Japan's social health insurance system ensures universal coverage1 but restricts eligibility to residents with a minimum stay of three months. Consequently, short-term visitors, temporary residents, and undocumented individuals are excluded,2 leaving immigrants more vulnerable to healthcare inaccessibility than Japanese nationals. This issue has been underscored in a previous systematic review, which synthesized existing literature on healthcare accessibility for immigrants in Japan.3
Historically, immigrants in Japan have encountered difficulty in accessing social health insurance. However, the author would like to expand on the discussions in the previous manuscript3 by highlighting legislative measures, such as the expansion of the Specified Skilled Worker (SSW) program in 2019, which broadened eligibility for employer-sponsored insurance and thereby increased coverage among foreign workers.4
Nevertheless, there remain circumstances in which individuals may become disenrolled from social health insurance. In recent years, many technical interns have left their initial workplaces for better working conditions.5 In such cases, they lose access to previously provided employer-sponsored health insurance. While they may enroll in the social health insurance system administered by local governments, maintaining coverage requires the continuous payment of premiums. A lack of awareness of this requirement may result in inadvertent loss of insurance eligibility. Moreover, Japan's healthcare system implements an income-based cap on monthly healthcare expenditures; however, this benefit is exclusively available to individuals who have formally declared their income, potentially exacerbating disparities in healthcare access among immigrants.
Over time, Japan's public health insurance system has undergone policy modifications to extend coverage to a broader spectrum of immigrants. Nonetheless, a fundamental challenge remains: individuals must possess adequate knowledge of the system to fully utilize its benefits. Therefore, the dissemination of information through appropriate channels, such as multilingual resources, is crucial for further strengthening universal health coverage.
Declaration of interests
The author declares no competing interests.
References
- 1.Ikegami N., Yoo B.K., Hashimoto H., et al. Japanese universal health coverage: evolution, achievements, and challenges. Lancet. 2011;378(9796):1106–1115. doi: 10.1016/S0140-6736(11)60828-3. [DOI] [PubMed] [Google Scholar]
- 2.Yasukawa K., Sawada T., Hashimoto H., Jimba M. Health-care disparities for foreign residents in Japan. Lancet. 2019;393(10174):873–874. doi: 10.1016/S0140-6736(19)30215-6. [DOI] [PubMed] [Google Scholar]
- 3.Khin Y.P., Owusu F.M., Nawa N., Surkan P.J., Fujiwara T. Barriers and facilitators for healthcare access among immigrants in Japan: a mixed methods systematic review and meta-synthesis. Lancet Reg Health West Pac. 2025;54 doi: 10.1016/j.lanwpc.2024.101276. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Kyodo News Japan enacts laws for new foreign worker scheme amid labor crisis. 2024. https://english.kyodonews.net/news/2024/06/5e8e7231c30d-japan-enacts-laws-for-new-foreign-worker-scheme-amid-labor-crisis.html
- 5.Immigration Services Agency of Japan Public information (list of supervising organizations, administrative sanctions, number of missing persons, etc.) 2024. https://www.moj.go.jp/isa/applications/titp/nyuukokukanri07_00138.html