Japan’s two national health insurance programs are predicated on coverage for sick people. Anything that falls outside of that very simple and general guideline does not apply. That’s why your national health insurance does not pay for annual checkups, though most local governments offer cancer screenings and other preventive health measures for free, or mostly free. In terms of dentistry, orthodontia — considered cosmetic in Japan while in the West it is a health concern since crooked teeth are likely to cause dental problems later in life — is not covered by insurance. Neither is teeth-cleaning, strictly speaking, though many dentists, including my own, have found a way to get around it.
Having a baby is also not covered by Japanese national insurance, though it is in most Western countries that have state-funded medical insurance plans. Unless the expectant mother has a complication that requires medical attention, she has to pay for all pre-natal, delivery-related and post-natal care out of her own pocket. However, the government does have a system of reimbursement called shussan ichijikin, which means “one-time payment for giving birth.” Traditionally, a woman who gives birth pays her obstetrics bill, which usually includes a hospital stay in addition to doctors’ fees, and then applies for the payment to the National Health Insurance Union (Kokumin Kenko Hoken Kumiai), which administers payouts. Several months later she receives a standard ¥420,000 payment, regardless of how much money she spent.
Last October, the health ministry started a new system on a test basis. Under this new system, the shussan ichijikin is paid directly to the hospital, not to the woman who gave birth. The idea is that the woman is not burdened with a large fee when she leaves the hospital. At the moment the system is optional for hospitals, and according to a recent article in the Asahi Shimbun many who did opt for the system say they are not happy with it. Because they have to wait up to three or four months to be reimbursed, it plays havoc with their cash flow. As a result, the future of the system, which was originally planned to be instituted fully at the end of March, is in doubt.