Surgery and Disability Benefits in Japan

37 Responses

1. Thank you for sharing this. I had no idea the disability system would work like this here. If John were posting about this kind of surgery in the US, even if he had insurance, he would be amazed at how much would still be charged to him and how many different bills (surgeons, anesthesiologists, hospital, heart valve, PT/OT, etc., etc.) would trickle in over time. I like the US stock market for investing but I definitely think medical care works better for patients here in Japan. A 60 day hospitalization for a heart valve replacement is relatively long and I am glad John is doing well. Good health!

   1. “…he would be amazed at how much would still be charged to him and how many different bills (surgeons, anesthesiologists, hospital, heart valve, PT/OT, etc., etc.) would trickle in over time.”

      From past experience, the billing for this ‘event’ is completely done. And since I’ve paid and already submitted the receipts, the only thing now is to wait for probable reimbursements, and to let that process happen. While I’m not sure exactly how various things will be counted and what the final amounts will be, everything that happens from now on should be in my favor.

      For 2019 taxes I will eventually have to prep a spreadsheet to track costs after reimbursements for this calendar year. If still over ¥100k, I’ll be claiming that next February.

2. Thank you for sharing. As much as I complain about Japanese doctors, your story exemplifies the benefits of having good socialized medical care. If you don’t mind, I have a few questions:

   1) Were you on Kokumin Kenko Hoken or on an employment based insurance program?

   2) How did you select the hospital (or was it the nearest hospital to your location that could perform the surgeries)?

   3) Generally speaking, how did you find the process of being admitted to hospital (assuming you were conscious)? Were you transported by ambulance? How long was the wait for the surgery? Any tips or insight into this process would be really cool. My interactions with hospitals in Japan has always been somewhat chaotic so I wonder how smoothly the process went for you in what I assume was an emergency situation.

   4) 60 days seems like a long time to recuperate in a hospital. Was their ever any conversation about being discharged to recover at home? My sense is Japan likes to keep people in the hospital for longer than necessary – would you say this is the case?

   I am really glad you have recovered well and here’s to your further good health!

   1. Good questions!

      1) This is something I intentionally left out, as not crucial to the overall picture. So here goes. This hospitalization straddles two systems. I was on 私学共済 up thru March 31st, and switched to 国民保険 as of April 1st. (私学共済 was extendable for two years post retirement, and 3/31 was the end of that.) Admission was on March 7th, surgery on March 26th, and the hospital split the bills with the change in providers in mind. So one system will be reimbursing for the 3/7–3/31 chunk of this, the other for 4/1st and after. City hall is handling this, and has even verbally told me what 私学共済 will cover, and, they say to submit evidence of that payment and the bill, and that they (city hall/国民保険) will cover the rest! (March bill) The changeover between systems was simple (cannot emphasize that enough), and the people at city hall are easy to deal with, straightforward, helpful, and seemingly knowledgeable & competent. This transition was so easy that I still think it is tangential to the overall picture.

      2) I’d been referred to the 大学付属病院 and was there for some tests. One test showed a serious red flag, serious enough that they said, “don’t leave, don’t go home, check in right now.” (Very bad back flow—aortic valve not closing at all properly.) I was incredulous, called the wife at her work and the doc repeated it all. Two days prior I’d done a 90 minute walk with family and the dog, with quite a bit of uphill, and they’re telling me I have this critical heart problem? Huh?

      3) So the admission was a surprise, a big one. My wife came after work (taxi) to take my car home (I’d driven that day), and to bring me some things. Part of what convinced me to stay was the comment, “if you leave and go home, we can’t be responsible for what happens.”

      4) 60 days is a long stay. On admission, they were considering emergency surgery, but I guess decided to hold off and monitor things. 3/26 was then scheduled for that. Meantime all sorts of tests, continual cautions for me not to exercise or move much, etc.

      The long stay is due to the cause of the heart valve damage—bacteremia (菌血症), a blood infection. They wanted to make sure it was gone (me, too!). Treatment for that was an antibiotic via IV for that many weeks after initial recovery from surgery. I think it was 6x/day for a while, then dropped to 4x/day. An IV is not an outpatient thing here, esp. not when it happens every six hours (04:00, 10:00, 16:00, 20:00). Luckily, they put a catheter in one arm (and then the other), which minimized (tho didn’t eliminate) the needles. Bottom line: the fever seems to be gone/cured. Had it not been for the IVs, I think I could have checked out three weeks earlier, maybe four.

      And (5, a bonus), the blood infection was caused by a prostate biopsy I’d had done late last fall—a relatively common enteric bug jumped from my colon to my blood in the process. Fever followed, and eventually got really bad. Several docs have referred to this as the probable path/cause, but it is not provable as accident/malpractice since there are other possible causes/paths for the infection. (And I’ve put that aspect of it all behind me.)

      1. This hits home for me since I’ve performed about a hundred of those biopsies. When I visited the national cancer center in Tsukiji around 1994 I was amazed to see that in Japan the typical prostate biopsy required a 3 day admission for antibiotics and observation (at Stanford the patient was in the hospital for an hour for the 15 minute procedure). Now I think prostate biopsies are also done outpatient here in Japan. A meaningful (febrile) bacteremia after the procedure occurs maybe 1% and cardiac valve infection would be a tiny fraction of those cases. In 2007-8 the American Urological Association changed the guidelines for antibiotic prophylaxis to lower the coverage for prevention of endocarditis and in 2013 a case similar to yours led to a call to revise the guidelines back to what they were when I was doing those biopsies. Google “Acute Aortic Valve Rupture” and first author Julia Ansari to see an article on the subject. I think you got great care for your endocarditis and I’m sorry you were unlucky for that urologic procedure.

         1. https://www.ncbi.nlm.nih.gov/pubmed/23471201

            I think that’s the article you refer to. I was in for an overnight of observation, but it really took off after nagging at me for a good month (with oral antibiotics during that earlier phase). Maybe they should’ve treated more aggressively then?

            1. Yes that is the article and in retrospect (of course) it would have been better to treat more aggressively earlier. However, this kind of bacterial endocarditis is known to be very difficult to treat once it starts. Things could have gone much worse and you were wise to take the advice for immediate hospitalization and treatment once the problem was discovered.

      2. Thanks so much for the detailed replies! It is reassuring that the Kokumin Hoken offers substantively similar coverage and that the city hall was so helpful – the last thing you need when recovering is dealing with a Kafka-esque medical fee situation.

3. I had a cardiac ablation surgery 8/2/2016. I was hospitalized for 3 days and my surgery was for three hours. Total bill was 100,000 yen. I had this procedure done at the Tsurumai cardiac hospital. I am a Registered Nurse and I know what good is good medical care. Their care was exemplary. I have heard quotes that this procedure costs anywhere from 25,000 dollars to 100,000 dollars in the U.S. . Japan’s medical care is superb.

   1. Comments like these are great. Thanks for sharing. The quality of medical care should be foremost in anyone’s mind when they are deciding where they want to retire. This post and the comments has re-assured me that Japan offers incredible medical care at extremely good value.

4. My friend had a bad stroke and was hospitalised for over three months. He is paralysed down the right side but mentally completely back to normal. He had kaigo hoken because of being over 70, and the doctor gave him the top rating for disability, and I’m amazed at the amount of care he is eligible to as a result, with adjustable bed, wheelchair and visits from nappy changers every day to regular visits from therapist, hairdresser, nail cutter, wheelchair walkers, bathers, nurse and weekly visit from doctor… I don’t know exact details of the costs but I’m told his insurance and disability rating means that 90% is covered. It’s all very impressive.

   1. I have heard similar stories from others. However, my 92 year old mother in law who was quickly losing her mental abilities, but was still able to walk to the nearby shopping street, received only a couple hours help a week. Does care vary by city? Is senility ignored? I didn’t understand how she wasn’t able to get help in her poor mental condition and the clear signs of dementia. Is it only physical deterioration that is considered?

      1. You have to proactively seek help. The first step is to consult with an advisor who will draw up a care plan, then arrange for services as needed. I think it does vary somewhat by locality.

         My in-laws and wife’s relatives have received pretty good care so far.

   2. Kaigo hoken kicks in at the age of 65 and currently it cost about 5200 yen a month. Also it is taken out of your bank account along with NHI.
      Don’t pay, no NHI.
      Disability benefits will vary from city to city. Usually one gets free NHK, you have to apply for it though. Also a free city bus pass is standard and a 10 percent discount off of taxis. A list will be given to you which businesses in town will give you a discount also.

      1. Is there a difference in coverage? My husband will turn 65 next year. Should he be getting extra checks in case he needs some surgery now? Will the coverage be the same when he changes to the “over 65” plan?
         We don’t seem to get many benefits in our town.. whereas friends in a neighboring city get a free bus pass, we only have a private bus system. Not even a discount for our trains and buses that I can see.

      2. Formerly, as a legit employee I always paid in, and yes, the 介護保険 is now auto-deducted out of my pension payments (some passive income tho, so mine is more than ¥5200/mo). Kind of knowing the systemic safety was there before was reassuring, but having it actively there now is wonderful.

5. I will forward this to all my friends, both here in Japan and in other countries. It is amazing what goes on here in Japan with regard not only to hospital care, but also transportation, education and the concept of overall peace and security.

   For all the foreigners who constantly complain about how bad Japan is, I suggest they reassess their outdated concepts.

   America could learn a tremendous amount of valuable lessons – if only they took the time to listen more – and complain less.

   Thank you for the tremendously informative article.

   Best wishes,

   Lawrence Klepinger
   Kobe, Japan

6. Hello and congratulations on, hopefully, a complete recovery that will allow you to successfully re-enter into your normal life routine.

   I have told a few friends of my experience with medical help in Japan but mostly have kept the experience to myself, but today I will share as a point that what happened to you was nothing unusual in this country.

   I had cancer 5 years ago and up until being diagnosed and admitted to Gifu University’s affiliated hospital, I refused to accept the truth and continued to ignore the symptoms. I was suffering from colonorectal cancer. For some unknown reason, I went went to a local clinic, had a CT Scan, and the young doctor told me that there was some swelling in my lower body area and wrote a letter and instructed me to give it to the doctor when I visited the hospital. Again, for some unknown reason, I did what he suggested was told I needed to have a colonoscopy which I did, and not surprisingly, I was close to my deathbed. I was assigned a principal doctor whom I met with my daughter and wife, and the very first words out of his mouth (all those reading this please remember that the entire episode I am about to detail took place in Japanese) were, “why didn’t you come earlier?” You are one sick Jose!

   The tumor in my colon and the butterfly pattern of my rectal cancer had begun to metastasize to my prostate and bladder, so the doctors chose to start with chemtherapy and radiation therapy before my operation in hopes of shrinking all the baddies. I had 12 rounds of chemo (6 before and 6 after) surgery and 24 rounds of radiation therapy. I will refrain from telling any horror stories, but in truth, there were more than a few. The result was that the metastistion(?) stopped and actually reversed and the tumor shrank considerably.

   My operation lasted 10 hours. We all had agreed that I wanted to be treated like an American patint, getting out of the hospital as soon as possible. The doctors agreed, but as we all know life doesn’t always go the way you want it to, I came down with complications, principally a 10 cm gash in my rectum from pulling out the drainage tube and a hole in my prostate. The only way to cure either problem was through the natural process of healing. In the case of my prostate, since it sits below your bladder, they inserted a catheter directly into my bladder to drain the urine before it could get to the prostrate, thereby allowing it to natually heal.

   Finally, I was healed but what was supposed to be a 2 week stay in the hospital turned into 6 weeks. Believe me, I was constantly being probed and poked and prodded. Finally, the day came to be discharged. My doctor also said that I would be eligible for a disability rating (level4) and he completed the paperwork quickly and I had my card within 2 weeks. I don’t quite have the same benefits as mentioned above, but almost all of them.

   This whole narration now points to the fact that after everything I went through, and what the doctors and nurses did for me to help ease my suffering, my total bill came to 120,000 yen. I was certain that was just the down payument, but no, that was my total hospital bill! However, let’s not forget I had to pay for chemo and radiation treatments but at only 30% of the true cost.

   I don’t know what most foreigners think of the state of the art of medicine in Japan is, but I absolutely worship the care I have received here after having lived in this country for 40 years.

   The one final point that I would like to emphasize is that the type of treatment you can expect to receive will skyrocket if you can speak Japanese, even at a basic level. If you plan to reside and die, like I do, in this country, it behooves you to at least attempt to try to understand of little bit of Japanese culture.

   I love Japan!

7. Being in a hospital where you don’t speak the language can be nerve racking. How did you communicate with the hospital and City Hall staff? Are you sufficiently fluent in Japanese to function on your own? Did your wife provide the bulk of translation support? Or was there a mix of English that the staff knew and Japanese that you know?

8. Actually everything you mentioned, but basically, I was on my own and spoke 90% of the time in Japanese. Let me also add that outside of 3 months of Japanese lessons when I worked for SONY 30 years ago, I have not studied the language, but rather, it seeped in through osmosis!

   1. You’re fortunate, and blessedly you’ll be around to use it even more. I think having Japanese skills that are good enough to deal with the medical system is valuable. Hopefully those without those skills will take this as a reason to work on their skills.

      1. I fervently hope so as well. Not just from a medical standpoint, but from a practical point of view of understanding where you live. Believe, as with all countries one has never visited, Japan has layers and layers of culture, history, human interaction, and on and on. The more you can understand the culture that you have chosen to call home will increase your enjoyment of your surroundings a 1,000 times.

      2. Tho still not fluent (will I -ever- be?!?) I’ve had the ‘benefit’ of being hospitalized before a couple times, both fairly long stays. Thankfully, the primary goal of docs, nurses, and PT people is communication–and not getting flustered or stand-off-ish when you make mistakes. It’s total immersion. Also, back at my uni I taught pharmacy students for a good 15 years and would often work on learning the Japanese glosses for the English vocabulary in the readings, and that has helped a lot. (And maybe I should go back and review those materials more often!)

9. It seems that those who receive a disability rating have considerable financial assistance. But I recall a friend’s husband had a stent placed, possibly in and out in one day (is that possible?) and her comment about how expensive it was..seems like it was upwards of a million yen…which would leave them with a third of that cost? I may be forgetting some part of the details. In any case, I recall that they had to pay quite a lot. Has anyone on here had major medical expenses, and not gotten any disability ratings, and been stuck with expensive bills? I’m wondering how much things will cost in a less ideal situation.
   I’m also wondering how long the current system will be able to cover the bulk of expenses like this. I fear that by the time I need to have some expensive procedure, things will be quite different.

   1. The monthly cap on medical expenses is probably more relevant to most people than the disability system. It is based on your age and taxable income, but most people won’t pay more than a maximum of 100,000 yen a month or so. You can find details on your local government website.

      1. Yes, that is very true. Also the city goes over the medical record expense and finds over charges that the patient gets reimbursed on.

10. From your comments, I’m assuming you are fairly young and correct to worry about the health insurance system in the future. As we’ve just finished a political season and much of the talk always seems to be concerned about paying too much in consumption taxes, please remember that one of the goals for its introduction was to help insure the health system, among other programs, would and could remain solvent for future generations. Therefore, if you are concerned about future costs for a variety of reasons, I would highly encourage you to think of the consumption tax in a more positive light. As you know, the tax will increase to 10% in October, but that is still way too short to cover expected future costs. Keidanren and other business associations have suggested that the tax needs to be raised to 16% if future generations can hope to enjoy the benefits for those of us in need of them today.

11. No, actually retirement is just around the corner. We just haven’t needed much medical care… thus far. So we’ve paid in our many millions over the years, but hope not to need too much ..That could change quickly though. One never knows… But surely we will need some care in 10 or 20 years’ time. Even with the increase in consumption tax (a regressive tax which I feel will only increase the wealth disparity) we are surely headed for difficult times.

    1. Very true in smaller cities across Japan.

12. I’m curious, where can one learn more about what counts as a disability in Japan, how the disability corresponds to the Levels, and then the process of applying and receiving the disability benefits? Either in Japanese or English.

    1. If you search for 「障碍者手帳」 you should be able to find your local government’s explanation.

       Here is the one for Sendai: http://www.city.sendai.jp/shogai-kikaku/kurashi/kenkotofukushi/shogai/shien/shiencenter/sogoshien/shogaisha/techo.html

       Also an article: https://snabi.jp/article/1

       1. https://www.researchgate.net/publication/42587268_Permanent_disability_social_insurance_programs_in_Japan

          Thank you for the links.

          I found a research article about the process and system in English as well (see above).

13. Hallo Lawrence,
    As taxpayers and residents but not given recognition of the same rights as Japanese citizens in the Japanese Constitution and having this reinforced by discriminatory practices sometimes especially as there is no real law against racial/ethnic discrimination, foreigners have every right to complain about those aspects of Japan that make it difficult for non Japanese to live here.

    Now for the wonderful healthcare system and other taxes we are supposed to welcome and be grateful for.
    Sure there are some good aspects of Japanese healthcare. There are also ones that seem laughable for a developed country – when you go to hospital you have to bring your own plates, cutlery and more. If the health insurance were cheap then that wouldn’t be so bad but countries such as Australia manage to provide all this as part of hospital service and in fact its public health insurance is very cheap and indeed free for a significant number of people living there.

    In Japan people on what are considered small incomes of two thousand dollars and less per month in other developed countries, pay significant health insurance fees per month. Again in some developed countries such as Australia this income is considered low and healthcare is mostly free for those on that income.

    Kokumin kenko hoken and kokumin nenkin plus income tax plus citizens’ tax – note that we foreigners do not have equal rights in the constitution and citizenship/permanent residency are very difficult/difficult to obtain but are classified as ‘citizens’ of course when it comes to paying money – slug such low income earners very hard. Throw in rent and utilities etc and it’s an incredibly inequitable system in terms of the health system/pension demands/other tax demands.

    Low income earners on 200,000 yen per month before tax are paying incredibly high rates of taxation in Japan in proportion to their income including for the health insurance. There is also no fairness in the way in which you can completely never use the health insurance you pay for to city hall but are never given a discount. I know somebody who has lived in Japan for 15 years, never cost the system one cent in health costs and has never received any recognition of this in terms of reduced payments,

    Yeah this is Japan – but it’s not great. Its healthcare doesn’t measure up to Australia, Canada, NZ, Denmark, the UK which is another country where people on low incomes don’t pay, etc. Japan hits low income earners very hard. And for those who don’t like to believe in fairytales, there are plenty of real life stories about some bad attitudes towards foreigners everywhere including in the medical sector.

    The fondness for putting non Japanese on posters warning about HIV when in fact Japan has a huge sex industry and still high levels of ignorance about safe practices for all sexualities should be the starting point for realism instead of playing along with Japanese self-delusion and mythmaking.

14. Everything I have just read is like the proverbial fairy tale that life on the other side is always better.

    Well, if you feel and think the way you do, then why are you still here? You just named a half dozen countries that are more progressive, so rather than complain, why not leave for your supposed land of “mika and honey?”

    I am so tired of nonnative people complaining about something they basically have no idea of what’s going on!

    Sorry to be blunt, but shut up or leave!!!

15. Dear Gary,
    I don’t know if you’re Japanese or a foreigner – but you give away YOUR bias by asserting I and others who make critical points about Japanese society ‘basically have no idea of what’s going on!’

    Really? I and those people live in Japan, some of us have done so for quite some time and we support this society with our skills and taxes despite the fact that it draws strict distinctions in key ways between Japanese people and others. We are the others, the out group. The Japanese Constitution excludes us. In immigrant countries like Australia, the US and Canada, Japanese who are international students have more rights in some ways than we tax paying residents of Japan.

    As I noted, there are some good things about Japanese healthcare. There are also inequities and a disproportionate burden is placed on low income earners. I let Lawrence know that because clearly he has no idea of other health/social insurance systems. I also could have mentioned the wastefulness of tax payers’ money especially the burdened low income earners on elderly people who pay little but excessively use the system for trivial complaints.

    I think Ben’s giving John space to talk about his experiences with serious surgery is great and informative but those good aspects of the Japanese healthcare system are not the entire picture. This is a wonderful blog.

    As for your ‘shut up or leave’ – sorry, this is 2019. Japan and the Japanese want the privileges and benefits of a globalised world, Japanese citizens live everywhere and in fact in immigrant countries such as mine have equal rights and privileges. In turn Japan is going to have to accept that its sense of exceptionalism is a myth and it will have to begin to behave like a country in the 21st century regarding its non Japanese population. Time’s Up!

16. I’ll be honest, I am not thrilled with the last few comments on this post. One thing I love about RetireJapan is that it is a positive place where people support each other and discuss things in a respectful way. I haven’t really had to monitor or moderate comments so far, either here on the blog or in the forum, and I really hope it stays that way.

    I’m the first to call out things I don’t like about Japan, but I would rather see specific issues than vague complaints.

    I’d also prefer people discuss points rather than each other.

    Personally I find Japan a very pleasant place to live. From what I can see, the UK and the US are becoming actively hostile to immigrants, and I am grateful things haven’t gone that way here yet.

    Anyway, here’s to getting back to discussing annual fees and portfolio allocations 😉

17. Thank you, Ben Tanaka!!!

    That’s the kind of conversation that we need. I’ve lived in this country, yes, I am a foreigner, for almost 40 years, and yes, Japanese feel elitist, but the talk I just have been subjected to is not elitist as hell as well? Everything that anyone on this blog has claimed may be true or not. Only, we as individuals with our loved ones can tell the truth from the lies (Tatemae or Honne)! Which is the truth? It all lies in the eyes of the beholder!

    I am now down to two beloved men that I can call friend and brother. One, in which I am his senior by 6 months, is 180 degrees opposite of everything “politically” that we hold dear, but I love him, not for his “politics”, but because he is honest and worth loving. We agreed 40 years ago to disagree on issues we may not see eye to eye on, and our bond has lasted ever since. What should we care about? Politics, ethnicity, culture, or what ? Personally, I believe in love! As for those of you who have thoughts of my definition of love for another man, I have been married (mostly happily) to the same woman (Japanese) for 38 years with the most absolutely beautiful daughter in the world who is now a grown woman!

    What does this have to do with this blog is this: the doctors at Gifu University’s affiliated hospital saved my life, and I will be forever grateful for their heartfelt efforts from preventing me from “going beyond the veil!” Japanese medicine works and oftentimes performs miracles. Don’t tell me that Japanese medicine is “bad!” Sorry to say but there are “bad” doctors in every country in the world. What I was trying to say is that if you seek to understand your surroundings, you may be surprised at what you might find! During my life here, I have not tried to become “Japanese” because I can’t nor do I want to. In reality, I am an American who lived his formative years (60s and 70s) to the limit and beyond, but I am still on this planet today because of the skill and dedication of the team of doctors at Gifu University affiliated hospital who took care of me.

    Let’s not be judgemental, but rather, why not try to live together as brothers and sisters and “agree to disagree?”