INTRODUCTION

 

The National Health Insurance scheme is a public medical insurance program in which all residents and foreigners with long-term visa must be involved. This is a mutual support system based on each member paying certain insurance premiums scaled by their annual income. The amount of this premium does not change the limit and type of services chartered.

Accepting the NHI plan does not make the medical provider a public servant.

 

ALL USERS OF THIS WEBSITE ARE ADVISED TO CALL YOUR INSURANCE PROVIDER (COMPANY OR CITY HALL) FOR QUESTIONS REGARDING COVERAGE. THE KING CLINIC is not in the position to answer these questions.

 

 

 

TWO MAIN MEMBERSHIPS

 

1. Kokumin Kenkou Hoken ("Kokuho")

        Municipal NHI, issued by the local government.

2. Shakai Hoken ("Shaho")

        Worker's NHI, issued by the individual companies and corporations people belong to.

 

Both plans mutually deliver the same service to the patients, and the medical fees are calculated by the government standard scales. There is no system as a "relative value" in this system, so if two exactly-identical medical services were provided by the equally-sized facility, the up-front co-payment should be about the same.

 

 

 

PATIENT FINANCIAL RESPONSIBILITY

 

The co-payments are due at the time of service.

THERE WILL ALWAYS BE A CO-PAYMENT.

 

Patients will not have to worry about filling out any insurance claim forms for the usual visit.

IT IS RECOMMENDED THAT NHI HOLDERS CARRY ENOUGH CASH TO BE SERVED.

 

 

 

FURTHER INQUIRIES

 

We kindly ask you to be guided by the issuer of your insurance about the system and your questions. THE KING CLINIC is not in the position to answer your questions.

 

 

 

INSURANCE COVERAGE

 

Please do not expect all the tests and procedures, that are routinely performed in North America, to be covered or done under the NHI scheme.  American standard is not a global standard, due to insurance policies. If you wish to be treated without being restricted by the NHI policy, please inform us that you are willing to be on your own for that visit.

 

Below is a brief list of coverage by the NHI. Patients must be aware that combination of A-C and any of the 3-16 will cause refusal of coverage by the NHI. Thus resulting in a complete scaling on private practice.

 

All procedures, treatment plans, prescription (dosage, strength, indication, usage and choice) and any tests must follow the NHI guidelines. Otherwise, patients must opt for non-NHI service. Please note that some services you may demand or expect (by the Western standard) may not be covered by the NHI.

 

If you expect higher quality of care and attention, along with enhanced accessibility, you will need to opt for the Non-NHI Credit Card Care.

 

COVERED

 

1. A.Acute and ongoing illness.
   

2. B.Chronic and/or pre-exisiting condition.
   

3. C.Tests and laboratory works with clinical indication. Patient may not request what they want to have tested for.
   

 

 

NOT COVERED

 

1. 1.Medical certificates / claim forms.
   

2. 2.Plastic cases and bottles for the prescription.
   

3. 3.Vaccines and other preventative measures of any method.
   

4. 4.Cosmetic surgery and medication/prescription.
   

5. 5.Normal pregnancy and giving birth.
   

6. 6.Abortion/contraceptive service.
   

7. 7.Injury due to an illegal or immoral act or personal fight, injury or illness as a result of being drunk or caused by a traffic accident. These are the perpetrator's responsibilities, and patient must compensate the service up-front, for medical provider cannot intervene the cases.
   

8. 8.Self-inflicted illness or injury.
   

9. 9.Medical checkup, health examination, or screening.
   

10. 10.Laboratory tests exceeding the NHI limits.
    

11. 11.Treatment/prescription exceeding the NHI or Japanese dosage and strength.
    

12. 12.Treatment or prescription not approved in Japan or not accepted by NHI.
    

13. 13.Second opinions.
    

14. 14.Discussion or seeking advice over normal medical examination result, vaccinations, travel medicine, alternative medicine, recommendations, etc.
    

15. 15.Simultaneous consultation over the same condition to multiple providers.
    

16. 16.Prolonged service charge.
    

17. 17.Photocopy, telephone, fax, mailing, and shipping fees with handling charges.
    

 

 

TIPS

 

As you may imagine from the general view, what you may have felt surprised by your experience(s) at some of the Japanese hospitals/clinics, could have been caused by the NHI scheme, and the doctors that are "brain-washed" by this system (and obviously, of the cultural differences).

 

For instance, a surgical admission. It is not because of the skills or level of practice that makes hospital stays longer in Japan.

1. ★The insurance does not grade the medical providers.
   

2. ★The higher the bed turn-over rate is, the higher the hospital income is... not like in the States, where longer stay will give higher income (but lower grading).
   

3. ★More Japanese patients feel safe and happy to be “allowed” to stay longer. (The shorter the stay, the more they feel “refused” or unimportant.)
   

4. ★At times, insurance may refuse coverage if post-surgical stay is too short (being suspicious of a “good practice”).
   

 

 

Our wish is to lessen patients' misunderstanding and under-evaluating the Japanese medical standards. The medical "standards" and "science" is one of the highest you can probably get on this planet. It is usually the language, the cultural concept, the mentality, and the regulation that may be discouraging the recipient. The whole system works quite well amongst the local society. Majority of the citizens spend less time with the doctor. Thus the "Government" probably have never thought about the possibility of a single patient spending close to an hour in the doctor's office (they most likely "know" but ignoring the fact). So, without understanding the difference and the background of the Japanese medical service, foreigners in Japan can be surprised (or at time under-evaluate the Japanese medicine). It is very easy to see what the NHI restriction can do, by focusing into the Japanese dental services... and why many internationally known private insurance providers decline from covering dental services in North America.

 

The government and insurance companies are essentially similar, when they think of how much they are willing to compensate for the subscribers: Less the better.

 

At THE KING CLINIC, we struggle to provide our patients the best of what we can do to meet the Western logics and mentality, patients should be aware that you should not expect this kind of service to be available at many of the local hospitals/clinics. So, if you are opting a Japanese style hospital/clinic and choose the NHI as your health insurance, you are mutually agreeing to accept the "Japanese way". WE MUST ALSO ADMIT THAT THE NHI WILL OBLIGE US TO FOLLOW THEIR RULES, so if you want the Western service, please opt for the NON-NHI SERVICE AT THE KING CLINIC.

 

If any patient is seeking for a better medical attention and service, what about considering a private insurance and visiting a Western-minded medical provider, including THE KING CLINIC?

 

Being a member of the NHI means being a part of the Japanese society. The basic sense people have in Japan is that it is not a gathering of independent-and-individual people, but each people is a part of the community, just as one leaf of a huge tree.

 

 

 

ADDITIONAL FACTS

 

Some may be aware of the fact that Japan is one of the "long-life" nation, and at the same time ranking in the 7th place for the annual medical expense per person (USA is 2nd) and only 7.2% of the GDP (19th place in the world. USA: 14.0% = 1st place).

This means, "high medical outcome, with low expense". Isn't it ideal?

 

This extremely low payment to the medical providers is one of the reason (although the scientific standards are high) that the medical service and care are poor compared to the Western nations.