Japan’s ruling Liberal Democratic Party (LDP) is advocating for a policy shift that would require foreign residents to pay national health insurance (NHI) premiums upfront during their enrolment process.
The Mainichi reported that this recommendation, developed by a dedicated party committee, aims to improve the low premium payment rates among non-citizen residents and will soon be presented to relevant government departments.
Foreign nationals living in Japan for over three months are obligated to join the NHI scheme if not covered by employer-based insurance. Under the current system, enrolees receive a bill by post following registration.
The proposed model would introduce a prepayment requirement, whereby premiums for a specified period would be collected immediately at local government offices during enrolment.
A Ministry of Health, Labor and Welfare review found that only 63% of foreign residents are paying their NHI premiums, compared with a 93% rate across all enrolees, including Japanese citizens.
The ministry’s findings stem from a survey conducted among roughly 150 municipal governments.
According to the LDP committee, the shortfall in premium collection is partly due to a lack of understanding of Japan’s taxation and social insurance systems among non-Japanese residents.
To address this, the group has recommended that information on the insurance framework be disseminated before individuals enter Japan, ensuring better awareness of their obligations.
The committee’s proposal also outlined potential enhancements to policy enforcement. These include mechanisms to share information about unpaid premiums for use in immigration-related decisions and the regular publication of data related to premium collection and disbursement.
These steps aim to improve system transparency and policy accountability.
This policy initiative coincides with a broader investigation by the Japanese government into how foreign residents engage with the public health insurance system.
Initiated in April 2025, the Ministry of Health is analysing the balance between contributions made and benefits received by non-citizen enrolees. The results of the review are expected by mid-year and could influence future policy decisions.
In the fiscal year ending March 2024, about 970,000 foreign nationals were registered in the NHI, representing 4% of the system’s total participants. During that period, the system disbursed approximately ¥980.3 billion in reimbursements. Of this, ¥11.8 billion – around 1.2% – was paid to foreign enrolees.
A ministry official noted that this figure was proportionate to the group’s share of total membership.
Despite this alignment, some policymakers have expressed concern. Democratic Party for the People leader Yuichiro Tamaki, in a social media post, questioned whether the current structure could allow temporary residents to access high-cost treatments with minimal personal contributions.
The Ministry of Health has not yet confirmed whether changes will be made to the NHI system, but officials have indicated that the review results may guide future reforms.
