How health care works in Japan

Everyone is in a public scheme: 1 in 3 people in the five main schemes is in the one for employees of small and mid-sized firms.

Trade unions' own national health insurance (国保組合) and seafarers' insurance are not in this count. Nor are people on public assistance; the last step says what pays for them.

Everyone 75 and over is in one scheme. Under 75, a person is in a work scheme, as an employee or a family member, or else in the town scheme.

Members counted by the ministry at the end of March 2023: 3,944万, 2,820万, 2,413万, 1,913万 and 982万 (万 is ten thousand). The total, 12,072万 (120.7 million), is Dooram's sum.

Source: 厚生労働省 (Ministry of Health, Labour and Welfare), 我が国の医療保険について (about our country's health insurance), pages 2 and 9 of the file, read 17 October 2026.

Current spending on health, public and private, without investment in buildings and equipment, as a share of gross domestic product (GDP), the value of everything the country produces in a year, by the count of the World Health Organization (WHO), made with each country's own data: 10.74% for Japan in 2023, rounded here to one decimal. 2023 is the newest year the WHO has for every country on the dial, so every figure it is set against is the same year and the same count.

On the dial, "typical" means between the lowest quarter and the highest quarter of the 10 countries Dooram covers: from 8.8% to 11.6% of GDP. "Less than most" is below that, "more than most" above it.

Read on 21 October 2026 in the WHO's Global Health Observatory and again in the World Bank's copy of the same series; the two give the same figure for every country.

The health ministry's own count is 8.08% of GDP for fiscal 2023 (the next card): it counts only the care that health insurance can pay for, so it leaves out check-ups, vaccinations, normal births and more that the WHO's count takes in. Both are right for what they count.

Sources: World Health Organization, Global Health Expenditure Database, through its Global Health Observatory and the World Bank's World Development Indicators, Global Health Expenditure Database, current health expenditure as a share of gross domestic product (GHED_CHEGDP_SHA2011), 2023 (the World Health Organization's health accounts, every country's share of its economy spent on health, 2023), GHED_CHEGDP_SHA2011; the World Bank's SH.XPD.CHEX.GD.ZS, read 21 October 2026. 厚生労働省 (Ministry of Health, Labour and Welfare), 令和５(2023)年度 国民医療費の概況 (national medical care expenditure, fiscal 2023), read 17 October 2026.

$342.3 billion (¥48.1 trillion) in fiscal 2023, 3.0% more in yen than the year before: $2,753 a person (¥386,700).

It is the ministry's estimate of what was spent treating illness and injury that insurance could pay for. It leaves out normal pregnancy and birth, check-ups and vaccinations, and artificial limbs and eyes.

“当該年度内の医療機関等における保険診療の対象となり得る傷病の治療に要した費用を推計したもの”

In English, Dooram's translation: “an estimate of the cost of treating illness and injury that insurance could cover, in medical institutions in the year”

So it is 8.08% of Japan's economy, while the World Health Organization, which counts more kinds of care, gives 10.7% for 2023, or US$3,638 a person. Both are right for what they count.

Sources: 厚生労働省 (Ministry of Health, Labour and Welfare), 令和５(2023)年度 国民医療費の概況 (national medical care expenditure, fiscal 2023), results and table 1, read 17 October 2026. World Health Organization, with data from Japan, Global Health Expenditure Database, 2023, read 17 October 2026.

An estimate the ministry makes each year from insurance claims and other records. Fiscal 2023 is April 2023 to March 2024. Per person is the ministry's own figure, 3.5% more than the year before. The trillions are Dooram's rounding of its 億円 (hundred million yen): ¥480,915 hundred million.

Dollars are converted by Dooram at the 2023 average rate of ¥140.49 to $1 (World Bank, from the IMF; the Federal Reserve gives ¥140.50). In dollars, the year before's ¥373,700 a person was $2,842 at 2022's rate of ¥131.50 (Federal Reserve: ¥131.46): more dollars than 2023's $2,753, because the yen fell, while spending in yen rose.

Sources: 厚生労働省 (Ministry of Health, Labour and Welfare), 令和５(2023)年度 国民医療費の概況 (national medical care expenditure, fiscal 2023), read 17 October 2026. World Bank, World Development Indicators, from the International Monetary Fund, Official exchange rate (LCU per US$, period average), PA.NUS.FCRF, read 18 October 2026. Board of Governors of the Federal Reserve System, G.5A Foreign Exchange Rates (Annual), read 18 October 2026.

Contributions paid by the people insured: the employee's half of a work scheme's premium, and the premiums of town and over-75 schemes. The employer's half is its own band. Local government is the prefectures and towns.

Patients at the counter paid 11.8%, $40.5 billion (¥5.7 trillion). The rest of that last band, 0.5%, is paid by those liable for an injury, for example through car insurance.

Worldwide cross-check. The World Health Organization puts 84.8% of Japan's health spending with government and compulsory insurance together, and 12.2% out of pocket, for 2023.

Sources: 厚生労働省 (Ministry of Health, Labour and Welfare), 令和５(2023)年度 国民医療費の概況 (national medical care expenditure, fiscal 2023), Table 3, read 17 October 2026. World Health Organization, with data from Japan, Global Health Expenditure Database, 2023, read 17 October 2026.

Three of the ministry's tables, each the same total: where the money came from (財源別), which scheme paid it out (制度区分別) and what kind of care it paid for (診療種類別). Nothing joins a band in one column to a band in the next, because the ministry does not say which money paid for which care, so Dooram does not draw that. Shares are as the ministry prints them; dollars at ¥140.49 to $1, the 2023 average, so close, not exact.

Sources: 厚生労働省 (Ministry of Health, Labour and Welfare), 令和５(2023)年度 国民医療費の概況 (national medical care expenditure, fiscal 2023), Tables 2, 3 and 4, read 17 October 2026. World Bank, World Development Indicators, from the International Monetary Fund, Official exchange rate (LCU per US$, period average), PA.NUS.FCRF, read 18 October 2026.

Public money pays about half, and younger people's insurance about four in ten; people over 75 pay about 1 in 10 through their own premiums.

The ministries print these as rounded shares (約, about), and Dooram draws them as printed. On top, people over 75 pay their own share at the counter.

Sources: 厚生労働省 (Ministry of Health, Labour and Welfare), 我が国の医療保険について (about our country's health insurance), page 13 of the file, read 17 October 2026. 財務省 (Ministry of Finance), 令和８年度予算政府案 (fiscal 2026 budget, the government's draft), budget points, read 17 October 2026.

¥12.7 trillion for medical benefits in its plan for fiscal 2026, up from ¥12.3 trillion: 10.4% of all it plans to spend.

A plan, not money spent: the government's draft of 26 December 2025. Medical benefits are the national government's share of insurance and public programmes, part of social security, ¥39.1 trillion. Prefectures and towns pay their own share from their own budgets.

The share is Dooram's division of the ministry's amounts (¥126,895, ¥390,559 and ¥1,223,092 hundred million). The ministry's chart gives a second, larger medical line (¥12.8 trillion) by another definition; the table's medical benefits are used.

Source: 財務省 (Ministry of Finance), 令和８年度予算政府案 (fiscal 2026 budget, the government's draft), social security budget, read 17 October 2026.

Visits without a stay are 入院外, outpatient care at hospitals and clinics. Medicines given in hospital are inside the first two; pharmacies are prescriptions filled outside. Shares are Dooram's division of the ministry's amounts; the parts add to ¥100 million less than the total, as the ministry prints them.

Dollars at ¥140.49 to $1, the 2023 average (World Bank, from the IMF), so close, not exact.

Sources: 厚生労働省 (Ministry of Health, Labour and Welfare), 令和５(2023)年度 国民医療費の概況 (national medical care expenditure, fiscal 2023), Table 4, read 17 October 2026. World Bank, World Development Indicators, from the International Monetary Fund, Official exchange rate (LCU per US$, period average), PA.NUS.FCRF, read 18 October 2026.

An employee in Tokyo on ¥300,000 a month pays ¥14,775 a month for health insurance, and the employer pays the same.

The premium also covers the employee's family insured as dependants, and part of every work scheme's premium goes to the care of people over 75. So a premium is not "your care", and these figures are not one person's account.

Care costs far more with age. Spent on one person in a year, fiscal 2023: aged 15 to 44, $1,056 (¥148,300); aged 45 to 64, $2,184 (¥306,800); aged 75 and over, $6,789 (¥953,800), more than six times the youngest group's.

The premium is ¥29,550 a month in all, as the insurer's table prints it, half each: ¥14,775. The year's ¥354,600 is Dooram's sum of twelve months.

The rate differs by prefecture, from 9.21% in Niigata to 10.55% in Saga. People aged 40 to 64 also pay 1.62% for long-term care, and from April 2026 everyone pays 0.23% for children and child-rearing. Bonuses pay premiums too; they are left out here.

Sources: 全国健康保険協会 (協会けんぽ, the Japan Health Insurance Association), 令和8年度都道府県単位保険料率 (prefecture premium rates, fiscal 2026, and Tokyo's premium table), read 18 October 2026. 厚生労働省 (Ministry of Health, Labour and Welfare), 令和５(2023)年度 国民医療費の概況 (national medical care expenditure, fiscal 2023), Table 5, read 17 October 2026.

One worked example from the insurer's own table: a standard monthly pay of ¥300,000, Tokyo, under 40, from March 2026; its rates are quoted as printed, with the source, as its terms allow. The spending is the ministry's average for each age group, not what any one person used.

The 2026 premium stays in yen; 2026 has no yearly average rate yet, and Dooram does not mix years. Spending is in dollars at ¥140.49 to $1, the 2023 average.

Sources: 全国健康保険協会 (協会けんぽ, the Japan Health Insurance Association), 令和8年度都道府県単位保険料率 (prefecture premium rates, fiscal 2026, and Tokyo's premium table), read 18 October 2026. World Bank, World Development Indicators, from the International Monetary Fund, Official exchange rate (LCU per US$, period average), PA.NUS.FCRF, read 18 October 2026.

People over 70 with an income like a working person's pay 30%. From age 75, others above a set income pay 20%.

There is a monthly limit on what a household pays, set by income; above it, insurance pays the rest. The limit is being changed in stages from August 2026, and Dooram has not read the new amounts, so none is shown.

Sources: 厚生労働省 (Ministry of Health, Labour and Welfare), 我が国の医療保険について (about our country's health insurance), pages 4 and 10 of the file, read 17 October 2026. 財務省 (Ministry of Finance), 令和８年度予算政府案 (fiscal 2026 budget, the government's draft), budget points, read 17 October 2026.

People on public assistance leave national health insurance; medical assistance pays for their care. Nothing is paid at the counter.

“生活保護受給者は、国民健康保険の被保険者から除外されているため、ほとんどの生活保護受給者の医療費はその全額を医療扶助で負担。”

In English, Dooram's translation: “People receiving public assistance are excluded from national health insurance, so for most of them the whole cost of care is paid by medical assistance.”

A 2025 ministry paper sets the two side by side: health insurance 「自己負担あり」, medical assistance 「自己負担なし」 (Dooram's translation: a share to pay; nothing to pay).

Sources: 厚生労働省 (Ministry of Health, Labour and Welfare), 医療扶助について (social security council paper on medical assistance, 4 November 2008), read 17 October 2026. 厚生労働省 (Ministry of Health, Labour and Welfare), 医療扶助・健康管理支援等に関する議論の整理 (medical assistance and health support, the discussion summed up, 17 November 2025), page 7 of the file, read 17 October 2026.