Japan Proposes Transparency Reforms, Reviews Foreigners’ Role in Health Insurance

Tokyo – Japan is advancing efforts to enhance transparency and oversight in its public health insurance system, alongside a comprehensive review of foreign nationals’ participation.

A recent committee proposal outlined several policy enforcement improvements, including mechanisms to share information on unpaid premiums for possible use in immigration decisions. It also called for the regular publication of data on premium collections and disbursements to bolster system accountability.

These measures coincide with a broader investigation by the Ministry of Health, launched in April 2025, into how non-citizens engage with the National Health Insurance (NHI) scheme. The ministry is assessing the balance between contributions made and benefits received by foreign nationals.

In the fiscal year ending March 2024, around 970,000 foreign nationals were enrolled in the NHI, accounting for 4% of total participants. During the same period, the system disbursed approximately ¥980.3 billion in reimbursements, of which ¥11.8 billion—roughly 1.2%—went to foreign nationals. A ministry official said this proportion aligns with their share of the system.

Despite this, concerns have emerged. Yuichiro Tamaki, leader of the Democratic Party for the People, questioned on social media whether temporary residents may be accessing expensive treatments while contributing minimally.

While no policy changes have been confirmed, officials say the ongoing review, set to conclude by mid-2025, could inform future reforms to the NHI framework. – News Agency