Foreign workers struggle to access healthcare in Japan

Longing for the same tomorrow ~Foreigners in Japan struggling for a healthy life~

Stopping by at a convenience store, you pick up a bento box. Please pause for a few moments to look at it. Who works at the food factory which it came from? Who rings up at the cashier?

In 2019, a new status of residence, Specified Skilled Worker, has been created and Japan is now moving towards accepting more foreigners. In fact, the number of those working in Japan has increased by 13.6 percent compared with 2018 and it recorded the highest ever since the Ministry of Health, Labor and Welfare has collected statistics[1].

Foreign workers contribute to Japan in various fields, however, inviting them does not mean just importing labor force. “Their lives” come to this country, too. Foreigners work hard in an unaccustomed place, not knowing which end is up. Of course, they may get stressed out both mentally and physically. No wonder their physical condition is worsening. Then a formidable hurdle stands before them－medical care in a foreign land.

This time we interviewed a non-profit organization called Medical Information Center Aichi (MICA), which provides medical support for foreign residents in Aichi prefecture.

MICA ~Protecting Health of Foreigners~

MICA provides information of medical institutions to foreigners and holds free medical consultations once a month. In these free medical consultations, doctors and nurses join the events as volunteers and translation is also provided if necessary. The nationalities of those come to the consultations vary. These consultations are at no charge and include basic medical check-ups such as x-ray exams, blood pressure and dental examinations.

MICA also places importance on consultations with doctors in this check-up. If doctors find physical disorders that could be serious illnesses, they suggest visitors go to hospitals where they can receive more specialized treatment. Actually, this helps visitors to find out various diseases from life-style related ones to malignant tumors.

Some started going to hospitals regularly or decided to take an operation from consulting with doctors in this check-up. However, in some cases they need highly advanced medical treatment. Then a doctor prepares a letter of referral and encourages them to receive appropriate treatment.

When the cost of medical care is expected to be extremely high, MICA supports visitors to make a feasible plan for it by introducing how to make full use of insurance system or letting them consult with social workers about loans.

Moreover, health certificates they received at workplaces will be the key to understanding their health conditions and improving their lifestyles. MICA encourages visitors to bring their health certificates to the check-ups and explains the results written in Japanese since it is hard for foreigners to understand them in detail.

Norimi Fujita, MICA, says, “Foreigners get motivated for staying healthy even though they used to be ignorant of preventing sickness. Watching TV programs on health, exchanging information at their workplaces or going to check-ups, they gradually become motivated.” It is obvious MICA plays a significant role in promoting awareness of health.

Who comes to MICA? ~Harsh Reality of Insurance~

In what situation are foreign residents in need of medical support? Let’s take a closer look.

First, whether or not they enroll in some kind of public health insurance system decides their medical environments. The reason is if they can use health insurance, the cost of treatment will not be so high even if they find a serious illness in MICA’s check-ups and need to take advanced medical care.

However, it is almost impossible to receive expensive medical care if they do not enroll in health insurance. Although about 80% of those visiting the check-ups join public insurance system, the remaining 20% do not. Under the current system, all registered residents in Japan are obliged to enroll in some public health insurance. In reality, not all foreign residents join it.

Factors behind this is that the insurance system is too complicated for them to understand and sometimes they do not see any points in paying for it since they hesitate to see a doctor because of a language barrier and rarely use medical institutions.

What’s more, especially on the health insurance for salaried workers, employers are supposed to bear half the fee of the insurance but they are reluctant to take this responsibility in some cases.

For instance, a manager of a small company said to a foreign worker, “We do not have you enroll in the Social Insurance Systems [which includes Employees’ Health Insurance that requires employers to bear half the fee]. Please enroll in the National Health Insurance [which does not impose financial burdens on employers].” Then the worker went to a public office with no other choice. This time, officers told the worker “Since you are a salaried worker, please enroll in the Social Insurance Systems.”

This is one of the cases where foreign workers are at the mercy of companies and administrations, ending up in not being secured by any health insurance.

Considering the situation above, MICA asks if visitors have public health insurance before the check-ups. However, the reality is cruel. Fujita says, “If they do not have any insurance, we will introduce a low-priced clinic. But when they have serious illnesses, medical institutions will be troubled by the deficit so it is really difficult to deal with the problem.”

However, it is also true that some of those visiting MICA’s check-ups have more fundamental concerns. There are those who do not have a valid status of residence in Japan or asylum seekers.

Among the former, some got discharged by Japanese companies for their own conveniences and lost valid status of residence, being deceived by them. Resultantly they are considered staying in Japan illegally. Especially when they do not carry valid status of residence, they might be taken to detention facilities by the immigration control authority. Therefore, MICA does not inquire social backgrounds of visitors so that they can come to the check-ups without anxiety.

Also, those who were granted Provisional release, which the immigration control authority gives to detainees to temporally stop detention, came to MICA’s check-ups before.

However, Fujita says, “They have neither visas nor money but still require medical treatment. Unfortunately, the cost of care is unaffordable for them.”

In order to improve this harsh reality, MICA proposes “a public insurance that all foreigners can use regardless of status of residence.” With such system, all foreigners in Japan will be able to receive medical care without monetary concerns and it lessens the situations where they cannot pay for treatment. This will also prevent medical institutions from suffering financial disadvantages.

Japan now challenged ~Beyond Medical Care~

As mentioned in the beginning, Japanese government is now working on accepting more foreign workers. Meanwhile, it does not consider enough how to secure their health. In reality, not the government but private organizations like MICA are assuming safety net for their health.

For sure, MICA’s activities function as a lifeline to maintain health conditions of foreigners. However, if Japan wants to be heading towards “a country of immigration”, isn’t it the responsibility of Japanese government to take a leading role in protecting their healthy lives?

According to MICA, language barrier is the first to be solved. Of course, some cannot understand what a doctor explains without interpreters. However, 95.0 percent of all medical institutions in Japan do not assign medical interpreters[2].

What is more, under the current system, public insurance does not cover fees for interpretation. When foreigners use medical interpretations, doctors and patients have to decide burden ratio of fees for the service in most cases. If patients do not afford to pay for it, hospitals are forced to bear the cost.

Therefore, MICA proposes the government set a fee for medical interpretations within public insurance, which clears away financial burden of the service for hospitals. This will also be incentives to hire medical interpreters. With that, foreigners no longer need to face a language barrier, which encourages them to see a doctor and enroll in insurance system.

But just arranging the medical system does not realize their healthy lives. MICA questions environments foreigners spend every day.

“Human health cannot be maintained only by medical care. Various factors affect our bodies and spirits. If foreigners work in a good working environment, they would not have excessive stress and get sick so often. Unfortunately, unfair dismissals or one-sided termination of employment damage their health. When they lose jobs, they have no income and live an unsteady life. Even if they get ill, they would not go to hospitals until the symptoms get deteriorated. What is worse, they may not be able to see a doctor in the first place. This is why only improving medical system is not sufficient. It is essential to consider their surrounding environments as well,” says Fujita.

Social burdens Japan imposes on them are certainly undermining their health. To improve the situation, lawyers and administrative scriveners join as volunteers in MICA’s check-ups. Visitors consult with them on wide range of problems concerning working conditions and status of residence in MICA’s check-ups. For those who are saddled with debts to come to Japan and got swamped with work, they can be an important chance to remove worries in their lives. 

Furthermore, MICA talks about the future of Japan as follows. “Those who come from overseas and work in Japan pay taxes as we do. First of all, we hope Japan treats them as fellow people, not just as a workforce. They are contributing to our country,” Fujita says. Foreigners may be busy working somewhere unseen but it is presumed that Japan does not reward them properly despite the fact they are definitely parts of our society.

 “All people shall have the right to maintain the minimum standards of wholesome and cultured living” stipulates The Constitution of Japan[3]. It is natural “All people” includes foreign residents as well. “Borders do not matter for people to stay healthy” ― is this will be true in the 21st century?

Written by Manae Otsuka Edited by MitaCam crew

[1] 「外国人雇用状況」の届出状況まとめ（令和元年10月末現在）厚生労働省実施

https://www.mhlw.go.jp/stf/newpage_09109.html

[2] 令和元年度「医療機関における外国人患者の受入に係る実態調査」の結果、調査結果（全体版23頁）　厚生労働省実施 全国の病院５６７３件の内。

https://www.mhlw.go.jp/stf/newpage_11202.html

[3] 参議院ホームページ

https://www.sangiin.go.jp/eng/law/tcoj/index.htm