Whey Protein in Japan

Want to buy some whey protein for maximum macho muscle madness? Or some other reason? As with so many things, AccessJ has got you covered.


The cheapest place to buy your stuff is Amazon.co.jp. There you can find 3kg of flavoured protein powder for just over 7,000yen. That's almost 5,000yen less than the same product in Xebio. It's also one of the lowest calorie choices on the market (if that is something you care about).

You can get chocolate flavour, and milk flavour.

Of course, if you have some criteria other than price and calorie content, there are choices for you, too. Here are a couple, or you can just run your own search on Amazon.

Savas Whey Protein, which is just over 8,000yen for 2.5kg.
Savas Weight Down, which is a low-cal soy protein alternative at about 4,000yen for 1.2kg
Kentai 100% Whey, which is a muscle-building higher-calorie choice (400kcal per 100g) and around 5,000yen per kg.
Big-in-Japan brand DNS has numerous 100% whey flavours at about 10,000yen per 3kg.

Don't forget your shaker bottle!

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• AccessJ is not trying to get you to buy this protein to make money. I buy a bag of this stuff (cheapest) every month or so. It's perfect.

Over-the-Counter Drugs in Japan

Nothing is worse than getting sick in a far-away land and having to drag yourself off to a doctor. Following our recent medical theme, today's feature we will explain the world of Japanese over the counter (OTC) medications (一般用医薬品 ippan-yo iyakuhin).

Drug Classifications
There are three main classifications of OTC drugs

• Type 1 Drugs (第一類医薬品 dai-ichi-rui iyakuhin）-- These drugs are classified as having side effects that could "interfere with daily life" as well as the potential for serious health risks if used improperly. A pharmacist must be on hand to dispense these drugs and give adiquit advice about side effects and necessary precautions. 

• Type 2 Drugs (第二類医薬品 dai-ni-rui iyakuhin)-- These drugs are classified as having potential side effects that can interfere with daily but not with the severity of Type 1 medication. A pharmacist or a "registered seller" (登録販売者 toroku hanbai-sha) must be on staff to sell these drugs and provide consultation if necessary.

• Type 3 Drugs (第三類医薬品 dai-san-rui iyakuhin)-- These drugs are consider to have non serious side effects and, in most cases, won't impair one's functionality in any major way. A pharmacist or a "registered seller"  must be on staff to sell these drugs and provide consultation if necessary.

In addition to the above mentioned category, there is another classification of drugs known as i-yakubu gaihin (医薬部外品) shitei i-yakubu gaihin (指定医薬部外品). In English, these are ofter refered to as "quasi-drugs" or "supplements." This category includes vitamin drinks, nutritional supplements, cough drops, and all those energy tonics. These can be sold in any establishment including convenience stores and super markets.


Buying Drugs
As we have discussed in the previous article covering prescription drugs, pharmacies are plentiful in Japan and there is a solid chance that your local grocery or home center store has a non-prescription drug section, too.

But you may notice that these sections of the grocery store periodically get fenced off. This happens whenever a registered seller is not on staff since it is not legal to sell Type 2 and Type 3 drugs without a registered staffer on hand. Even 24 hour chains will generally close these sections off after 9 or 10 pm or so, so don't bank on getting pills for those late night headaches.

Unlike many North American and European countries, the sales of drugs over the internet are still strictly regulated. Currently, online drug stores can only sell Type 3 drugs and quasi-drugs. The sale of Type 2 drugs are limited to specially designated outlying islands and remote areas. The sale of Type 1 drugs over the internet is strictly forbidden.

Type 1 drugs usually only are available on request. In other words, you're going to have to ask for it at the counter - bring along enough Japanese to do so.

If you are worried about what's in your drugs, or what they may do, check out our article on side-effects and ingredients.


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• Pharmaceutical sales in Japan have long been a highly regulated affair. Until the recently passed Revised Pharmaceutical Law came into effect, you weren't allowed to sell so much as an aspirin without a pharmacist on hand.
• Price wise, OTC drugs in Japan are generally significantly more expensive than the USA but probably closer to prices found in Europe.
• Japanese OTC drugs are usually weaker than their Western counterparts. So, double check the dosage of something you have taken elsewhere before.

And that is all for drug and health. Keep on checking back regularly for more great information on all kinds of topics and don't forget to peek back at our coverage of Japanese health insurance, doctors, and dentists if you are still lost.

Pharmacies and Prescriptions in Japan

Now that we have covered health insurance, medical specialties, and dentists, it seem only fair that we tell you about the ins and outs of your local Japanese pharmacy establishments.

Types of Pharmacies
There are a few types of pharmacies (yakkyoku 薬局 or kusuriya 薬屋) in Japan. The first are the big commercial chains like Matsuo Kyoshi, similar to US counterparts insofar as they sell a variety of food, beer, cleaning supplies and so on in addition to over the counter drugs. However, not many of these big chains fill prescription drugs (shohoyaku 処方薬). If you are filling a prescription at a chain store, make sure to double check to make sure there is a pharmacist on hand.

Another common sight are small, family-run establishments which are almost always found right across the street from a doctors office. These small pharmacies only fill prescriptions and, for the most part, don't sell extra goodies.


Types of Prescription Drugs
Despite being a major drug market, Japan is legendarily strict when it comes to prescription medication. Legal maximum prescription sizes tend to be significantly smaller than the US, and when you want to renew a prescription you need to see a doctor directly. Furthermore, the dosage strength of Japanese medicine is generally weaker than its Western counterparts. 

Also, keep in mind that drugs have different brand names and possibly even slightly different ingredients compared to your home country. Japan does not strictly recognize US Food and Drug Administration approval or the European equivalent so drug makers must go through an additional cumbersome process in order sell their drugs in Japan. Therefore, your drug of choice may not yet be legal here or only available in a different form/dosage. One popular ADD drug, Adderall has actually been illegalized due to fears of over prescription.  


See our previous post on medication side-effects and ingredients.

Filling a Prescription (shohosen 処方箋)
Since all prescriptions must have doctor's original seal, e-prescriptions are pretty much unheard of since seals cannot be transmitted electronically. However, large hospitals and clinics will sometimes offer to fax a copy of your medication to the pharmacy of your choice so it can be ready for you on arrival.

Using Your Drugs
Don't be surprised if a lot of drugs come in the form of granules in little plastic baggies. Be it a cultural thing or some sort pharmaceutical industry quirk, lots of pain killers come in the form of nomi-gusuri (飲み薬) that must be mixed with water and drunk.

Another odd type of drug that appears a lot is the ugai-gusuri (うがい薬) which are solutions that must be mixed and gargled. Usually these types of medications are for sore throats and cough suppression. Even though they may look like cough syrups, make sure not to drink them.

The pharmacist on duty should explain everything to you when you get your drugs and many shops will print out nice detailed sheets with dosage information and instructions in case you need to get your prescription filled at another facility.

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• Japan has a drug market worth 93.2 billion USD, only trailing the USA's ludicrous 301.3 billion USD (Financial Times, 2010). Therefore, just about every tiny hamlet has a fairly extensive collection of pharmaceutical establishments.

Got all that? Pop back to AccessJ soon since our next topic will be over the counter medication.

Going to the Dentist in Japan

Today: the dentist (歯科 shika).

Despite the fact that the Japanese seems to suffer from a rather high case yaeba (double or indented teeth), cosmetic dentistry is still much less common when compared to Western countries.

However, there are plenty of dental clinics all over the country. In today's guide we will cover all the important differences and points of interest regarding the Japanese dental establishment.


Finding a Dentist and Making an Appointment
In Japan, dentistry is considered part of the basic medical establishment (see our previous article on medical specialties for details) and all the basic rules of Japanese health insurance apply to a dentist office (i.e. paying 30 percent of expenses up front, out-of-pocket expense limits, etc.). However, there is one important difference, which is that dentists almost always require appointments. 

The waiting list for dentists varies greatly depending on the size of the clinic, staffing, time, and general popularity of the dentist. Like regular doctors, dentists generally keep a split schedule with morning and afternoon hours. In this author's experience, wait times for non-emergency peak hours are generally 1 to 3 weeks depending on the dentist.

Dentists are plentiful and, like doctors, are often family establishments passed down through from parent to child. You can use websites like shikaiin.com or haishasan.net to find all the various clinics in your local area as well as their specialties and office hours.

Dental Visits and Follow-Ups
Dental clinics (歯科医院 shika iin or 歯科クリニック shika kurinikku) are generally private practice establishments, however almost every doctor employees a few dental hygienists (歯科衛生士 shika eiseishi) to help with his or her duties. Chances are, unless you are getting a tooth drilled or braces put on, you will mainly be seeing the hygienist. 

One common complaint about Japanese dentists is that they rarely do everything in one sitting. Many dentists offices are quite small and, like doctors, the insurance system encourages seeing as many patients per day as possible. It's quite possible that you will get x-rays one day, come back for brushing and gum checks the next and then get your teeth cleaned over a series of appointments. 

Some people have complained that dentists schedule unnecessary follow ups simply to milk you for insurance money and, while that may be the case, my experience has largely been positive.

Check-ups and Cosmetic Dentistry
After your initial check up, dentist offices will generally send you out yearly post cards to remind you to come in for your annual appointment.



Keep in mind that insurance only covers necessary treatments like cleanings, check ups, treating broken teeth, cavities and so on. Elective treatment (選択医療 sentakuiryo) must be paid totally by the patient and for the most part these procedures are not cost controlled. 

In the case of dentistry, elective treatment includes aesthetic dentistry (審美歯科 shinbi shika) and corrective dentistry (矯正歯科 kyosei shika). This covers tooth whitening, specialized tooth cleaning, braces, customized implants, and high quality fillings. If you get a cavity filled, insurance will only cover the most basic type of filling and cap. Implants are generally considered an extra as well. Unlike other countries, braces are never considered to be a medical necessity, even in the case of extreme tooth deformation.

As it's where the money lies, dentists aren't shy about pushing for braces and extra cleaning. Generally speaking, braces are still considered a luxury in Japan and they are generally significantly more expensive when compared to the US.

A few last things to keep in mind are that if you are looking for more invasive dentistry (surgery, gum work, etc.), make sure you find a clinic that specializes in oral surgery (口腔外科 koku geka). Like a doctor's office, its a good idea to bring a Japanese speaker along to fill out forms and explain your symptoms in detail. Luckily, many younger dentists have a fair comprehension of written English and basic medical terminology so its not impossible to communicate.


And that's a wrap. If you have any personal experiences or advice you want to share, please feel free to add comments. Also, check back to our health insurance, medical specialties and doctors office articles if you have other any burning medical questions.

Know Your Japanese Prescription Drugs

For those of you who like to know the side-effects, ingredients and other details of your medications, there is an English-language site designed just for you.

Here's the link.

The page has alphabetical lists as well as a search function. There's also a Japanese version if your medication doesn't have a romanji name.

You can search by disease symptom, too, if you're into self-diagnosis.

Going to the Doctor in Japan

As you frequent AccessJ readers may have noticed, we have just covered the various medical specialities in Japan as well as the Japanese health insurance system. Following up on our medical theme, today we will look at the important points of getting fixed up at the local clinic.

Going to the Doctor's Office
While some specialists such as psychiatrists require advanced reservations, for the most part appointments are not needed - all you need do is walk in, present your insurance card and wait for the doctor to see you. For most small clinics, the wait is generally less than an hour but for big hospitals it can be longer. Also, some hospitals require reservations for certain specialists or services depending on the time and day of the week. For a detailed list of medical specialities avaliable in Japan, check out our post here.

Finding a clinic is relatively easy. Chances are there is at least one in your neighborhood. If not, Yahoo Japan, My Clinic, and Doctor.ne.jp all offer nation-wide doctor searches to help locate your nearest health care provider. You can also search by speciality and geographic location.

These sites also show times when the clinic is open. Most doctors divide their day into morning and afternoon blocks. Generally speaking, morning hours end around 11:00 or 12:00 followed by a two hour break wherein evening hours begin (generally until 5:00 or 6:00). Since most doctors still make house calls in Japan, its not unusual for a doctor to be late returning for his evening appointments. Some clinics may offer priority to returning patients or those with reservations. Referrals are generally not necessary except of certain appointment hours at large hospitals (usually late afternoon).

If you are not a Japanese speaker or reader, it is probably a good idea to bring a friend along so you can explain what ails you as well as fill out forms regarding allergies, medication history, etc. 

Dealing With Doctors
In Japan, like many other countries, a doctor is a position of particularly high esteem. Doctors are always addressed as sensei (先生) much like teachers and lawyers to reference their prestigious position. Despite being a lucrative business, many doctors practice well into their 60s and even 70s so except the average age of your practitioner to be on the older side.

Here are some points to keep in mind:

• For older doctors, asking directly for a second opinion is akin to calling him or her a liar. The good news is that this is changing as younger doctors take the reigns and medicals schools make their curriculum more patient-sensitive. More and more big hospitals are posting signs telling their patients not to fear asking for a second opinion.
• Due to the "doctor knows best" school of thought, doctors usually don't ask your opion regarding treatment, instead preferring to go right ahead with whatever treatment they deem necessary. Again, this tends to be more true for older doctors.
• Finally, doctors in Japan sometimes often come off as curt and down right dismissive. Keep in mind, doctors get paid per patient. Therefore, there isn't a lot of chit-chat involved and usually the doctor isn't interested in hearing anything but your immediate symptoms. 

As to the question of quality, Japan is internationally of high-regard medically, and this author's experience has been a largely positive one. If one particular clinic doesn't do it for you, then just take your business to another, more reputable doctor. 


What to Bring
If you are just going for a routine check-up, then all you need is an insurance card/booklet. If you don't have one yet (i.e. you are waiting for it to come in the mail), you can often submit a claim for reimbursement so long as you are current on your premiums and your insurance has officially kicked in. If you find yourself going to the doctor multiple times, most medical providers will check your insurance card once a month to make sure your insurance is current.

If you check into the hospital overnight or longer, most facilities ask that you bring your own towels, slippers, tooth brush, tissues, and other sundries. This may sound strange to many but hospitals love to bill you for anything that you don't bring yourself so if you find yourself hospitalized, it doesn't hurt to ask a friend to bring some goods to you. Also, if you want a nicer room, private quarters, and other goodies, then be prepared to pay a lot more out of pocket.


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• According to the OECD's 2003 health data, the average Japanese person visits a doctor 14.4 times a year, far out pacing the second place USA (8.9 visits per person). Not surprisingly, even a small city will likely have many doctors offices and specialists just waiting to take your insurance money.
• Unlike many other countries, doctors are almost always in private practice, although in bigger cities some doctors have multiple branches or cooperative clinics. For basic treatment, there are two main types of doctor's offices: "clinics" (クリニック kurinikku) and i-in (医院). The two are essentially the same except i-in are almost always private practices, while clinics can have multiple branches. 
• Furthermore, some cities like Tokyo have special "foreigner clinics" geared toward short term business travelers and temporary residents. These clinics don't accept Japanese health insurance and are usually more expensive although they provide English speaking staff.
• One thing that gets particularly confusing is the the exact definition of "hospital" (病院 byoin). In Japan, it is not unusual for a single doctor or a group of doctors to run small, private hospitals with a few beds and over night staff. These small hospitals also double as clinics. However, not all hospitals accept ambulances. Emergency intake is generally limited to big private hospitals, city run hospitals (市立病院 shiritsu byoin), prefectural hospitals (県立病院 kenritsu byoin), national hospitals (国立病院 kokuritsu byoin), and university hospitals (大学病院 daigaku byoin). 
• Almost all large hospitals have an extensive array of out-patient (外来 gairai) doctors that specialize in a variety of non-emergency medicine much like a regular clinic. Most hospitals and many clinics are part of a area-wide doctor practice group (denoted by 会 -kai).
• Clinics and hopitals will often give you a card with a patient number in case you come back. Hang on to this as it will make finding your medical records that much easier.

Well, loyal readers, that about covers our doctor visit guide. For our next post we will look at dentistry in Japan. With any luck you won't need to use any of this info on a regular basis, but in the event that you get ill just remember that AccessJ has your back!

Suicide Helplines in Japan

If living in Japan, or other things, are causing abnormal amounts of unhappy feelings, here are some numbers of people who can help.

These three sets of details are taken from suicide.org - a website with databases for many international countries' helplines and counselling services.

Befrienders International, Tokyo
Contact by: Face to Face - Phone - Letter:
Hotline: +81 (0) 3 5286 9090
Website: www1.odn.ne.jp/~ceq16010
Hours:
Mon, Tues, Wed, Thurs, Fri, Sat, Sun: 20:00 - 06:00

BI Suicide Prevention Centre, Osaka
Contact by: Face to Face - Phone - Letter:
Hotline: +81 (0) 6 4395 4343
Website: spc-osaka.org
Hours:
Mon, Tues, Wed, Thurs, Fri, Sat, Sun: 00:00 - 23:00

Tokyo English Lifeline
5-4 22 rm 302, Minami Aoyama
Minao Ku
107-0062
TOKYO
Contact by: Face to Face - Phone
Hotline: Counselling: 03 5774 0992
Hotline: Face to Face: 03 3498 0231
Website: telljp.com

Medical Specialties in Japan

Since we have recently been covering the topic of health insurance, it seems logical to follow up with information about the various types of services you can get for your hard earned insurance money. Today, we will look at the medical specialities in Japan.


Unlike the UK and US, Japan lacks anything like a general practitioner (GP) or family doctor. People simply go to whatever specialist suits them. The most basic type of doctor is internal medicine (内科 naika) which is the closest thing to a GP. Almost every doctor has at least this one qualification and many doctors in private practice have several specialities, although they usually advertise one in particular. The various specialties are listed (for the first time in English) below:

内科 naika Internal Medicine
小児科 shonika Pediatrics
神経内科 shinkeinaika Neurological Internal Medicine
リウマチ科 riumachika Rheumatology
消化器科 shoukika Gastroenterology
臨床検査科 rinshokensaka Laboratory Medicine/Clinical Pathology
耳鼻咽喉科 jibiinkoka Otorhinolaryngology/Ears-Nose-Throat
性病科 seibyoka Sexual Transmitted Disease Specialist
歯科 shika Dentistry
東洋医学科 toyoigakuka Eastern Medicine
乳腺外科 nyusengeka Mammary Surgery
胃腸科 ichoka Gastro-intestinal Medicine
腎臓内科 jinzonaika Nephrology
心療内科 shinryonaika Psychosomatic Medicine
小児外科 shonigeka Pediatric Surgery
放射線科 hoshasenka Radiology
気管食道科 kikanshokudoka Broncho-Esophology
肛門科 komonka Proctology
矯正歯科 kyoseishika Corrective Dentistry
予防医学科 yoboigakuka Preventative Medicine
不妊治療 funinchiryo Infertility Treatment
血液内科 ketsueki naika Haematology
外科 geka Surgery
呼吸器外科 kokyuki geka Chest and Respiratory Surgery
形成外科 keisei geka Plastic and Reconstructive Surgery
麻酔科 masuika Anaesthesiology
アレルギー科 arerugika Allergist
産科 sanka Obstetrics
小児歯科 shoni shika Pediatric Dentistry
審美歯科 shinbi shika Aesthetic Dentistry
呼吸器科 kokyukika Pulmonology
神経科 shinkeika Neurology
整形外科 seikei geka Orthopedic Surgery
心臓血管外科 shinzo kekkan geka Cardiovascular Surgery
美容外科 biyo geka Cosmetic Surgery
内分泌科 naibunbika Endocrinology
皮膚科 hifuka Dematology
婦人科 fujinka Gynecology
歯科口腔外科 shikakoku geka Oral Surgery
インプラント inpuranto Medical Implants
循環器科 junkankika Cardiology
リハビリ科 rihabirika Rehabilitation
胸部外科 kyobu geka Thoracic Surgery
病理科 byorika Pathology
内視鏡科 naishikyoka Endoscopy
泌尿器科 hinyokika Urology
眼科 ganka Ophthmology
スポーツ科 supootsuka Sports Medicine
予防歯科 yobo shika Preventative Dentistry

Note: Obstetrician and Gynecology (婦人産科 fujin sanka) are often practiced by the same doctor much like a Western OBGYN, although in bigger clinics they may be divided into separate sections.

Typically, a doctor's main field of specialization will be in the name of the clinic (i.e. Taka Internal Medicine Clinic) or the specialities of a given practice will be listed after the clinic name. In the case of large hospitals, various out patient specialities will be divided by section, floor, and sometimes even by building.


That about does it. But what good is a list without an explanation of how to handle going to the Japanese doctor? No worries, next week: "Going to the Doctor's Office in Japan"!

Health Insurance Guide #5: Do I Need Insurance At All?

Now for the final installment of our health insurance series, where we will address the monetary and moral dilemma of whether or not you really need insurance.

The Dilemma

First and foremost, not everyone has the luxury of choosing whether or not they enroll in a health insurance scheme. However, for students, self-employed, or those working for small English schools or dispatch firms, the choice to go down to the city office and enroll in NHI is all yours.

The main pain of NHI is that payments will be deceptively cheap only to jump drastically after your first year of paid salary. Depending on your income and number of dependents, this can be a significant expense, generally more so than those who are enrolled in EHI. Moreover, you have the added chagrin of knowing that a large portion of your premiums go to covering the cost of low-cost insurance for the elderly. Therefore, it is tempting to just keep that 15,000-30,000 or so yen a month that would go to health care and save it for a rainy day.

Lets look at the pros and cons health insurance

Pros

• Living (relatively) worry free-- This is probably an obvious point but being insured can assure you a great deal of freedom by providing a social safety net. You don't have to fret about one dehabilitating and potentially costly injury ruining your life savings. Obviously, there are out of pocket costs associated with health care but when you have to get that super expensive operation it will seem like a bargain

• Planning for the Future-- As a young, virile individual, its easy to dismiss health care as a service for old fogies. However, we are all doomed to become geezers sooner or later and, more importantly, you never know what the future holds. Many people come to Japan with the intention of only staying a year or two and then end up settling down and making a family. When you have neglected to pay insurance premiums for all those year, singing up will cost a bundle in back payments which cash strapped municipalities are unlikely to forgive.

• Being a Good Citizen-- Public health insurance is, by its very nature, a cooperative effort where in neighbors pool together to help those who have fallen on hard times. More than just not sorting your garbage or refusing to pay neighborhood association fees, not having health insurance is not only a violation of the law (albeit an unenforced law with no punishments), but you are also failing to support your fellow citizens. That said, there are more than a few Japanese who don't pay into the system but nuts to them.

Cons

• Cost-- While Japanese health insurance may seem like a steal for Americans who are accustomed to being ripped off for health care, Japan is unique amongst many other countries insofar as health insurance is not paid through general wage taxation. NHI in particular can be extraordinary expensive for those on a limited budget and who have multiple dependents. Although the cost of EHI is rising as well, NHI tends to be a bit more expensive for those who don't qualify for exemptions.

• The Old Folks Factor-- The truth of the matter is that, as an NHI insurance, the lion's share of your tax and "elderly support fee" go to support Japan's massive geriatric community who are by far the biggest users of public health care. Those 75 and over entitled to extremely cheap insurance wherein they only pay 10 percent out of pocket and pay a very low monthly premium as well as low limits on high medical care. The fact that the septuagenarian crowd eats up so much of your insurance fees while paying so little is enough to make people opt to not join the system.

• Administrative Hassle-- Since NHI fees are based on the previous years earnings, you have to make sure you properly file taxes resulting from non-full time and/or part time work. If you are student, you have to make sure to file for a student reduction every year at the town hall as well as submit all your withholding slips to town hall. If you are self employed or work multiple jobs then this can be an extra hassle.

While not everyone has the option to avoid the system, the choice to join public health insurance is ultimately your own. In this author's own opinion, joining the NHI is not only the socially responsible thing to do, it is a great boon in the odd event that your Iron Man body fails you. Having insurance is precisely for those times that you can never possibly predict. Yeah, the cost sucks but in the end you have peace of mind and you are one step closer to being a productive member or Japanese society.

Well, that about does it folks! Thanks for taking a look at our Japanese health insurance super feature.

Other posts in this series

• The Fundamentals [part 1] [part 2]
• National Health Insurance
• Employee Health Insurance
• Optional Insurance
• Do I need Insurance at all?

International Supermarkets and Other Home Comforts

I have written before about getting your Japan fix in the UK. But what about getting your home comforts whilst in Japan?

I have learned to live with (and sometimes love) the Japanese alternative of most things: teabags, chocolate, shampoo etc.

But there are certain English (and presumably other nationality) products which are just better than the Japanese counterpart! Mainly toothpaste, deodorant, HobNobs and face-wash. I know there are some sites out there bent on convincing would-be ex-pats into thinking that the toothpaste and deodorant problem is just a rumour... well it's not! I have not found a single brand of toothpaste which doesn't make me gag (my students use a toothpaste in a fetching gray shade...yuck), and the deodorant is like sprinkling flavoured water on yourself.

To get these home comforts, and a few other luxuries (e.g. a good, spicy curry paste) we have mainly been relying on few and far between home visits, friends and family on holiday or other ex-pats willing to bring back things when they are on a trip back.

There are however many international supermarkets in Japan; stocking everything from English biscuits to American root beer, a range of international liquor, not to mention the hundreds of things you didn't even know you missed!

Beware: Japanese toothpaste

This informative website, exploring all the delicious things Japan has to offer also features a list of international supermarkets in the Tokyo area and beyond.

Another way to get these home comforts is by ordering online.

However this can prove difficult, if not impossible for some food items. The meat guy stocks some of the things you might be craving, such as couscous and specialities like pumpkin pie to meet your thanksgiving needs (and proper size and shape steaks).

The flying pig, and yoyomarket, also stock imported food including frozen and chilled goods,  as well as electrical items, books, and personal items, as does The Deli, which will also order in an extensive selection of American produce.

Finally, you can find shops outside of Japan who deliver here. This is slightly more difficult as there are, of course, customs regulations preventing the import of certain items (cheese for example, and certain medications). I have used Direct chemist in the past to purchase toiletries and vitamins (which can be incredibly expensive in Japan), and as noted in a previous article, Health Span UK and Nature's Best also ship vitamins and minerals.

If you can recommend anywhere else to buy food and toiletries online (and which deliver to Japan) please let us know in the comment box below.

Peach out.

Health Insurance Guide #4: Optional Insurance

Today's topic is optional health insurance, which covers hospital fees and doctor fees that are not covered by your regular insurance.

The Basics
Supplemental insurance is usually known as "medical treatment insurance" (医療保険 iryo hoken) and is sold by numerous different agencies including Japan Post, Aflac, Metlife, and so on.

Unlike the one-size-fits-all insurance schemes, supplemental insurance comes in a variety of flavors. Since most doctors visits will only drain you of a bit of pocket money, optional insurance is usually aimed at prolonged hospitalization (入院 nyuin), cancer treatments (がん gan), surgery (手術 shujutsu), or "advanced medical treatment" (先進医療 senshin iryo)--which is usually defined as cutting edge recently approved treatment methods that might not be fully covered by the public insurance system.

Coverage
Most companies divide their insurance products into two main categories which include the aforementioned treatment insurance, and cancer insurance (がん保険 gan hoken). Many companies offer a comprehensive package that covers both cancer and medical treatment with various yearly and monthly payout limits.

When shopping for cancer insurance, make sure you look at the fine print. Many companies have multi-tiered plans and lower cost options often do not include treatments for certain types of common and/or invasive cancers. One of the big restrictions is for cancers of the digestional tract (消化器がん shoka-ki gan) due to the fact that there is significantly high occurrence of this form of cancer in the Japanese population. If you want "full coverage" you will have to pay a higher monthly rate.

Furthermore, there are two basic types of coverage: fixed term (定期 teiki) and life-time (終身 shushin). Fixed term is set for a given time (usually measured in years) and life-time, as the name implies, is good until you kick the bucket. Many life-time plans include survivor benefits in the result that you die of medical complications or non-natural factors over the course of treatment

Eligibility and Shopping Around
Since medical treatment insurance is a private concern, companies reserve the right to turn down your application based on factors such as health problems and having an overly hazardous line of work. Many companies do not require a doctors exam before signing up, although this can vary based on age and other factors. In addition, insurers reserve the right to request a check-up and any necessary information from your doctor if they have any doubts about your insurability. Pre-existing conditions generally are not covered by optional insurance.

Luckily, due to Japan's bountiful supply of medical insurance providers, you can shop around for plans of all shapes and sizes. Many insurers have monthly premium calculators on their website and major shopping sites like Kakaku and Yahoo Japan have insurance comparison websites where you can look at a variety of quotes all at once.

Cost and Reimbursement
Cost for optional insurance is almost entirely based on age. Therefore, a healthy 20 or 30 year old can get insurance for as little as 1000-something yen a month while an individual in their 50s or 60s can expect to pay double or triple the price depending on the benefits offered.

Once you start paying for your plan (usually in monthly or yearly installments), your insurance company will send you an insurance certificate (保険証券 hoken shoken).


Your insurance will not kick in until after your first payment. Payouts are generally made in the form of reimbursements where in you send the insurance company your receipts and paperwork and, after an employee reviews your eligibility, the company will transfer you the money to either your bank account or the account of your medical provider. Make sure to check with your provider about what sort of forms are required before you submit a claim.

Some hospitals may allow you to defer out of pocket payments for treatment so long as you designate the hospital as the recipient of the insurance money. However, this is by no means universal so make sure you check with your medical provider. The hospital or doctor may require proof that you are current on your insurance payments and that your plan covers your treatment.

If you plan on getting your own plan and you don't know much Japanese, it is advisable to bring along someone who does, as most forms are not available in English.



Pop by again next Friday for our feature on the moral and monetary quandary of enrolling in Japanese Health Insurance.

Other posts in this series

• The Fundamentals [part 1] [part 2]
• National Health Insurance
• Employee Health Insurance
• Optional Insurance
• Do I need Insurance at all?

Health Insurance Guide #3: Employee Health Insurance

Welcome to part 3 of AJ's Japanese health insurance extravaganza! Today we will be covering the second part of the Japanese public health system, the Employee Health Insurance (EHI) scheme.


What is EHI?
Employee Health Insurance does not refer to a single system so much as it does as set of semi-public/non-profit entities operating under a single framework. The main components of the system are as follows:

• The All-Japan Health Insurance Association (全国健康保険協会 zenkoku kenko hoken kyokai) -- A relatively new government designated non-profit that has taken over the responsibilities of the old Social Insurance Agency (社会保険庁 shakai hoken cho)
• Mutual Aid Societies (共済 kyosai) -- Government sponsored or non-profit entities for designated professions such as civil servants, public school teachers, police officers, etc.
• Union Managed Insurance (組合管掌健康保険 kumiai kansho kenko hoken) -- Insurance plans managed by large corporate unions. Sometimes these unions can cover specific industries (IT workers, etc) while other times they are exclusive to very large companies (NTT, Panasonic, etc). Membership depends on union rules, company policy, and employment status. 

The Social Insurance Agency no longer exists, having been shut down after a series of mismanagement and gaffs, although many websites still use the phrase "social insurance" (社会保険 shakai hoken) to refer to the system. The term "various types of social insurance" (各種社会保険 kakushu shakai hoken) often pops up on job postings and it usually refers to health insurance in addition to employment insurance, worker's compensation insurance, and so on. 


Benefits
Regardless of what institution acts as your insurance provider, benefits are very much the same as NHI. EHI covers health, dental, specialists, and just about every approved treatment so long as its non-elective. Special health check up vouchers are available for those in their mid 40s but most basic check ups are covered by school or work.


Also, like NHI, pregnancies are not covered directly but rather in the form of a 420,000yen lump sum reimbursement.


One important benefit is the ability to recoup 2/3rds of your salary after 3 consecutive, non-paid sick days. Naturally, you need to submit proof from work and a doctor that you are not at work and not earning a wage for your sick leave. Consult your work or insurance institution regarding how to claim your benefits.


Eligibility
As we have covered in the previous section, companies and organizations are obliged to enroll their employees in an EHI scheme if they have 5 or more full time employees and/or you work at least 2/3rds the hours of a regular employee.


To avoid the extra costs associated with EHI, many dispatch firms and ALT companies classify their employees as contractors or state that mandatory work hours are just below the 2/3rds limit. Therefore, even if you work for a big company, you may not be covered by EHI insurance. 


EHI is also available to immediate family members including spouses and children as well as grandparents directly related to the primary insuree (i.e. not your wife's parents etc) so long as they are under 75 and live in the same household. Children or spouses making over 1,300,000 yen a year (1,800,000 if disabled) must enroll in their own insurance scheme. 


Costs
EHI rates differ by institution but the rates are generally a fixed portion of your pre-tax salary. For instance, the All-Japan Health Insurance Association's rates are set by individual prefectures, although in theory they don't differ too widely. You can look at all the rates by prefecture and salary level here.  Costs are shouldered equally between you and your employer so you are technically only paying half of the full fee.


The right side of the table covers insurance rates which is broken down into salary (標準報酬 hyojun hoshu) by month (月額) and day (日額). The two rates represent regular insurance rates (the lower percentage) and insurance rates with nursing insurance (only for those 40 and over). There may be small adjustments for children and spouses depending on your insurer. Contact your work place's HR department or insurance group for exact rates. 


Out-of-Pocket Costs
Like NHI, all procedures are billed with the "insurance point" system and insurees must shoulder 30 percent of all out of pocket costs. Children 6 and under only need to cover 20 percent of costs. 


Also, like NHI, there is a maximum cap on out of pocket expenditures of 81,000 yen + (Total Medical Bill - 267,000) x 1% or 44,000 if you receive multiple procedures in a short period of time. This applies if you earn less than 530,000 yen a month. Those who fall in the high earner category have their maximum expenditure cap calculated 150,000 + (Total Medical bill - 500,000) X 1% with a recurring treatment cap of 83,400. Low income earners have a fixed 35,000 yen cap and a 24,600 yen cap of recurring treatments.See the NHI article for more details.


Changing Jobs and Unemployment
Since EHI is directly linked to your employment, quitting or being otherwise terminated means that you have to change insurance. 


If you quit, are fired, or otherwise rendered unemployed, then you have two available options: the first is continuing your coverage for up to two years. The other option is to join the NHI. 


In the cast of the All-Japan Health Insurance Association, you must pay for both your own portion of the premium as well as the portion covered by your work. If you opt to go to the NHI system, your health insurance organization will send you a card in the mail (usually called a 被保険者資格喪失届 hihoken-sha shikaku hoshitsu todoke) within 20 days of your termination. You can take this to the city hall and use it as proof of unemployment to apply for NHI or bring it to your new work place in the event you are enrolled in a different insurance group. 


The ability to continue you insurance while not working may differ between insurance groups so make sure to consult your EHI provider in the event that you become unemployed.




Well that about covers the important points of the EHI system. Check back to AccessJ soon as we look at optional medical treatment insurance.

Other posts in this series

• The Fundamentals [part 1] [part 2]
• National Health Insurance
• Employee Health Insurance
• Optional Insurance
• Do I need Insurance at all?

Health Insurance Guide #2: National Health Insurance

Welcome to the second part of our (weekly) comprehensive health insurance guide. 

In this section, we will be looking at the fundamentals of the National Health Insurance (kokumin kenko hoken 国民健康保険 or simply "NHI"); specifically eligibility, costs and benefits.

National Health Insurance is the basic plan for all of those who are not elegible for the employee health system (which will we cover in the next section). Unlike some developed countries, it is not "free" (i.e. funded by general taxation) but rather paid by a seperate tax based on income.

Although it is referred to as "national insurance" the system is actually very much run locally, with the prefectural governments helping out. The national government issues grants to cover cost deficit, although these have been shrinking in recent years.

NHI is separate from Advanced Age Insurance (後期高齢者医療保険 koki koreisha iryo hoken) which is a relatively new, separate system for senior citizens 75 and older (65 and older if disabled) that covers costs 90 percent of medical expenses. This system will likely not effect most of our readers although you will find yourself paying an extra fee to help out your elderly neighbours. 

Benefits

NHI covers all essential treatment, surgeries, and dental. However it does not cover check-ups, vaccinations, child birth, abortions, elective procedures (i.e. braces, cosmetic surgery), and extras like private hospital rooms.

Having an insurance provider not cover check-ups may seem odd but keep in mind that Japanese schools and work have extremely extensive yearly (usually free) health checks. In addition, municipalities generally offer extras such as vaccination clinics, special check ups for children, and so on. There are also vouchers available for special health checks and cancer screening for those over 40. 

Pregnancy costs are covered in the form of a lump sum reimbursement (shussan ikuji-kin 出産育児金) of around 420,000 yen. This lump sum does not change regardless of the cost incurred by the hospital stay (which can vary by location, doctor, and optional costs) so it is possible to come out of a pregnancy with extra cash or even a net loss. Some hospitals have systems in place where in the money will be sent directly from the NHI provider to the hospital while others demand upfront payments.

Eligibility

Despite being a "compulsory system," there is no automatic enrolment. You should do so yourself at the town hall or ward office (see part 1 of this guide for details).

 

You are eligible for NHI under the following circumstances:

• You are self employed or the sole proprietor of a business
• You run or work in a business employing 5 people or less
• You work part-time, temp work, and/or dispatch work (less than 3/4ths the amount of time a full time employee would work is considered part time)
• You work in farming, agriculture, or fisheries and are not eligible for agriculture or fishery cooperative insurance
• You work in designated service industries or as an outside contractor
• You are unemployed
• You are a student

NHI extends to children and spouses so long as they do not make over 1,300,000 yen a year and/or have his or her own health insurance policy available through work.

Cost

The exact costs of NHI vary significantly from prefecture to prefecture, and even town to town. The costs are adjusted at the end of every tax year (March) and are based on your previous year's income. For this reason, many who have just arrived in Japan will be shocked to find how cheap their insurance is the first year only to find a massive spike in their NHI tax the following tax year. 

Although costs differ, there is a standard formula in use that just about every NHI system uses. 

Medical Care Portion + Senior Citizens Support Fee + Long-Term Care Insurance = (Total Cost x Fee Reduction Percentage) 

• The medical care portion consists of the following formula (Basic Fee x Number of Insurees) + (Basic Levy for All Members x Fixed Percentage). There is a maximum limit of about 500,000 yen for this portion.
• Basic Fee and Number of Insurees refers to a fixed price, usually in the 30,000 yen or more range set by the city. This is multiplied by the number of immediate family members on your NHI.
• Basic Levy is calculated by taking your previous years' household income minus 330,000 yen.
• Senior Citizen Support Fee is the section that goes toward the aforementioned Advanced Age Insurance and is calculated as (Basic Levy x Number of Insurees) + (Basic Levy x Fixed Percentage). There is a maximum of approximately 130,000 yen for this portion.
• Long Term Care Insurance supports nursing care for the elderly but it is only paid by those 40 to 64 years old and is calculated as (Fixed Fee x Basic Levy for Insurees 40 to 64 years old) + (Basic Levy for Insurees 40 to 64 years old x Fixed Percentage). There is a maximum of approximately 100,000 yen for this section. 

There are deductions available for those who are unemployed, below a certain income threshold, have young children, or cannot work. The most common deductions are for low-income earners, students, the recently unemployeed, and the disabled. The Fee Reduction Percentage is generally in the range of 20 to 70 percent. Consult your local town hall for details.

You are liable for payments from the first day of eligibility (i.e. the first day you arrive in Japan) for a maximum of 2 years back payments. So if you fail to sign up after getting your alien registration then you are technically liable for all the back payments up to the day you change your mind and decide to join. Late payments will invalidate your coverage (although not immediately) and many city halls won't allow you to join late if all the back payments are not paid in full.

Finally, don't forget to submit your earning and withholding (gensen choshu shomeisho 源泉徴収証明書) statement during tax time (February-March). Reporting your income or lack thereof is particularly important for students with part time work since they are generally entitled to a hefty discount. Unemployed should similar report a continued lack of income in order to get reduction benefits.

Out-of-Pocket Costs

As we have covered previously, you are responsible for 30 percent of all medical expenses. Children under six only need to pay 20 percent. There is a maximum out-of-pocket expenditure limit (kogaku iryo-hi 高額医療費) of 80,100 yen plus 1 percent of any portion exceeding 267,000 of total medical costs for treatments occurring up to 3 times in a month. For treatments that occur over 4 times a year there is a cap of 83,400 yen. This maximum amounts are higher for those taxed as "high income" and lower for citizens 75 and older and/or those who are exempt from local residence taxes.

Any money paid over the maximum cap is returned in a reimbursement from your city hall. 

If you lack the means to pay for your immediate out-of-pocket expenses, many providers will use a temporary loan (kashitsuke seido 貸付制度) or a charge payment system (inin-barai seido 委任払制度) wherein you arrange for the local NHI system to receive the excess payments directly. Consult your medical provider and local town hall to see if there are any such arrangements in place.

More

• Since NHI is administered on a local level, you must register your address at the city hall. Also, if you change or renew your residence status, make sure to report it to the city hall.
• Once you are in, you generally cannot leave the NHI unless you leave the country. In this author's experience, simply telling city hall that you plan to move to another prefecture is generally enough for you to get out of the system although not every city hall is that forgiving. Some prefectures may require proof of having moved or even a copy of plane tickets home before they let you go. It all is on a "case-by-case" basis, it would seem. For all intents and purposes, don't assume that leaving the system will be an easy task short of leaving Japan.
• Finally, if you get a job that provides health insurance under one of the Employee Health Insurance schemes then you need to show your new proof of insurance to city hall before they let your out of the system.
• Since fees are generally paid in installments, you may be entitled to a reimbursement after you quit the local system (i.e. move to a different municipality). For example, if you move prefectures at the end of the month, you will be liable for the whole month's payment in your previous prefecture in addition to any payments in your new location, but you will receive a reimbursement for the days in which you were not covered.

As you can see, the whole NHI system is more than a bit complex. Welcome to Japan. Check back soon for our next section where we will cover the Employee Insurance System.

Other posts in this series

• The Fundamentals [part 1] [part 2]
• National Health Insurance
• Employee Health Insurance
• Optional Insurance
• Do I need Insurance at all?

Health Insurance Guide #1: The Fundamentals 2/2

Welcome back to part 2 of AccessJ's Japanese health insurance super guide. In this section, we will continue discussing the fundamentals of the insurance system including how to pay, co-payments, and third party damages. 


Read on...



Premium/Tax Payment
There are several options available for paying your health insurance premiums (in the case of EHI) or tax (in the case of NHI). The options are as follows:

• Deducted directly from your monthly salary (EHI only)
• Pay at an institution (convenience store, post office, etc) in a series of 6-10 installments (NHI only)
• Pay via automatic bank transfer (NHI only)

EHI premiums are split between you and your employer wherein you pay in the form of a monthly fixed premium deducted from your paycheck before taxes. However, if you are on the NHI program, your payments are classified as a tax. This is an important distinction because you are obligated to pay the tax on your own without your employer to deduct it from your pre-tax earnings. If you opt to skip out the tax for whatever reason city/prefectural government you can go to court and ask for a draft or lien on your bank account.  


In the coming installments we will discuss the details of how premiums are calculated.


Costs
Although you pay regularly for your insurance, you are in most cases required to bare some additional costs when visiting the doctor. The magic number to remember for most people is 30%, since that represents the portion of the costs you must shoulder yourself for NHI and EHI. There are deductions and discounts available to the elderly, disabled, and for infants which we will cover later. 



While 30% may seem like a lot, medical treatment prices in Japan are heavily cost controlled and even at full price, most procedures are only a fraction of the price found in the USA. Amounts are subject to change annually as the doctors union haggles with the government over proper pricing. Doctors and hospitals in Japan charge based on a point system (保険点数 hoken tensu) assigned to each treatment, medication, and procedure. Clinics also add extra points for things like a first time visiting fee (which gets reduced if you continue to see the same doctor) and points for writing prescriptions. 


Third Party Damages and Coverage

There are limits to "third party damages" (i.e. stuff caused by the actions of others or circumstances out of your control) when applied to public and private health insurance. For instance, if you are in a traffic accident accident and need medical attention afterwards then you must submit a proof of accident form and/or any settlement papers regarding said accident to your insurance institution. Failure to do so will result in non-payment of your doctor's bill.


The All-Japan Health Insurance Association (全国健康保険協会 zenkoku kenko hoken kyokai) lists the following as grounds for "adjustments" to your benefits:

• Malicious criminal acts and incidents
• Injury resulting from fights, intoxication, and/or "significant misconduct"
• Conditions resulting from failure to follow your doctor's instructions or follow the diagnosis of your health care provider without proper cause
• Receiving or attempting to receive insurance payments via fraud or other improper means (i.e. "borrowing" a friends insurance card for a visit to the clinic)
• Failure to comply with document submission requests and/or inquiries made by the insurer
• When receiving benefits from local or national institutions as prescribed by the Infectious Disease Prevention Act and other related laws.
  

So, long story short, if alcochol tends to give you a bad case of angry fists or you don't take those pills your doctor gave you then be prepared to pay out of your own wallet for treatment. 




Well, that about covers the basics of health insurance in Japan. Tune in to our next installment where we'll cover the system in more detail.

Other posts in this series

• The Fundamentals [part 1] [part 2]
• National Health Insurance
• Employee Health Insurance
• Optional Insurance
• Do I need Insurance at all?

Health Insurance Guide #1: The Fundamentals 1/2

At first glance, the Japanese health insurance system my seem more than a little opaque; and employers are often unhelpful when it comes to signing up (English conversation schools and dispatch firms being the biggest culprits). 


But fear not, we at AccessJ have your back with our newest guide.




The Basics
In Japan, the term "health care" (健康保険 kenko hoken) refers to a plethora of public, semi-public, and private schemes. There are two main forms of insurance available to the public: National Health Insurance (国民健康保険 kokumin kenko hoken or NHI) and Employee Health Insurance (sometimes referred to as Social Insurance 社会保険 shakai hoken or government managed insurance 政府管掌保険 seifu kansho hoken--both of which are a bit out of date but still used). Employee Health Insurance (EHI) actually covers a whole group of public and semi-public systems (which we will cover in due time).


There is also an optional private component known as Medical Care Insurance (医療保険 iryohoken) which will reimburse the portion of medical expenses not covered by your insurance, in addition to survivor benefits. Cancer Insurance (がん保険 gan hoken) is private and, as the name implies, covers cancer treatment not covered by the aforementioned public and private systems.


Unlike the US, pre-existing conditions are not a factor for NHI and EHI but aren't typically covered by private supplementary insurance.



Who Needs Insurance?
According to the letter of the law, any individual with a valid status of residence (在留資格 zairyu shikaku) residing in Japan for a year or more must be enrolled in NHI or employee sponsored insurance insurance. Your overseas health insurance coverage is not considered sufficient reason to skip out on the Japanese system, although some universities and vocational schools don't require short term study abroad students to sign up provided they have health care back home. There are several firms that cater to short term visitors but they are usually limited to reimbursement payments.


Where to get Insurance
When it comes to NHI and EHI, there are two basic ways to sign up: go to the NHI Division (国民健康保険課 kokumin kenko hoken-ka) of your local city hall (市役所 shiyakusho) or ward office in big cities (区役所) or, in the case of EHI, your employer will do it for you.


If you sign up for NHI, bring your alien registration card (外国人登録証明書 gaikokujin toroku shomeisho) or a passport with a valid status of residence sticker. Also bring your official seal (印鑑 inkan) if you have one, although sometimes a simple signature will suffice. Usually EHI is all done behind the scenes once you are hired, although some companies may have additional paperwork. 





As we will discuss in future instalments NHI differs by prefecture, so some may issue a health insurance card on the spot while others may post it to your house. Some  prefectures only give one card per family while others give a passbook. EHI cards are mailed to you or your employer. 

An example of health insurance certificates

Well, that about covers the first half our AccessJ's introduction to the Japanese health insurance system. 

Other posts in this series

• The Fundamentals [part 1] [part 2]
• National Health Insurance
• Employee Health Insurance
• Optional Insurance
• Do I need Insurance at all?