The U.S. and Japan Healthcare System Comparison


The main difference between the U.S. and Japanese healthcare systems is the approach to the nation’s health. The focus of the Japanese health care system on preventive measures has allowed the state to create a healthy nation with a high life expectancy. In the United States, the focus is on high-tech treatment, not prevention. However, significant differences exist in health insurance coverage, treatment of different population groups, and costs paid by patients. The unifying factor for two different systems is the concern for the health of citizens.


While most Americans need to take care of their own medical needs, the government covers specific populations’ healthcare needs through Medicare, Medicaid, and the Children’s Health Insurance program. Medical care for children and adolescents under 19 years is covered by governmental funds; the program is administered by each state individually (, 2018). Both countries aim to cover all medical services with insurance regarding attitudes toward children.

Japanese clinics are divided according to their specialties, and patients visit a particular specialized clinic based on their symptoms; however, this is not necessary with pediatricians. Pediatric medical care in Japan covers children up to 15 years of age (Ehara, 2018). For infant vaccinations and checkups, the process for visiting a pediatrician is the same as for any other doctor. Children enrolled in Japanese health insurance such as the National Health Insurance, or Social Health Insurance should be eligible for the Certificate of Free Infant Health Care (Ehara, 2018). The child can receive treatment and medicines free of charge with this certificate. Insurance does not cover a child’s immunizations and checkups, but the county or city office issues coupons to the parent to cover these costs.

Unemployed People

The healthcare system in Japan is available to every citizen, including foreigners staying in the country for more than a year. To receive compensation, self-employed and unemployed citizens must enroll in a general health insurance plan. An unemployed patient can get an affordable health plan through the Marketplace with savings based on their income and family size in the U.S. system. An unemployed person may qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP) (, 2018). Family size and income, not employment status, determine what kind of health insurance a person is eligible for and what help they get when paying for coverage. Thus, Japan and the United States assist the unemployed in the health sector.

Retired People

Retirees, like the unemployed, in Japan qualify for National Health Insurance from the local region; each of Japan’s prefectures has its insurance plan. After patients are insured, they can expect to receive a doctor’s consultation, medicines, treatment, and hospitalization. If patients in the U.S. are 65 or older, they may think they do not need additional coverage because they qualify for Medicare. However, a 65-year-old couple who retired in 2021 can expect to be paid $300,000 in health care and medical expenses at the time of retirement (Mackenzie, 2020). Thus, it is much cheaper for pensioners in Japan to receive medical care.

Coverage for Medications

Health insurance in Japan is mandatory, so everyone must be insured. The government system means that the same high level of care is available to everyone, with insurance premiums tied to income and deductions for medical bills. The Japanese government covers 70% of a hospital or prescription drug bills (InterNations, 2022). A high part of total health care costs in the U.S. are expenses on the prescribed drugs. The cost of medicines is rising every year, and it is becoming clear that in order to ensure accessibility, their cost must be covered by the insurance plan. However, as drug prices have risen, many insurance companies have placed further limits on what they will and will not cover. This means that even Americans enrolled in a plan with prescription drug coverage may incur high out-of-pocket costs.

The Requirements to See a Specialist

To meet a specialist in the U.S., a patient needs to make an appointment with a general practitioner, go to an emergency clinic or go to the emergency room. American medicine is very specialized, so the patient is often referred to a narrow specialist. Most emergency departments must accept the patient and provide treatment to stabilize the patient’s condition, regardless of the ability to pay. Getting to a specialized specialist in Japan is much easier; patients can go to any clinic without an appointment. However, depending on the workload of the clinic or doctor, a long wait may be required.

Coverage for Preexisting Conditions

A preexisting medical condition in the U.S. affects the health insurance plan. If a patient applied for insurance, some health insurance companies would accept it under certain conditions, granting a preexisting condition exclusion period or a complete preexisting exclusion. Although the health plan would accept the patient, the patient would not have coverage for any care or services related to the preexisting condition. In Japan, health insurance is provided regardless of preexisting illnesses. The government will intervene and bear the cost to help citizens get health care.

Financial Implications

A simple and consistent system allows the Japanese government to bargain with pharmaceutical companies for drug and procedure prices well below those in the U.S. Japan’s National Insurance, which is compulsory, is not the same as in the U.S. The patient must pay every time they visit the clinic, but this amount is only 30%, and this is the maximum limit so that serious diseases do not hit the wallet (InterNations, 2022). The fact that it costs money may discourage people from going to the clinic for minor things. However, in practice, people are treated early, and therefore many serious problems never develop. The most significant disadvantage is that it is difficult for Japanese doctors to earn a decent living. This needs to be addressed as it is a highly skilled job requiring a lot of work and long hours. It cannot be said that one healthcare system is better; however, people in Japan receive much cheaper medical care than people in the U.S.


The healthcare systems in Japan and the United States are vastly different, each with pros and cons. The main difference between the healthcare system in the U.S. and Japan is that the latter is focused on disease prevention. In addition, it is much cheaper to be a patient in Japan since the state bears 70% of the costs (InterNations, 2022). The systems are similar in their intention to protect children and the elderly in health care.


Ehara, A. (2018). Accessibility of pediatric inpatient services in Japan. PLoS ONE, 13(8), 1-12. (2018). Children’s Health Insurance Program (CHIP) Eligibility Requirements.

InterNations. (2022). Guide to Health Insurance and Healthcare System in Japan.

Mackenzie, G. A. S. (2020). Is There a Retirement Crisis? An Exploration of the Current Debate. CFA Institute Research Foundation.

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