## [2] Health and Medical Services

## (1) Health Care Insurance

## Health Care Insurance System

Outline of Health Care Insurance System

(As of January 2013)

System	Insurer (as of the end of March 2012)	Number of subscribers (March 2011) [Insured Families 1,000 persons]	Insurance benefits	Financial resources
Medical care benefits	Cash benefits	Premium rate	State subsidy
Co-payment	High-cost medical care benefit, Unitary high-cost medical/long-term care system	Hospital meal expenses	Hospital living expenses
Health Insurance	General employees	JHIA-managed Health Insurance	Japan Health Insurance Association	34,877 [19,631]	After reaching compulsory education age until age 70	(High-cost medical care benefit system) • Maximum co-payment (Persons younger than 70) (High income) ¥150,000 + (medical fee - ¥500,000) × 1% (General) ¥80,100 + (medical fee - ¥267,000) × 1% (Low income) ¥35,400 (Persons aged 70 or older but younger than 75) (More than a certain level of income) ¥80,100 + (medical fee - ¥267,000) × 1% (General (•)) ¥62,100, outpatient (per person) ¥44,400 (Low income) ¥24,600, outpatient (per person) ¥8,000 (Extremely low income) ¥15,000, outpatient (per person) ¥8,000 • Per-household standard amount If more than one person younger than 70 pay ¥21,000 or more in a single month, per-household standard amount is added to the benefits paid • Reduced payment for multiple high-cost medical care For persons who have received high-cost care three times within a twelve-month period, the maximum co-payment of the fourth time and up will be reduced to: (Persons younger than 70) (High income) ¥83,400 (General) ¥44,400 (Low income) ¥24,600 (Persons aged 70 or older with general or more than a certain level of income (•)) ¥44,400	(Co-payment for meal expenses) • General Per meal ¥260 • Low income Per meal first 90 days ¥210 Per meal after 90 days ¥160	(Co-payment for living expenses) • General (I) Per meal ¥460 + Per day ¥320 • General (II) Per meal ¥420 • Per day ¥320 • Low income Per meal ¥100	• Sickness and injury allowance • Lump-sum birth allowance, etc.	10.00% (national average)	16.4% of benefit expenses (16.4% for Support coverage for the late-stage elderly)
Society -managed Health Insurance	Health Insurance Societies 1,443	29,504 [15,553]	Before reaching compulsory education age until age 70	(General) ¥80,100 + (medical fee - ¥267,000) × 1% (General (•)) ¥62,100, outpatient (per person) ¥44,400 (Low income) ¥24,600, outpatient (per person) ¥8,000 (Extremely low income) ¥15,000, outpatient (per person) ¥8,000	(General) ¥460 + Per day ¥320	Same as above (with additional benefits)	Different among health insurance associations	Fixed amount (subsidy from budget)
The insured under Article 3-2 of the Health Insurance Act	Japan Health Insurance Association	18 [12] 6	Before reaching compulsory education age 20%	(General) ¥80,100 + (medical fee - ¥267,000) × 1% (General (•)) ¥62,100, outpatient (per person) ¥44,400 (Low income) ¥24,600, outpatient (per person) ¥8,000	(General) ¥460 + Per day ¥320	Same as above (with additional benefits)	Per day Class 1: ¥390 Class 11: ¥3,230	16.4% of benefit expenses (16.4% for Support coverage for the late-stage elderly)
Seamen's Insurance	Japan Health Insurance Association	132 [59] 73	70 or older but younger than 75	(General) ¥80,100 + (medical fee - ¥267,000) × 1% (General (•)) ¥62,100, outpatient (per person) ¥44,400 (Low income) ¥24,600, outpatient (per person) ¥8,000	(General) ¥460 + Per day ¥320	Same as above (with additional benefits)	Per day Class 1: ¥390 Class 11: ¥3,230	9.45% (sickness insurance premium rate)	Fixed amount
Mutual aid associations	National public employees	20 mutual aid associations	9,189 [4,523]	20% (*) (30% for persons with more than a certain level of income)	(General) ¥83,400 (General) ¥44,400 (Low income) ¥24,600 (Persons aged 70 or older with general or more than a certain level of income (•)) ¥44,400	(General) ¥460 + Per day ¥320	Same as above (with additional benefits)	-	None
Mutual aid associations	Local public employees, etc.	64 mutual aid associations	9,189 [4,523]	20% (*) (30% for persons with more than a certain level of income)	(General) ¥83,400 (General) ¥44,400 (Low income) ¥24,600 (Persons aged 70 or older with general or more than a certain level of income (•)) ¥44,400	(General) ¥460 + Per day ¥320	Same as above (with additional benefits)	-	None
Mutual aid associations	Private school teachers/staffs	1 Corporation	Municipalities 1,717	Municipalities 35,197	(General) ¥83,400 (General) ¥44,400 (Low income) ¥24,600 (Persons aged 70 or older with general or more than a certain level of income (•)) ¥44,400	(General) ¥460 + Per day ¥320	Same as above (with additional benefits)	-	-
Mutual aid associations	Farmers, self-employed, etc.	Municipalities 1,717	Municipalities 1,717	Municipalities 35,197	(General) ¥83,400 (General) ¥44,400 (Low income) ¥24,600 (Persons aged 70 or older with general or more than a certain level of income (•)) ¥44,400	(General) ¥460 + Per day ¥320	Same as above (with additional benefits)	-	41% of benefit expenses, etc.	47% of benefit expenses, etc.
Mutual aid associations	Retired persons under Employees' Health Insurance	Municipalities 1,717	Municipalities 3,116	Municipalities 35,197	(General) ¥83,400 (General) ¥44,400 (Low income) ¥24,600 (Persons aged 70 or older with general or more than a certain level of income (•)) ¥44,400	(General) ¥460 + Per day ¥320	Same as above (with additional benefits)	-	-	-
Late-stage medical care system for the elderly	[Implementing bodies] Wide area unions for the late-stage medical care system for the elderly 47	14,733	10% (30% for persons with more than a certain level of income)	10% (30% for persons with more than a certain level of income)	(General) ¥83,400 (General) ¥44,400 (Low income) ¥24,600 (Persons aged 70 or older with general or more than a certain level of income (•)) ¥44,400	(General) ¥460 + Per day ¥320	Same as above (with additional benefits)	-	-	-
Late-stage medical care system for the elderly	[Implementing bodies] Wide area unions for the late-stage medical care system for the elderly 47	14,733	10% (30% for persons with more than a certain level of income)	10% (30% for persons with more than a certain level of income)	(General) ¥83,400 (General) ¥44,400 (Low income) ¥24,600 (Persons aged 70 or older with general or more than a certain level of income (•)) ¥44,400	(General) ¥460 + Per day ¥320	Same as above (with additional benefits)	-	-	-

(Note) 1. Insured persons of the late-stage medical care system for the elderly includes those aged 75 or older or 65-75 certified as having a specific disability by a wide area union.

2. Persons with a certain amount of income include those with a taxable income of ¥1.45 million (monthly income of ¥280,000) or more, those in households of two or more elderly with a taxable income of ¥5.20 million, and those of a single elderly household with a taxable income of ¥3.83 million. Persons with a higher income are considered to be those with a monthly income of ¥530,000 or more (annual income of more than ¥6 million for NHI). Persons with a low income are considered to be those who belong to a municipal-tax exempt household. Persons with an extremely low income are considered to be those with a pension income of ¥800,000 or less, etc.

3. The fixed-rate national subsidy for National Health Insurance shall be at the same level as that of Japan Health Insurance Association-managed Health Insurance for those exempt from application of Health Insurance and those and their families that newly subscribed to the National Health Insurance on and after September 1, 1997. The average national subsidy for the respective National Health Insurances, being based on the FY2013 budget (plan), was 42% of the benefit expenses, etc.

4. The numbers of subscribers are preliminary figures. The sums in the breakdown may not equal the total due to rounding.

6. The premium rate of Seamen's Insurance is the rate after the deduction resulting from the measure to reduce the burden of insurance premiums for insured persons (0.35%).