## [2] Health and Medical Services

## (1) Health Care Insurance

## Health Care Insurance System

Overview

Outline of Health Care Insurance System

(As of May 2014)

System	Insurer (as of the end of March 2013)	Number of subscribers (March 2011)	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	JHIA-managed Health Insurance	Japan Health Insurance Association	35,103 [19,871]	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 (°)) ¥44,400, 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 • Reduced payment for persons receiving high-cost medical care for a long period Maximum co-payment for patients suffering from hemophilia or chronic renal failure requiring dialysis, etc.: ¥10,000 (high-income patients younger than 70 receiving dialysis: ¥20,000) (Unitary high cost medical/long-term care benefit system) Reduced payment for persons whose total co-payments of health care and long-term care insurances for a year (every year from August to July of the next year) is extremely high. Maximum co-payment is determined carefully according to their income and age.	(Co-payment for meal expenses) • General Per meal ¥260 • Low income Per meal first 90 days ¥210 Per meal after 90 days ¥160 • Extremely low income Per meal ¥100	(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 ¥210 + Per day ¥320 • Extremely low income Per meal ¥130 + Per day ¥320 • Applicable to those aged 65 or older in long-term care beds * For patients with intractable diseases, etc. and thus in high need for inpatient medical care, the amount of co-payment is the same as standard co-payment for meal expenses	• Sickness and injury allowance • Lump-sum birth allowance, etc.	10.00% (national average)	16.4% of benefit expenses, etc.
Society -managed Health Insurance	Health Insurance Societies 1,431	29,353 [15,537]	After reaching compulsory education age until age 70	(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 (°)) ¥44,400, outpatient (per person) ¥44,400 (Low income) ¥24,600 (Extremely low income) ¥15,000	(General (I) Per meal ¥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	19 [58]	Before reaching compulsory education age until age 70	(General (°)) ¥44,400, outpatient (per person) ¥44,400 (Low income) ¥24,600, outpatient (per person) ¥8,000	(General (I) Per meal ¥420 + Per day ¥320	• Sickness and injury allowance • Lump-sum birth allowance, etc.	Per day Class 1: ¥390 Class 11: ¥3,230	16.4% of benefit expenses, etc.
Seamen's Insurance	Japan Health Insurance Association	129 [58]	Before reaching compulsory education age until age 70	(General (°)) ¥44,400, outpatient (per person) ¥44,400 (Low income) ¥24,600	(General (I) Per meal ¥420 + Per day ¥320	Same as above	9.60% (sickness insurance premium rate)	Fixed amount
Mutual aid associations	National public employees	20 mutual aid associations	9,000 [4,501]	70 or older but younger than 75	(General (°)) ¥44,400, outpatient (per person) ¥44,400 (Low income) ¥24,600	(General (I) Per meal ¥420 + Per day ¥320	Same as above	-	None
Local public employees, etc.	64 mutual aid associations	9,000 [4,501]	20% (*) (30% for persons with more than a certain level of income)	(General (°)) ¥44,400 (Low income) ¥24,600	(General (I) Per meal ¥420 + Per day ¥320	Same as above	-
Private school teachers/staffs	1 Corporation	-
National Health Insurance (NHI)	Farmers, self-employed, etc.	Municipalities 1,717	37,678	(*) 20% for those turning 70 years old in April 2014 and later, and 10% for those already turned 70 years old by the end of March 2014	(General (°)) ¥44,400 (Low income) ¥24,600	(General (I) Per meal ¥420 + Per day ¥320	Calculated for each household according to the benefits received and ability to pay Levy calculation formulas differ among insurers	41% of benefit expenses, etc.
NHI associations	Municipalities 34,658	Municipalities 34,658	(*) 20% for those turning 70 years old in April 2014 and later, and 10% for those already turned 70 years old by the end of March 2014	(General (°)) ¥44,400 (Low income) ¥24,600	(General (I) Per meal ¥420 + Per day ¥320	Calculated for each household according to the benefits received and ability to pay Levy calculation formulas differ among insurers	47% of benefit expenses, etc.
Late-stage medical care system for the elderly	[Implementing bodies] Wide area unions for the late-stage medical care system for the elderly 47	15,168	10% (30% for persons with more than a certain level of income)	Maximum co-payment Outpatient (per person) (Persons with more than a certain amount of income) ¥80,100 + (medical fee - ¥267,000) × 1% (Multiple high-cost medical care) ¥44,400 (General) ¥44,400 (Low income) ¥24,600 (Extremely low income) ¥15,000	Same as above	Same as above, except for • Recipients of old-age Welfare Pensions Per meal ¥100	Calculated using the amount of the per capita rate and income ratio of insured persons provided by wide area unions	• Premium Approx. 10% • Support coverage Approx. 40% • Public funding Approx. 50% (Breakdown of public funding) National : Prefectural : Municipal 4 : 1 : 1

(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. Fixed-rate national subsidy for National Health Insurance shall be at the same level as that for the Japan Health Insurance Association-managed Health Insurance for those exempt from application of Health Insurance and that newly subscribed to the National Health Insurance on and after September 1, 1997 and their families.

4. The sums in the breakdown may not equal the total due to rounding.

5. National subsidy rate for the Japan Health Insurance Association (general insured persons and insured persons under item 2, Article 3 of the National Health Insurance Act) is 16.4% for the period between July 2010 and FY2014.

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 (0.50%).