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Gov't eyes requiring foreigners' dependent families to live in Japan to get health coverage

The Central Government Building No. 5 in Tokyo's Chiyoda Ward that houses the Health, Labor and Welfare Ministry is seen in this file photo taken on Oct. 14, 2015. (Mainichi)

TOKYO -- The government is considering requiring dependent families of foreign residents in Japan to live in the country as a condition for giving those families access to public health insurance coverage, those familiar with the matter have disclosed.

The move comes as the government aims to accept more foreign workers to make up for chronic workforce shortages. Specifically, the government plans to revise the Immigration Control and Refugee Recognition Act to create two new residency statuses for laborers with certain knowledge and experience, and for those in jobs requiring special expertise.

Currently, the medical expenses for foreign residents of Japan's dependent family overseas are covered by the foreign resident's public health insurance. The executive branch of the government will submit a bill to revise the Health Insurance Act to make the change.

There are two types of health insurance programs for company employees -- those managed by individual major companies, and those operated by the Japan Health Insurance Association for employees of smaller businesses. These health insurance programs cover the policyholder's dependent family members up to the third degree of kinship. Family members living outside Japan are covered if they meet certain conditions, such as that they live on money sent by the policyholders.

As the government aims to expand Japan's acceptance of foreign workers in April 2019, ruling Liberal Democratic Party (LDP) legislators have expressed concerns that Japan could be forced to shoulder an extra financial burden by having to pay the medical costs of foreign workers' dependent families living outside Japan.

Shinya Adachi, a legislator of the Democratic Party for the People (DPFP), pointed out at a House of Councillors Budget Committee session on Nov. 7 that "requirements for residency of foreign policyholders' dependents should be reconsidered."

Prime Minister Shinzo Abe responded that the government would like to create a system to "properly respond" to a possible increase in the medical costs of foreign residents' families living overseas. Health, Labor and Welfare Minister Takumi Nemoto, meanwhile, said the government "will consider its response based on the outcome of discussions on the issue within the LDP."

However, Japan's social security system does not discriminate against beneficiaries based on their nationalities. If such requirements were to be set for foreign policyholders, then similar restrictions would also apply to their Japanese counterparts. Therefore, the government plans to allow exceptions for those who are temporarily living outside Japan to study overseas or for other purposes.

The executive branch will consider specific conditions for such exceptions by the end of this year.

The plan to require the families of foreign residents in Japan to live in the country as a condition for giving them access to public health insurance coverage is rather of a political nature.

The welfare ministry had previously considered a similar plan but decided not to immediately implement it on the grounds that there was "no need to hurry." However, the ministry leaned toward implementing the measure in response to concerns expressed mainly by conservative legislators within the LDP that "the system could be abused" and "the financial state of health insurance programs could worsen."

Specifically, concerns had been voiced that some foreign residents could abuse the system by falsely registering non-relatives as their dependents, for example. This prompted the ministry to examine various health insurance associations' recognition of policyholders' dependents this past March. However, no such illegal practices were found.

A senior welfare ministry official also raised questions about concerns over deterioration of the financial state of health insurance programs. The medical costs of policyholders' dependents living or temporarily staying overseas, which health insurance associations shouldered in fiscal 2016, totaled roughly 2 billion yen. This represented 0.02 percent of those associations' total costs for medical coverage in the same fiscal year.

According to the ministry, more than 1.27 million foreigners were working in Japan as of October 2017. Up to about 40,000 foreign workers will come to Japan under new residency statuses in fiscal 2019.

However, despite the concerns, one high-ranking official of the ministry commented, "It's highly unlikely that the fiscal state of health insurance programs will be immediately affected" by the expansion of the acceptance of foreign workers.

(Japanese original by Masahiro Sakai, Medical Welfare News Department)

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