naika doctor you like, don't be afraid to keep coming back — they've probably already memorized your family tree anyway.
Despite the friend-like rapport you may have with your naika doctor, or perhaps because of it, you might not want to present any sexual health issues to them. Rather, I suggest you and your inflamed nether regions pay a visit to a gynecologist or urologist.
In Japan, gynecologists are called fujinka (婦人科), or somewhat anachronistically, a "ladies' clinic" in English. A Japanese gyno can help you buy birth control, get an abortion, or conduct STI tests. A urologist, on the other hand, can conduct vasectomies, screen for diseases, and test for STIs in male sex organs.
Bear in mind that some medications that you can get over the counter in countries like the US require a doctor's approval in Japan, including the morning-after pill. Activism to make the morning-after pill available OTC is ongoing, but for now, you'll have to hike to your nearest OB/GYN to get a prescription. Especially if you're used to buying this pill freely, the extra red tape can be irritating to wade through in Japan. Just know you're not alone in the frustration.
From my experience helping a friend get the morning-after pill, the gynecologist will almost certainly prescribe it to you after some fairly awkward explanation of why you need it. This is one of those cases where hand gestures might prove useful. Also, I recommend calling it the "after pill," or afutā piru (アフターピル), as the English loanword seems to offer more polite euphemistic distance than the native Japanese kinkyū hinin'yaku (緊急避妊薬), or "emergency contraceptive."
Sadly, contraceptives in general aren't covered by Japanese insurance, so the morning-after pill will cost about 10,000-20,000 yen, plus the consultation fee. Hopefully change is on the horizon though, so keep your eyes on the news and your feet in the stirrups for the latest information.
Mental Health Specialist (メンタル)
After dealing with the bureaucratic hoopla surrounding contraceptives in Japan, you may find yourself in need of a mental health specialist. If you're looking to try medication and/or therapy through a counselor or psychiatrist, they are definitely available at some Japanese hospitals, clinics, and universities. Just look for the word "mental" (mentaru, メンタル) or "psychiatry" (seishinka, 精神科) to track down the brain doctor of your choice.
A word of warning: Due to differing levels of mental health awareness in Japan, psychological services can be hit-or-miss. Fortunately, activism on topics like depression, body image, and self-care has been gaining some traction on Japanese social media, especially among young people. But old ways of thinking are still entrenched in the system and slow to change, so leaving any newfangled and/or Western expectations at the genkan3 may help preserve your sanity.
For therapy, I actually suggest first trying virtual meetings with a professional from your country, both to avoid the language barrier and any cultural differences that may make it harder for you to receive care. Either way, no matter where you seek help, the first therapist you see may not be the right fit for you. So don't be afraid to shop around and ask for references from people you trust, even in Japan.
As far as medication goes, several psychiatric drugs commonly used in the US, like Adderall and Prozac, are illegal in Japan. Also, because of a recent rise in concern among Japanese doctors about the addictiveness of anti-anxiety meds, you may even have a hard time convincing anyone to prescribe you technically legal "benzos" like Xanax. Instead, they may give you SSRI antidepressants such as Lexapro, even if you're treating anxiety or panic disorder and not depression. In any case, be sure to look up what's legal and know that you might be in for a sour surprise if you want a specific medication that's hard to get in Japan.
Eye Doctor or Ophthalmologist (眼科)
Taking care of your eyeballs can also be a bit different in Japan. When you take a Japanese eye test, you probably won't encounter the Roman alphabet, but the Landolt C chart. This chart is made up of C shapes rotated in different directions, so just say left (hidari), right (migi), up (ue), or down (shita) to indicate where the gap in each C is. If you're blind enough, the practitioner may just stand in front of you holding a paper with a big C on it, taking a step back and physically rotating it each time you answer.
But once you and your peepers have performed embarrassingly, how do you buy glasses and contacts in Japan?
On one hand, glasses are super cheap and easy to get — just stroll into any glasses store and tackle the eye chart on the spot for a new prescription. Many foreigners, especially ones with lower (read: less expensive) prescriptions, stock up on cheap frames from chains like JINS, Zoff, and OWNDAYS when they visit Japan. Prices are often below 10,000 yen, definitely more affordable on average than in the US. Even though glasses aren't covered by Japanese health insurance, they usually won't break the bank either.
For contacts, though, you'll first need to learn the word "ophthalmologist," or ganka (眼科), and then take yourself to one for a more thorough eye exam. Unfortunately, you may have trouble finding a ganka that doesn't require you to buy contacts directly from them in order to get a prescription. This can be troubling if you're looking for a specific length or brand that place doesn't carry, or if you'd simply rather buy contacts for cheaper online.
If you find yourself in this situation, you can always "try out" or buy a small amount of the ganka's contacts, make sure to get a full explanation of your new prescription before leaving, and order more online from wherever you want when you get home. It might feel a little shady, but you have the right to know exactly how horrendous your vision is and buy the contacts that are best for you.
But if you want to buy contacts from outside of Japan, here's a potential shock to foreigners: You can't import more than two months' worth of contacts into Japan without a customs declaration. Sometimes contacts with non-Japanese packaging will accidentally get by this requirement, but if not, you may get a perplexed email from the shipping company asking how large of a supply you ordered. If you exceed the limit and get caught, you'll probably have to let them be returned to sender. It's a pain, but good to know before you try to build a Jenga tower of contacts from overseas.
And now for perhaps the least enjoyable medical institution of them all, the dentist — shika (歯科), or more commonly referred to as haisha (歯医者). For any Americans with a dubious health insurance history, this may be your first time gracing the dentist's chair in a while. If so, you'll still be fine, but you might want to mention it on the medical questionnaire before they judge you for your disintegrating chompers.
Japanese health insurance covers "necessary" dental procedures, including cleanings, tooth pullings, and metal and (usually) composite fillings. On the other hand, it excludes anything cosmetic, such as whitening and orthodontia. Tragically, gold fillings over 14 karats aren't included either, to the dismay of Japanese pirates. The intake form may ask you whether you want only materials and procedures that are covered by insurance, but if it doesn't, I advise mentioning it to the dentist beforehand.
Also, Japanese dentists are known for splitting up procedures into many appointments, so another request you might want to make is for them to (kindly) speed it up. Let them know you're open to having more than one cavity filled per visit. Of course, it all depends on your circumstances — my dentist angelically agreed to do wisdom tooth surgery for me on the spot the first day I met him, as I only had three weeks left in Japan. Don't procrastinate as much as I did, but do communicate honestly about your situation. It'll probably be worth it.
Getting Your Wisdom Teeth Removed
On the subject of those wily third molars, I do recommend getting them pulled in Japan if you need to. Granted, you won't be knocked out unless you specifically request general anaesthesia, which will require a few nights in the hospital and cost more in the end. For these reasons, people usually just get a heavy dose of local anaesthetic for tooth removal in Japan.
As frightening as this sounds, don't worry! Being awake while the dentist yanked one sideways wisdom tooth out of my skull was surprisingly painless, and only took about 15 minutes. If this weenie can handle it, I'll bet you can too. Plus, the surgery cost me a mere 3,000 yen, or 4,000 yen including painkillers. For scale, tooth removal can easily be hundreds or even thousands of dollars in the US, so Americans especially may want to entrust their pearly whites to Japan while it's cheap.
Cultural Differences Between Japanese and American Healthcare
That does it for my tips on specific kinds of healthcare in Japan. But what about more general cultural differences that apply in all areas of Japanese medicine?
When going to a doctor's office in Japan, the cultural considerations go beyond just trading your shoes for some dashing rubber slippers at the entrance. Truth be told, there are plenty of unique aspects to the Japanese health system, which can be especially jarring if you're a foreigner accustomed to certain norms you thought were universal. But luckily, not all of them are hard to get used to.
Ease of Going to the Doctor
What's one of the good differences? As mentioned, going to the doctor is less of a big deal in Japan than in the US. People casually roll into the hospital on their way home for any old thing, so don't be afraid to consult a doctor even for minor illnesses.
If you're an American, you may have to explain how the medical system in our country works.
That said, due to this low barrier to healthcare, some doctors in Japan may be a bit baffled or even skeptical if you go to them with a long-standing, untreated medical issue. Thankfully, no doctor has ever doubted me enough to withhold treatment, but I have received no shortage of openly befuddled reactions when describing why I didn't get help sooner. If you're an American, you may actually have to explain how the medical system in our country works (or, for many, does not). Accessing healthcare in Japan is usually a breeze, but remember that this ease may affect how you're received by doctors.
Different Views on Confidentiality
When more people feel comfortable going to the doctor regularly, doctors tend to amass huge amounts of data on patients. Don't worry too much — Japan does have the Act on the Protection of Personal Information (APPI), similar to HIPAA in the US, so your information is still technically protected. But the APPI isn't as specific to healthcare, so doctor-patient confidentiality can be a little more relaxed in Japan.
As mentioned, anyone who worked at my local hospital could access every last detail of all my visits through each doctor's exhaustive records. Usually my conversations with Japanese doctors happened within earshot of several other nurses, while American doctors tend to speak to you one-on-one in a private room. And pharmacists almost always inquired about exactly what issue I went to the doctor for, no matter how hard I wished they'd spare me the discomfort.
To make matters worse, after your annual health check, doctors may even inform your employer about any problems they detected that they think could affect your performance. Thus, prepare to loosen up about your medical info in Japan. You'll probably be fine, but you don't want to be caught off guard if news of your nasty case of hepatitis gets around.
Consent to Withhold Diagnosis
Another cultural difference that can occur between Eastern and Western healthcare? Doctors are allowed to withhold a serious diagnosis from the patient if the patient's family would like to keep it a secret. Potentially discomfiting, but true nonetheless.
Doctors are allowed to withhold a serious diagnosis from the patient if the patient's family would like to keep it a secret.
In 1995, the Japanese Supreme Court confirmed that physicians may overlook a patient's right to self-determination and cede the decision to the family. This non-disclosure is meant to spare the patient from living with knowledge of their illness, especially when the disease is terminal. If you've seen the film The Farewell starring Awkwafina, you know what I'm talking about.
These days, Japanese questionnaires often ask whether you'd want to know if you have cancer or if you'd prefer not to be told, so individualized consent is growing more common. But families still tend to be more involved in the decision-making process than in the West. Hopefully you won't run into any issues of medical autonomy during your time in Japan, but it's good to know regardless.
Foreigners Held to Japanese Body Standards
With any luck, you won't have to deal with terminal illnesses in Japan. But what will you more likely come face to face with? The expectation that you should fit into Japanese body standards, regardless of how you're a foreigner.
Japan still runs on an outdated BMI and waistline measurement system, so plenty of foreigners get told they should lose weight in the results of their annual physicals, which can feel (and be) discriminatory. If you happen to have a trimmer frame that falls within Japanese guidelines, you probably won't encounter any issues. However, if you're larger than most people in Japan, bear in mind that you may be the recipient of unsolicited advice from healthcare workers. Unfortunately, many aspects of Japan still aren't designed to account for different or foreign body types — even within the medical system.
Maintaining Your Health in Japan
At this point, you've got a handle on how to use Japanese national health insurance, where to get your lung fungus treated, and the cultural differences you'll navigate while doing so. Now, the onus falls on you to make sure that fungus stays vanquished.
This means attending any mandatory health checks at your school or work, scheduling follow-up visits if necessary, and keeping track of your medication(s). Since Japan is known for being conscientious about health — perhaps even overzealously so — you'll probably find keeping yourself alive fairly easy if you just follow the culture around you.
Annual Health Checks at School and Work
One of the most telling signs of Japan's zeal for personal health is the free annual physicals given at schools and workplaces. The ippan kenkō shindan (一般健康診断) might be a nuisance, but it can also be a good first foray into the vibes of the Japanese healthcare system. Often, you're required to schedule an exam every year, though during pandemic-related states of emergency, some places have been more lax about making you show up in person.
As any foreigner in Japan knows, you'll probably have to take the infamous chest x-ray at some point.
Naturally, this health check includes basics like measuring your height, weight, vision, heart rate, and sometimes teeth. But it can also involve more intensive procedures, like a urine test and blood sample, that you may be able to opt out of, depending on your school or employer.
However, as any foreigner in Japan knows, you'll probably have to take the infamous chest x-ray at some point. Every time I've had the displeasure, it's involved removing my shirt in a room full of my peers. Understandably, this may not be your idea of a good time. But it only takes a minute, and as long as you know it's coming, you can prepare to strip for your colleagues without feeling too emotionally scarred. Plus, when your results come back a few days or weeks later, you can brag about how little tuberculosis you've got in your lungs.
Medication Tracking Apps
You know what's coming for you at the annual health check, but what if you're already on the meds you need? A good way to keep track of all the drugs you're taking is to download a medication tracking app. There are Japanese apps, like EPARKお薬手帳, as well as English versions, but any one should do the trick.
You can enter information like the kind of medication you take, the dosage, which clinic prescribed it to you, and how much it costs. These apps can help you keep track of the Japanese names of your drugs as well. You can also set notifications that remind you when to choke down your giant horse pills, so I advise using one of these apps even if you only take one medication.
How to Stay Healthy When You Return to the US
And thus ends everything I know about the Japanese medical system. I wrote a lot of this article from my own experiences, so remember that your mileage will vary depending on where you live, your ability to communicate, and your specific health issues.
Even so, if you're in Japan for more than three months, I highly recommend exploring Japanese healthcare. I'm so grateful I did, because it allowed me to treat several decades-old issues that would've been much costlier to address in the US.
But now that I'm back home, I'm forced to stave off death within the markedly less friendly American healthcare system. Transferring chronic medical treatment from one country to another can be a complex task, but it's necessary in order to maintain the level of health you achieved in Japan. So, how do you make sure the elbow tumor you got zapped in Japan doesn't grow back in the States?
It depends on what drugs you're taking, but it's definitely worth asking your doctor to prescribe the longest dose you can legally buy at once.
My biggest piece of advice is to stock up a bit on medication right before you leave Japan. It depends on what drugs you're taking, but it's definitely worth asking your doctor to prescribe the longest dose you can legally buy at once. Even though my naika doctor usually prescribed me one month's worth of mild medication at a time, I was easily able to get three months' worth before I left simply by asking.
Additionally, your country and Japan may have different strengths and kinds of drugs available, which I suggest researching beforehand. If you got something special in Japan that isn't sold everywhere, be sure to make note of that and investigate your options in your home country.
But it's not only getting your last dose of meds that you have to worry about — you also have to get all your medical work done before your final few days in Japan. Prior to leaving the country, you'll need to make a last "goodbye" trip to the ward office to notify them that you're leaving. On that weepy occasion, you'll get the choice to hand over your insurance card right then and there or return it by mail sometime before you exit Japan. (And thanks to the Japan Post boxes located in many Japanese airport terminals, you may be able to put this off to the very last second.)
Either way, once you've turned your health insurance card in, you won't be able to use Japanese insurance anymore. So make sure you've filled your last prescription before the bureaucrats pry it out of your warm, healthy hands!
Continuing to Care About Your Health
Okay, you've packed your last round of pills, and the customs officer is giving you the raised eyebrow. Now what? Well, you might want to consider — just consider — taking care of yourself in the US as well.
Your continued well-being is worth investing time and effort into, even if you're not in Japan anymore.
If living in Japan was your first experience with true medical care, you may have fixed some long-standing issues, confronted past trauma, and/or overcome a chronic avoidance of doctors in your time there. That deserves to be honored! So, even if you unfortunately can't access healthcare as easily in the US, I still urge you to maintain that progress in whatever way you can. Maybe you qualify for government-run healthcare, maybe GoodRX can make your meds more affordable out-of-pocket, or maybe you can use your stock of Japanese medication until you find employer-based health insurance in the States. In any case, your continued well-being is worth investing time and effort into, even if you're not in Japan anymore.
Lastly, to anyone who learned how to value their own physical health and bravely ask for help when they need it for the first time in Japan: I'm with you. I hope you and I both carry that growth with us wherever we end up living next.
"The Japanese language" in Japanese. ↩
Hospitals with 400+ inpatient beds charge the extra fee, sentei ryōyōhi, but some hospitals with 200-399 beds don't charge this fee. Be sure to check their website or contact them to double check if you are not sure. ↩
The entrance to a Japanese home or building, where people typically remove their shoes. ↩