Medical and Health Care in Japan – What to do at the Doctors Part II

If have not seen Part I of this series, I highly recommend you to go and check it out here!

Last week, I left you with a bit of a cliffhanger on part I. Sure you are now face-to-face with a doctor, but what happens next?! That is a good questions and it depends a lot on your personal situation, but after finishing last weeks article I still felt like I had more to say on the topic so here goes.

A few more things before you enter the 診察室

But first, we have to go one step back to the point where you submit your カルテ (the clipboard with a document that has all your relevant information on it). Depending on what kind of problems you are having, you might be asked to measure your pulse first. Yes, you often have to do this yourself but it is quite simple. They will show you to a machine that looks somewhat like an old printer from the 90s with a big hole on the side. You then stick your arm through that whole, tell the machine to start (there’s usually only one button, so press that one) and it will then measure your pulse. The result will be printed on a small paper slip which you hand to the reception staff. If you are nervous and have a high pulse as a result, they will ask you to try and calm down a bit and then measure again. If your pulse is still high after your second measurement, they might measure again manually or simply just roll with it.

Next, Japanese doctors love taking your blood (further confirming my theory that all doctors are secretly vampires) so expect to get pricked at least once. Again, depending on the type of treatment this might happen before or after you talked to the doctor but it is very likely to happen. The process of taking blood is pretty universal I think, the only stumbling block is when they ask you whether they can disinfect the area with an alcohol wipe first. Just say はい when you hear the word アルコール (a good idea in general if you are into that sort of stuff), or refuse if you are allergic.

Entering the lair

Now onto the really difficult stuff, the actual talking to the doctor. When you are called, you can proceed directly into the 診察室. Some people knock before they enter, but you do not have to. Unless you specifically go to a doctor that can speak English (or whatever language) and is advertised as such, it is best to expect that they can only speak Japanese. It is very important that you are able to express yourself properly, so the doctor can get a good idea of what is bothering you. If you cannot speak Japanese, best bring somebody who can.

During the interview, the doctor will try to diagnose as much as they can. Sometimes they might be able to tell what is wrong by simply looking at you. If more tests are necessary, you might have to go out and wait in the waiting room again until the tests can be performed. You will then be called to perform further tests until they can determine what they can do to help you, at which point they will call you into the 診察室 again and tell you as much. Generally, you will be given a thorough explanation of their findings and what they think is the best way to treat you. This often includes a boatload of pills and other medicines. Finally, you will be asked to go and wait in the waiting room while they process your payment.

Escaping the castle

Some people are want to leave, once the final consultation with the doctor is over but do not leave just yet. You still have to pay your 30% share of the costs. Simply go to the waiting room and wait until the receptionist calls for you. When paying, cash is often your best bet. Some clinics and hospitals may accept cashless payment, but from my experience most do not. If you do not have enough cash, it is generally acceptable to go to the next ATM and withdraw some (they have your info after all, should you decide to simply leg it). Make sure you double-check the receipt, I have been charged 60.000 Yen in the past when I should have been charged only 6.000. After you have paid, you will receive your prescription for your medication. Now you have almost made it.

The last step on your journey is to pick up your medication. Prescription medication is sold at the 薬局 (yakkyoku) and there are often several 薬局 in the vicinity of a clinic or hospital. You want to be on the lookout for the following sign: 処方せん受付 (shobousenuketsuke). This roughly translates to “We accept prescriptions” and is often displayed very prominently in front of the store. Go in, and present your prescription and insurance card first. Now comes another one of Japan’s peculiarities, the 薬手帳 (kusuritechou). This is a small booklet where all the prescription medication that you receive is logged. If you do not have one, they will make you one for free. If you forgot it, simply tell them, it’s no big deal. Also, you often have to fill out a カルテ again if it is your first time here. After that is done, it’s to waiting again. Once they have assembled all the medication you will be called and get the same explanation about the medications that you already got from the doctor. Then you pay and are finally free to go about your way.

That was quite the adventure, but I hope that it was useful to one or two of you out there. If you have any questions or concerns, feel free to leave me a comment or contact me via the contact form or social media. Have a good one and see you next week!

Medical and Health Care in Japan – What to do at the Doctors’

If you want to live in Japan – or even if you are just visiting – it is very important to get familiar with the medical system. Depending on where you are from, the medical system might be very different or not that different at all. Still, going to the doctor was always a challenge for me, even in my home country, so going to the doctor in Japan sometimes seemed like an insurmountable hurdle. Now that I have gotten a bit older, I feel like I have gotten somewhat used to the idea of having somebody else analyze and judge my body, although I still feel uncomfortable. So, for people that may still be struggling with the idea of visiting a hospital or a doctor in Japan, I hope that I can make it a bit easier for you.

But first, what about money?

If your stay in Japan is 6 months or longer, you are required by law to have health insurance. Generally speaking, there are two types of health insurance in Japan: one for unemployed people and one for employed people (I simplify a lot here, if you want to read more about insurance I have written an article about it). Once you are at a medical facility, the two types of insurance generally do work the same though. People who have insurance, generally only have to cover 30% of the fee of most general medical procedures with the insurance covering the remaining 70%. There are some procedures that are not covered by insurance (cosmetic surgery, childbirth, STD testing among others), so it is a good idea to check in advance. Also, since I see it mentioned sometimes: no calling an ambulance does not cost you anything unless you are judged to have made a prank call.

The language barrier

While there are some English-speaking clinics in Tokyo, and younger doctors may sometimes know rudimentary English, hospital or clinic staff will generally only be able to speak Japanese. If you feel like you might not be able to explain yourself, try searching online for places that might be able to help you in English (or any other Language) or bring someone who can translate on your behalf. There are also translation services available that will dispatch a translator to accompany you or translate for you over the phone – for a cost.

I have seen other blogs do vocabulary lists, so I guess I should try making one too. So here is a list of the different medical practices and what they are called in Japanese (not an exhaustive list since I will probably forget some). The translations are not literal and are meant for people to understand what they can expect when they visit this type of clinic.

内科 – naika – internist, generalist medicine
歯科 – shika – dentist
眼科 – ganka – eye medicine
耳鼻科 – jibika – ear, nose, and throat medicine
皮膚科 – hifuka – skin medicine
尿器科 – nyoukika – urology
胃腸科 – ichouka – stomach and bowel medicine
小児科 – shounika – pediatrician
(産)婦人科 – (san)fujinka – (obstetrician), gynecologist

Obviously, there are many more but I think the above list should cover most basic needs. Clinics will often specialize in one of the above. When it comes to hospitals, there are specialized, as well as generalist places that cover a wider range of disciplines.

I have a medical problem, what to do?

If it is an emergency, stop reading this and call an ambulance. Otherwise, choose what kind of treatment you need from the list above and take it to Google, together with the name of your area (for example “耳鼻科 小平市”). If you do not know what kind of treatment you need, go to an internist and they will generally tell you where you have to go. Google reviews are a decent indicator of what you can expect. If you want to take it further and make sure you go to the best doctor (often simply meaning the one with the friendliest staff), there are also dedicated review sites but they are all in Japanese. If it is not urgent, consider calling in advance to make an appointment. Especially in bigger cities, waiting times can be quite long if you simply walk in.

Speaking of which, once you walked into a clinic/hospital, the first thing you need to do is make your way to the reception (受付, uketsuke). Explain why you are here – just something like “My eye hurts and I would like it looked at” is enough – and if you have an appointment, let them know. Then you will be asked to hand over your insurance card and, if it is your first time at this particular clinic/hospital, you will also be asked to fill out a カルテ (karute from German Karte, many german loan words in Japanese medicine), which forms the basis of your medical file. The カルテ is in Japanese and most places will expect you to fill it out in Japanese, so if you can not write Japanese very well, ask somebody who can. That being said, some of the information asked is very basic, such as your name, age, and address, but sometimes it might ask for important information such as allergies or illnesses you have/had, so make sure you read and understand everything.

Once you have filled out your カルテ, hand it back to the receptionist and they will return your insurance card to you. Now you have to wait for the doctor to see you. Some places have a number system, where you receive a number at the reception and are called by that. Other places will simply call you by your name. In any case, once you are called, you may proceed to the 診察室 (shinsatsushitsu, examination room) where the doctor will have a first chat with you, figure out what is wrong and how they can help you.

And with that, we have reached the end of this article, since everything that comes after this point will vary greatly on a person-by-person basis. I hope I was able to give you a general idea of what you can expect. If all goes well, I will write a bit more about this topic next friday. See you then!

Shopping in Japan

Shopping in Japan will not be so different from other countries that you might already be used to. There are malls, supermarkets and department stores, as well as of course a variety of other shops selling all manner of goods and items that you might need. 

An important part of the shopping culture in Japan is the convenience store, or as it is called in Japanese, the konbini (コンビニ). If you desperately need something, for example, you forgot to buy salt at the supermarket, odds are that it will be sold at the konbini. Starting from toiletries, stationery and other goods that might be useful in a pinch, they sell sweets and snacks, whole ready-meals and you can buy drinks and alcohol as well. Some people live entirely on konbini food and drink, but be warned, prices can be a lot more expensive than simply going to the supermarket. At the konbini, you are not paying only for goods, you are paying for 24h around the clock service (though not every konbini will be open 24h) and accessibility as well. 

Supermarkets in Japan are as they are in many other countries. There are many different aisles, reserved for a variety of different foods, and other products. Usually, there is a section for fresh vegetables and fruit, as well as a section selling raw fish and meat. Many different chains exist, with none sticking out above another. Most people will simply go wherever is closest to their home. One thing to note is that, unlike some other countries, Japanese supermarkets sometimes do not stock toiletries such as toilet paper or toothpaste etc. In that case, there will usually be a drug store nearby that has whatever you need.

Speaking of which, drug stores are as they are in most other countries as well, selling cosmetics, shampoo, toilet paper and similar goods. Japanese drug stores will often also sell a variety of foods and beverages, such as snacks, frozen goods and sometimes even alcohol.

Taxes, shaken or stirred

One thing to be careful of when shopping in Japan is whether an article has been listed including or excluding sales tax (10% since October 2019). Some stores will display price without tax (zeinuki、税抜き), others will include the tax in the price (zeikomi 税込). If you are paying cash, it is always a good idea to check this, so you do not get caught out with not enough money when trying to pay at the register.

Public Transport in Japan – Trains, Busses and Taxis

If you are commuting to work or to school, you can get what`s called a commuters pass (teikiken, 定期券). You can buy them at the station office or the ticket vending machines. You will be asked to fill in the name of the station that is closest to your house, as well as the name of the station that is closest to your work, pay a set amount and then you will be able to use the train going to and from those two stations as many times as you want for up to one, three or six months. Important to note here, is that you can get off anywhere you like in the middle, and it will still be free. Usually, these will be simply printed on the aforementioned IC-cards, but paper versions are available as well.

Public transport in Japan is widely available. Especially the train network is often praised as one of the most well-run and punctual in the world. In the larger metropolitan areas, many people rely entirely on trains to get to work, go shopping or whatever other transport needs might arise. With space being very limited, parking is often very expensive in city centres so many people commute by train. Train stations can be confusing at times since stations are usually not shared between train companies, so if multiple companies are servicing one area, there will be multiple train stations with similar-sounding names. Besides, many stations will have multiple ticket gates (kaisatsu, 改札), and even more exits.

Most people use so-called IC-cards (aishii kaado, IC-カード) when using public transport. These cards can be charged with money, and when you want to ride the train you simply touch the appropriate area at the ticket gate with your IC-card to go through. You do the same when exiting the station where you get off, and the appropriate sum will be taken from your card. If funds are insufficient an error message will appear, and the gates will not open. There are always charging points in the station, so simply top up your card and you will be able to exit. If you do not have the cash to charge your card, you might have to go all the way back to the station where you started and speak to a station attendant there. There are regional variants of IC-cards, but the two most common types, the PASMO and Suica cards can be used almost everywhere in the country. IC-cards can be bought at ticket vending machines in train stations, with Japan Rail (JR) stations selling the Suica card, and most other stations selling the PASMO card.

Busses and taxis are of course available as well. But busses are not as vital of a link in the mobility chains, being mainly used by elderly people, and are a lot less frequent than they might be in other countries. Taxis are convenient and offer a variety of payment options but can be expensive. One final option for getting around in Japan is of course the car. Requirements for being allowed to drive in Japan differ depending on the country you are from, so make sure to check the website of the Japan Automobile Federation.

Paying your Taxes in Japan

Like in any other country, if you do remunerated work in Japan (i.e. you are getting paid for your work) you have to pay taxes. Generally, there are two kinds of taxes in Japan that almost everybody will have to pay. If you are self-employed or some such, circumstances might be different for you so make sure to check with the tax counter at your local city hall. There are of course other taxes as well, like the property tax or the consumption tax (VAT), but for now, we will be only discussing the income and resident tax.

Employees will have to pay two kinds of taxes, income and resident tax. The income tax (shotoku zei, 所得税), like you, can guess from the name, is based on your income and usually deducted directly from your income. Usually, your employer will take care of this payment for you and you do not need to submit anything on your own. If this does not show up as a deduction on your salary statements, make sure to ask your employer what`s going on.

The resident tax (to / juu / shiminzei, 都・住・市民税) is also calculated based on your income, but it is calculated based on your income from the year before. Thus, if you just started working in Japan, you do not have to pay the resident tax for the first year. Many companies will handle payment of the resident tax on behalf of their employees as well, but some companies do not so make sure to check with your employer whether they will handle the payment for you or not. One thing to note is that you pay resident tax at the place where you live, not where your work. For example, if you worked in Tokyo but lived in Yokohama, you would have to pay your resident tax to the district of Yokohama that you are living in.

Paying taxes is mandatory and failure to do so is punishable. You will also be asked to produce a statement from your local city or district hall, proving that you paid all your taxes when you apply for a new visa, so make sure to check whether your taxes are paid properly or not.

Pension in Japan

Continuing on with my posts about things you have to do once you first come to Japan, next on the list we have pension. Regardless of nationality, everyone has to pay pension in Japan, a fact that many people still not know (myself included when I first came to Japan). 

Starting from the time you legally become an adult (age 20 in Japan), every resident of Japan (no matter if they are Japanese or not) is obliged to pay into the pension fund in one form or another. You can apply for exemption from this, but only if you are a student or otherwise can prove that you only have limited income.

There are two major forms of pension in Japan. The first one is the “social pension” (kousei nenkin, 厚生年金), usually reserved for people that are employed at a company (shain, 社員). Then there is the “national pension” (kokumin nenkin, 国民年金) for people that do not qualify for the social pension (part-timers, housewives etc.). For the social pension, contributions are calculated based on your salary, deducted straight away and your employer will take care of the payment. For the national pension there is a set contribution of around 16.000 JPY that you have to pay every month. You can either pay via payment slip, that you will receive in the mail, pay by credit card or set up a bank transfer.

Especially in the case of national pension it is good to make sure whether you have to pay or not because the Japanese bureaucracy is not very good at sharing information. For example, if you go to city hall and register your address with a student or working holiday visa, the local pension division will only receive the information that you registered, but not that you are a student or on a working holiday. If you do not specifically go to their counter and complete the application for exemption from pension contributions, you may suddenly receive a letter asking you to pay over 100,000 JPY in missed contributions. You can still do the exemption procedure even If you received the letter, but you save yourself a lot of stress and anguish by simply going to the pension division when you first register your address in Japan and sorting things out in advance with them.

If you are planning to return to your home country, the pension contributions you made in Japan might seem like a waste. But not to worry, in that case, you can apply to get the money back in full. I have not done this yet, but from what I hear the process is very long and bureaucratic, so if you are wishing to go this route, I recommend you bring someone who can speak Japanese and help you through the process. If you have any experience regarding this, let me know in the comments how it went for you.