Policy Shift Aims to Boost Compliance
Japan’s ruling Liberal Democratic Party (LDP) is advocating for a policy shift that would require foreign residents to pay national health insurance (NHI) premiums upfront during their enrolment process. The proposal, developed by a dedicated party committee, aims to improve the low premium payment rates among non-citizen residents.
Under current regulations, foreign nationals living in Japan for over three months are obligated to join the NHI scheme if not covered by employer-based insurance. However, a Ministry of Health, Labor and Welfare review found that only 63% of foreign residents are paying their NHI premiums, compared to a 93% rate across all enrolees, including Japanese citizens.
The proposed model would introduce a prepayment requirement, whereby premiums for a specified period would be collected immediately at local government offices during enrolment. The LDP committee attributes the shortfall in premium collection partly to a lack of understanding of Japan’s taxation and social insurance systems among non-Japanese residents. To address this, the group recommends disseminating information on the insurance framework before individuals enter Japan, ensuring better awareness of their obligations.
The committee’s proposal also includes measures to enhance policy enforcement, such as sharing information about unpaid premiums for use in immigration-related decisions and regularly publishing data related to premium collection and disbursement. These steps aim to improve system transparency and policy accountability.
This policy initiative coincides with a broader investigation by the Japanese government into how foreign residents engage with the public health insurance system. The Ministry of Health is analyzing the balance between contributions made and benefits received by non-citizen enrolees, with results expected by mid-year.
In the fiscal year ending March 2024, about 970,000 foreign nationals were registered in the NHI, representing 4% of the system’s total participants. During that period, the system disbursed approximately ¥980.3 billion in reimbursements, with ¥11.8 billion (around 1.2%) paid to foreign enrolees. While a ministry official noted that this figure was proportionate to the group’s share of total membership, some policymakers have expressed concern that the current structure might allow temporary residents to access high-cost treatments with minimal personal contributions.
