The government's planned policy of accepting more foreign workers has brought in a new question of whether their dependents living overseas should by covered by health insurance programs offered by their employers.
Under the current system in Japan, all corporate employees, regardless of their nationality, are supposed to join corporate health insurance associations or the Japan Health Insurance Association. Their dependents within the third degree of kinship are covered by the health insurance. It is expected that as the number of foreign workers grows, so does the cost to pay for the medical treatment of their family members.
One of the reasons why this issue is attracting attention is reported cases of foreigners and their family members receiving expensive medical treatments following their visits to Japan. There are cases of foreign students joining the national health insurance program, or family members of foreign residents coming to Japan, only to rack up exorbitant medical bills.
Japan has the High-Cost Medical Expense Benefit program that supports the payment for expensive treatments. Users of this program shoulder just tens of thousands of yen per month even when the actual cost is more than 10 million yen per year. The difference is covered by their health insurance providers.
There apparently have been cases of abusing this program by taking advantage of study or work opportunities in Japan. In countries like China, online mediators are said to exist to make arrangements so that people can benefit from the program.
Despite the problem, excluding dependents of foreign workers from the coverage is pointed out as discriminatory. Coverage for the dependents of workers was incorporated in the health insurance system so that they can work without concerns. In principle, foreign workers, as long as they work inside Japan and contribute to their companies and communities, should be able to expect their dependents to receive the same treatment as their Japanese counterparts.
We are in an era where many foreigners from a variety of countries work in Japan. Determining the true purposes of their visits or the identity of their "family members" at home is practically not easy. Checks by municipal governments and health insurance associations have their own limits.
The Ministry of Health, Labor and Welfare is considering a plan to limit health insurance coverage to dependents of insurance policy holders living in Japan regardless of their nationality, while allowing Japanese students studying overseas and others to remain as beneficiaries.
This means applying different standards to those covered by the same programs, but the current situation was not foreseen when these systems were initially designed. Searching for a solution to meet the reality is a necessity.
The health insurance system is a mechanism of collective support based on mutual trust among policyholders. Leaving free riders unchecked will erode the public's confidence in the system.
Efforts should be made to reform the health insurance system to make it acceptable to policyholders while paying attention to the protection of human rights of foreign workers, and the fairness of the overall system.