Japan’s health care system edges foreign care in expat survey

by Tomoko Otake

Staff Writer

Just over half of non-Japanese residents feel Japan’s health care system is generally better than that in their home countries, a trend particularly pronounced among U.S. citizens, with 3 out of 4 rating it more highly, an informal Japan Times survey has found.

The survey, which was conducted online from Feb. 5 till Feb. 9 and which drew responses from 263 people of 48 nationalities, including naturalized Japanese, also found that many think Japanese health care is affordable and high-quality but troubled by doctors’ poor bedside manner and a system they say is too complicated to navigate.

Of all respondents, 29.3 percent said Japan’s health care was “much better” and 25.1 percent said it was “slightly better,” followed by 18.6 percent who said it was “about the same,” 15.2 percent who said “slightly worse,” and 11.8 percent who said “much worse.”

Asked to list the strong points of the Japanese system, 170 said affordability, followed by 132 who said generally high quality and 116 who said efficiency.

Asked to list the weak points, 123 said their doctors were not personable, followed by 107 who listed complexity and 74 who cited inefficiency.

For both questions, respondents were asked to select up to three strong points and weak points from a prepared list.

The survey shows that foreign views of health care in Japan are heavily influenced by where each person is originally from.

Of the 263, 71 were U.S. citizens, the biggest group by nationality, followed by 22 British, 22 Australians, 17 Filipinos and 16 French.

For many Americans, the 2010 Affordable Care Act, popularly known as “Obamacare,” and its impending repeal under the administration of President Donald Trump, led to relatively high marks for Japanese health care, which is characterized by universal coverage through public insurance schemes and free access to hospitals.

“Universal coverage, including for all dependents on my plan, is great to have,” said Peter Durfee, a 46-year-old American editor and translator in Tokyo. “I’ve never had a problem with level of care; very professional, willing to work with me to find good outcomes.

“My relatives back home have horror stories about navigating the expensive, limitation-filled swamp that is American health care, so I am very glad to have my family here in Japan.”

Yokohama resident John Matthews, 30, also from the United States and covered by Japan’s public insurance program, cited affordability as “the biggest win” for Japanese health care.

“Because hospitals are very well-informed as to what is covered and what is not by national health insurance, and because the coverage is transparent, there is no battling with insurance providers like there is in the U.S. The removal of those headaches, I think, significantly improves baseline quality of life for people here in Japan versus the U.S.”

Bess, a 33-year-old English teacher from the United States living in Kagawa Prefecture, is covered by her employer’s health insurance. She said she wants to stay in Japan for the rest of her life because she dreads the health care system in the U.S.

“I wish we had this at home,” the woman, who requested her last name be withheld, said, referring to Japan’s universal health care. “Probably no hope of that even happening now, so I kind of want to live and work here forever because I’m afraid to go back home and face the current lack of reasonable health care.”

It’s not all praise, however.

Many people said they are confounded by the unclear diagnoses issued by Japan’s doctors and the lack of language support for people who can’t speak Japanese.

Even big hospitals, such as the University of Tokyo Hospital, don’t have English-speaking staff to provide language support, even for patients undergoing complicated procedures, said Heidi Wiltamuth, a 43-year-old American employed by a Japanese electronics conglomerate as a business trainer.

“Even if you can speak some Japanese, the Japanese staff get impatient and are unhelpful — they are either too intimidated, shy or busy to deal with foreigners. They have no experience with foreigners so don’t know how to communicate with nonnative Japanese speakers. This greatly increases patient stress.”

Gordon Higgins, a 32-year-old Jamaican architect and researcher, said Japanese diagnoses — often issued without sufficient explanation — are also often wrong.

“Doctors are fast to issue judgments and vague in their diagnosis,” said Higgins, who still rated Japan’s health care slightly better than Jamaica’s. “I and many friends have been misdiagnosed and had to be hospitalized once for a misdiagnosed condition.

“The lack of general physicians/family doctors means you have to navigate a myriad of specialists in a specific language. I’m not sure how someone who didn’t know Japanese or have a Japanese friend to help would figure it out,” he said.

One respondent called Japanese health care “racist.”

“I was once denied attention at an ob-gyn clinic,” said Nuria, a 29-year-old Spanish web designer in Kyoto who asked that her last name be withheld. “They said they had to cancel my appointment because I was a foreigner and the doctor didn’t feel comfortable accepting people whom he wasn’t sure he could fully communicate with. I was attending with my Japanese husband and went there recommended by a friend who was also a patient in said clinic. Racism is so common in Japanese hospitals.”

A Canadian resident who wished to remain anonymous for privacy reasons is battling cancer in Japan. She is full of anxiety due in part to the medical practitioners’ poor communication skills.

“The doctors have been nice, but I literally found out that I had cancer from them here and it was unbelievably awkward,” the 27-year-old exchange student said. “The doctor was trying to be personable, but it came off as insincere. I would’ve preferred him to be a little more serious, given the situation. After my diagnosis, I was left crying in the hallway and all that the Japanese nurse said was ganbare (hang in there). It didn’t help. Now I’m going through all of the tests leading up to surgery, and we’ve warmed up a bit, but I have no idea what to expect, and I’m nervous about what’s to come . . .”

Some pollees cited reproductive health and mental health as areas of Japanese health care that are particularly unsatisfactory.

“There is a misconception that STIs (sexually transmitted infections) are not an issue in Japan,” said Virginia Sweiger, 25, a Canadian teacher at a private high school in Hyogo Prefecture. “No one gets tested regularly. As it turns out, if you request to be tested, they charge you per disease. A full regimen of tests would cost about ¥30,000. As a result, very few people get tested preventively.”

She also recalled the “awful” experience of getting a Pap smear at a clinic, where, instead of having a private room, she was given a sheet of paper to cover her face, while hospital staff walked by in front of her open legs.

A German resident in her 20s who declined to give her name recounted the short shrift she got when doctors prescribed her drugs.

“So-called mental health doctors pump you with a combination of pills and don’t even explain the dangers to you, (such as) not drinking alcohol or coffee while using them. Also, I’ve had one refuse to reduce the dosage after severe side-effects,” she commented. “There’s also absolutely no mental treatment, it’s just about getting medicine that calms you down and lets you fall asleep.”


The following is a sample of both positive and negative comments we received from survey respondents. We have preserved their anonymity but include the home country and age group of each respondent. Comments have been edited for clarity.

Bedside manner of medical staff

“You hand a list of symptoms to the front desk, get called in (after waiting one hour), and the doctor just lists off what medicine he’ll be giving to you.”

Australia, 30-39

“No questions allowed.”

France, 20-29

“Despite being thorough, I found the doctors and midwives less personable and somewhat robotic. It was definitely harder to form good relationships with them.”

Australia, 30-39

“The nurses and doctors were nice, but sometimes I felt like they wouldn’t let me talk more about my condition.”

Spain, 20-29

“I find that doctors here are not prepared to explain in detail the diagnosis or the side effects of the medication being prescribed. Some would even prescribe medication without administering any tests or investigations. This is very frightening in a developed country.”

Jamaica, 30-39

“Competency among doctors varies. One rule I have learned is to avoid clinics with lots of elderly people, as the doctors might not be serious.”

U.S., 30-39

Prescriptions

“It seems any illness can be treated with antibiotics, even if the problem is not an infection.”

U.S., 40-49

“Doctors often over-prescribe medicine, as it is in their interest to do so, as they earn money from working with pharmaceutical companies.”

U.K., 30-39

“If you are suffering from extreme pain, you can expect nothing stronger than over-the-counter ibuprofen except in the case of cancer. Theoretically the threat of addiction is what’s causing this reluctance, but…they have no problem giving out all sorts of antidepressants and other drugs which can be highly addictive and hard to quit using.”

U.S., 50-59

“The medicine itself is good but doctors can’t really comprehend that us foreigners are used to it and need larger or stronger doses.”

Indonesia, 20-29

“Japanese healthcare providers give foreigners very low dosages of painkillers, asthma medication, other prescriptions. I had a friend who almost died of asthma complications because they were given dosages that were equivalent to that of an 8 year old in their home country. Our bodies are different, we are normally bigger people, but the doctors do not take these differences into consideration.”

Jamaica, 40-49

Language issues

“I speak and write Japanese. Even so, I think it’s a waste of time to write down all your medical problems before seeing the doctor. You can explain to the doctor your problem without the need of writing it down every time…Foreigners who do not speak or read Japanese would be even more affected by this issue.”

Spain, 20-29

“Surprisingly, when I went to ‘normal’ non-English speaking doctors with a Japanese friend, I was taken good care of. With English speaking doctors, I waited a long time for a consultation that didn’t last more than five minutes.”

France, 20-29

“Most medicine is prescribed only in Japanese.”

Indonesia, 40-49

“There is a lack of English speaking staff and doctors at the clinics and hospitals.”

New Zealand, 19 or under

“It was scary as my Japanese is practically non-existent. Thankfully the clinic let my friend translate for me.”

Canada, 50-59

“Hospitals that offer services in English often have staff that refuse to speak English, due to their social awkwardness. This makes the whole medical experience a joke.”

Serbia, 30-39

Inefficiencies

“Care seems inefficient, and it took surprisingly long for doctors to diagnose that I had pneumonia. Dental care is also inefficient and can take multiple visits.”

U.S., 20-29

“You have to be ready to get a second, and sometimes third, opinion if your doctor just pats your hand and tells you to grin and bear what’s bothering you. And in a place where almost nothing is open on the weekends, and wait times are totally unpredictable, it is a monumental inconvenience to make an appointment.”

U.S., 30-39

“It is very slow. Even if you make an appointment, you have to wait 1-2 hours to see the doctor, which is very frustrating when you have work. Also opening hours are only during work hours (and sometimes only in the mornings).”

Australia, 40-49

“The documentation process is complicated in the language barrier, but also in the lack of general practitioners, with only specialized clinics, and the need to fill out many forms and sort out insurance in the waiting room.”

Australia, 20-29

“You may have to wait long hours in a waiting room, but you will not have to wait weeks or months to see a specialist. Comprehensive tests will be done quickly to pinpoint a problem and eradicate uncertainty.”

U.K., 50-59

“Doctors, and especially dentists, tend to spread the treatments out over more sessions, so they can charge more examination fees.”

U.S., 50-59

“The ability to email information such as x-rays would have been an advantage.”

Australia, 50-59

“A characteristic of state-owned health care is that it is [inevitably] bureaucratic.”

Australia, 50-59

“Long closing times in the middle of the day, and few walk-in services available when illness strikes, makes the systems congested and ineffective.”

Australia, 30-39

General practitioners vs. specialists

“Patients have to go to many different doctors depending on their condition. This makes it very difficult to build a relationship and history with one doctor and therefore creates a lot of needless repetition for the patient.”

New Zealand, 50-59

(In relation to lack of GP’s) “Without this sort of ‘relationship’, care can be cursory and distant.”

U.K., 60 or over

“Here in Japan, you usually need to self-diagnose and try to figure out on your own what kind of specialist you should visit.”

U.S., 40-49

“In Japan, general practitioners sometimes don’t check you over for issues; often either referring you to a specialist or sending you away with medicine that you don’t need.”

Costa Rica, 20-29

“Lack of international experience or vision from the doctors makes me less confident in the quality of care I receive here in Japan.”
“Lack of knowledge of cultural differences and illnesses that are rare within the Japanese population but common within Caucasian populations is an issue.”
“I need to see five different doctors for small ailments rather than being able to go to one [general practitioner] to get the same level of care I would receive in New Zealand.”
“Holistic healthcare is non-existent in Japan.”

New Zealand, 40-49

“Small surgeries mean sometimes going to more than one doctor. As the surgeons are specialists and not general practitioners, they may misdiagnose outside their fields. Also older doctors that perhaps shouldn’t be practicing [anymore] are rarely questioned in their diagnosis and this may endanger patients.”

U.K., 30-39

“When you have a more serious ailment, you are passed on to specialists at a larger hospital, but your local clinic doctor is not involved in the process, and can’t act as a source of advice or support.”

New Zealand, 40-49

Equal access

“I’m in favor of the Japanese health system being mandatory once you live or stay for a long time in Japan, for everybody no matter of nationality or income.”

Brazil, 40-49

“There are plenty of choices regarding clinics and hospitals.”

U.K., 60 or over

“There are terrible doctors, great doctors, and everyone in between — but unlike in the UK, I get to choose who I see and where I go.”

U.S., 30-39

“The yearly health checks that are paid by my employer are a good thing. We don’t have them in Germany, but diseases that might otherwise go unnoticed by the patient can be discovered.”

Germany, 20-29

“As a sexually active gay man, I feel the system neglects the needs of my community. Sexually transmitted infection (STI) testing procedures are behind the times: no oral or anal swabs are available when testing, the government offers outdated HIV testing, and the only other tests provided are those for syphilis. All other STI tests are offered only at private clinics and are not affordable.”

Brazil, 30-39

Obstetrics/gynecology

“To receive the pill, you have to take both a blood test and a pap smear twice a year or they’ll refuse to give it to you.”

Australia, 30-39

“Why are pregnancies so expensive and not covered by public insurance?”

Italy, 20-29

“In Japan, I was shocked when they took my baby away from me as soon as she was born and I didn’t see her again until the next morning. The nurses fed her baby formula without asking me if it was OK. This is completely different to Australia, where the mother has complete control over the baby.”

Australia, 40-49

“I loved how thorough and frequent the appointments were in Japan, compared to the remainder of my pregnancy in my home country.”

Australia, 30-39

“Japanese doctors need to be trained in how to speak to foreign pregnant women. You cannot tell a pregnant woman that she is fat and looks terrible.”

Jamaica, 40-49

Affordability

“Generally health care is quite affordable.”

Poland, 30-39

“Insurance premiums are high, but the out-of-pocket fees for treatment are low.”
“My Japanese husband passed away in 2014 from colon cancer. In the US, I fear that his operation, multiple long hospital stays and year-and-a-half of chemo would have bankrupted us. But here in Japan, that was not the case.”

U.S., 40-49

“The problem is that they require too many visits, which can be costly. Things that could be resolved in only one visit, require you to come in multiple times in Japan. Even if they tell you to take a certain medicine for 6 months, they will still make you come back every month for new prescription.”

Macedonia, 20-29

“Health care in Japan is extremely cheap compared to health care back home in America. Prices before insurance are not bad and prices after insurance are mind blowingly cheap.”

America, 20-29

Women’s issues

“Myself and other female friends have been told by male doctors that the symptoms of an ear infection, or in my friend’s case a heart problem, are because we’re female. Apparently, ‘women often become weak in cold weather.’ “

Australia, 20-29

“On one hand, doctors and their assistants are usually very careful about women‘s modesty. They don’t request patients to undress entirely and even provide towels for them to use. On the other hand, this might appear excessive, when doctors won’t dare to listen to the heart or the lungs of a patient.”
“Female patients hear sexist remarks from male doctors quite often in Japan. Sometimes, their symptoms are not taken seriously either.”

France, 40-49

“It wouldn’t hurt to have more female doctors.”

Spain, 20-29

Staff writers Mark Thompson and Shusuke Murai helped design and analyze this survey.