Doctors, insurance and emergencies in Tokyo

How insurance works

Everyone resident in Japan is enrolled in health insurance, either through an employer's scheme or through National Health Insurance at the ward office. The patient pays 30% of the cost of treatment between the ages of six and sixty-nine and the scheme pays the rest, with the same share applying to consultations, tests and prescriptions. A high-cost medical expense benefit caps what you pay in a month once treatment becomes expensive, which is the provision that stops a serious illness becoming a financial event.

• Employer schemes deduct contributions from salary; NHI premiums are based on last year's income.
• The patient share is fixed by law and applies across consultations, tests and medicines.
• The high-cost medical expense benefit caps monthly out-of-pocket costs — apply for the certificate in advance if you can.
• Show your My Number card, or the eligibility certificate that replaced paper insurance cards, at every visit.
• NHI premiums in your first year are low because they are based on Japanese income from the previous year.

Clinics, hospitals and referrals

Small specialist clinics — internal medicine, ENT, dermatology, orthopaedics — are everywhere and take walk-ins, often with a morning and an evening session and a long closed gap in the middle. They are the correct first stop for almost everything. Large hospitals are for referred cases and emergencies, and turning up without a referral letter means paying a separate charge for the privilege as well as waiting behind everyone who did it properly.

• Clinics open in two sessions with a midday closure; check the hours before walking over.
• A referral letter (shokaijo) avoids the additional charge at large hospitals.
• Prescriptions are dispensed at a separate pharmacy, usually next door.
• Keep the medicine notebook (okusuri techo) the pharmacy gives you — they will ask for it each time.

Language and finding care

English-speaking practice exists but is not the default, and it is concentrated in central Tokyo and around the embassies. The Tokyo Metropolitan Government's Himawari service, online and on 03-5285-8181, finds medical institutions with foreign-language support, and several international clinics operate on a private basis at higher prices. For anything involving a diagnosis, having a Japanese speaker with you is worth more than any application on your phone.

• The metropolitan government runs a multilingual medical institution search.
• International clinics in central Tokyo charge more and may not accept national insurance.
• Mental health provision in English is limited and worth researching before you need it.

In an emergency

119 calls the fire service and an ambulance, which is free at the point of use. Operators may not speak English, so state the address slowly and use the word for ambulance. Tokyo also runs a #7119 telephone line for advice on whether a problem warrants an ambulance or an emergency department, which is the number to use when you are unsure. Ambulances take you to whichever hospital can accept you, and finding one that can is sometimes the slow part.

In order

1. 1Join health insurance through your employer, or National Health Insurance at the ward office.
2. 2Get the My Number card, or keep the eligibility certificate your insurer sends.
3. 3Apply for the high-cost medical expense certificate before any planned treatment.
4. 4Find a local clinic near home, with Himawari if you need English.
5. 5Save 119, 110 and #7119.