Why Does Japan's Health Insurance Feel So Expensive?

Comparing Japan and Korea's Healthcare Systems

One of the things that surprised me after moving to Japan was the cost of health insurance.

Resident tax, pension payments, health insurance...

Every time I looked at my payslip or tax notice, I found myself thinking:

"Living in Japan costs more than I expected."

Of course, South Korea also has a national health insurance system, and using a health insurance card when visiting a hospital is completely normal there too.

However, after living in Japan for many years, I often felt that Japan's health insurance burden seemed heavier than Korea's.

So I decided to look into why that might be.

Korea and Japan Actually Have Similar Systems

The first thing I learned was that the basic structure of the healthcare systems in Korea and Japan is surprisingly similar.

In both countries, working generations pay insurance premiums, and that money is used to support medical expenses for people who need healthcare services, especially older adults.

In simple terms:

Working people pay insurance premiums
The healthcare system is funded
Patients pay less when visiting hospitals

Because of this, it isn't true that only Japan asks younger generations to support older generations.

Korea works in much the same way.

Then Why Does Japan Feel More Expensive?

The biggest reason is probably aging.

Japan is one of the oldest societies in the world.

As people get older, they tend to visit hospitals more often, take more medications, and require more surgeries, treatments, and long-term care.

As a result, the healthcare costs that society must cover naturally become larger.

Korea is also aging very quickly, but Japan entered this stage much earlier.

Even with the same healthcare structure, countries with a larger elderly population often place a heavier burden on the working population.

Japan Has a Special System for People Over 75

Japan has a healthcare system specifically designed for people aged 75 and older.

This system is funded by:

Government taxes
Contributions from the working population
Premiums paid by elderly people themselves

This means that part of the health insurance premiums we pay today is used to support medical care for older generations.

Korea has a similar concept, but because Japan has a much larger elderly population, the financial burden often feels greater.

Long-Term Care Insurance Starts at Age 40

Another thing many people don't realize is that Japan introduces long-term care insurance payments once you turn 40 years old.

By that point, monthly deductions often include:

Health insurance
Pension contributions
Resident tax
Long-term care insurance

Each individual payment makes sense on its own.

But when you see all of them together on your payslip, the total can feel quite significant.

How Expensive Is Japan Compared to the Rest of the World?

Looking at OECD data, Japan's healthcare spending accounts for around 10.6% of GDP, which is higher than the OECD average.

South Korea spends around 9-10% of GDP, which is closer to the OECD average.

In simple terms:

🇯🇵 Japan → Higher than average
🇰🇷 Korea → Around average
🇺🇸 United States → Extremely high

Countries such as Germany, Switzerland, and the United States spend even more on healthcare than Japan.

However, Japan is certainly not considered a low-cost healthcare country.

Japan: Expensive While Healthy, Helpful When Sick

Japan's healthcare system can feel expensive when you're healthy.

However, when serious illness, surgery, or hospitalization happens, many people appreciate the protection the system provides.

For example:

Total medical bill: ¥10,000
Patient payment: ¥3,000
Covered by insurance: ¥7,000

This protection becomes especially valuable during serious illness.

Korea: Lower Premiums, But More Out-of-Pocket Costs

Compared to Japan, many people feel that Korea's health insurance premiums are lighter.

Korea is also known for:

Fast medical services
Quick access to specialists
Short waiting times
Advanced medical technology

On the other hand, Korea relies more heavily on non-covered medical treatments and private insurance.

Because of this, patients sometimes end up paying more out of pocket depending on the type of treatment they receive.

Which System Is Better?

After comparing both systems, I don't think there is a clear winner.

Korea offers speed and convenience.

Japan offers stability and protection against catastrophic medical expenses.

As someone from Korea living in Japan, I sometimes feel that Japanese healthcare moves a little more slowly.

At the same time, I appreciate the fact that Japan tries to prevent medical costs from becoming financially devastating for patients and their families.

Final Thoughts