The government and the ruling Liberal Democratic Party are considering in principle excluding coverage under the public health insurance system for the family members of foreign nationals working in Japan that remain in their home countries, The Yomiuri Shimbun has learned.
The proposal is in preparation for the government's efforts to expand the number of foreign workers in Japan that it aims to start in April next year.
To realize the exclusion of the family members, they will promote discussions for submitting a bill to revise the Health Insurance Law in the ordinary Diet session next year, according to sources.
The move is aimed at decreasing fiscal pressure on the public insurance system by revising a mechanism in which Japan assumes the burden of medical fees for Japan-based foreign nationals' family members living overseas. It is also expected to resolve the sense of unfairness felt by Japanese workers.
The number of foreign nationals working in Japan was about 1.28 million as of the end of October last year, according to a Health, Labor and Welfare Ministry survey.
Under the current system, third-degree or closer relatives -- including children and grandchildren -- of foreign workers at large firms who are covered by health insurance societies, or those at small and midsize firms covered by the Japan Health Insurance Association, can be considered dependents even if they do not live in Japan.
Recognized dependents are able to receive coverage under Japan's health insurance system. Even if dependents outside of Japan use medical institutions in their home countries, their medical fees, excluding a personal contribution, are paid by the health insurance societies or the association to which the foreign workers pay premiums.
The government and the LDP judged it necessary to revise the current system, taking into account the expansion of foreign workers in the country.
However, to avoid criticism against possible discriminatory treatment toward foreign nationals, the government and the LDP are also considering excluding the dependants of Japanese workers from the health insurance system if they are based overseas and there is no actual life in Japan.
Whether to exclude the dependents of Japanese nationals who live overseas temporarily for studies or employment will be a focal point of the discussion. The dependents of Japanese nationals who stay overseas temporarily for such reasons as expatriate employees would likely continue to be treated under the system.
The government has submitted to the current Diet session a bill to revise the Immigration Control and Refugee Recognition Law, aiming to establish a new residence status for foreign workers with specific skills in April 2019.
As the category 1 status, which allows foreign workers to stay in Japan for up to five years, does not permit family members to accompany workers to Japan, the number of dependents of foreign workers who are left in their countries is expected to increase under the existing system.
It has been pointed out that some foreigners come to Japan and subscribe to health insurance policies for the purpose of reducing the burden of expensive medical fees in their home countries.
To address the issue, an LDP working panel on medical treatment for foreign nationals living in Japan is discussing countermeasures. The government intends to work on a detailed design in cooperation with the LDP.
Govt seeks to eliminate abuse of health insurance system
By Yuta Abe / Yomiuri Shimbun Staff Writer
The decision by the government and the Liberal Democratic Party to tighten the criteria for the nation's public health insurance system and rectify the deficiencies of the current system falls in line with the prospect of accommodating a greater number of foreign workers.
A series of problems related to the nation's social security system has been raised among local governments and other entities that deal with foreign residents.
There have been reports of foreign nationals coming to Japan ostensibly to obtain residence status as students or technical interns, though their main purpose is to receive medical treatment.
The current health and welfare system allows anybody who is covered by the national health insurance policy, the National Federation of Health Insurance Societies, or the Japan Health Insurance Association to have 70 percent of their total medical expenses covered. The National Federation of Health Insurance Societies covers those who work for large corporations while the Japan Health Insurance Association covers those who work for middle and small sized companies.
There is also a High-Cost Medical Expense Benefit for extremely expensive treatment, whereby the cost is subsidized based on a patient's income. A government official has said that the Japanese medical insurance system is "prone to abuse, because of its generosity."
There have been cases of patients visiting medical institutions and presenting another person's insurance card.
An LDP working group researching on the healthcare of foreign residents heard from a Kobe city official in August this year about a case of impersonation, in which a Vietnamese woman illegally living in the city used her sister's insurance card to receive HIV treatment for two years.
This case was discovered in 2014, and the total expense of the treatment, which the patient had partially paid, cost more than 10 million yen. Her sister was a member of the national health insurance system.
It is difficult for medical institutions to verify the identity of patients as insurance cards do not bear ID photos.
The Health, Labor and Welfare Ministry began this year to investigate such fraud cases. But they have made little progress due to the difficulty of establishing the health conditions of foreign nationals and their family members prior to arriving in Japan. They are yet to identify any cases of fraud.
The LDP's Health, Labor and Welfare Division called on the government to make efforts to explain thoroughly to foreign nationals the mechanisms, as well as the application procedures, of the pension and medical insurance systems.
Read more from The Japan News at https://japannews.yomiuri.co.jp/
