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Japan’s Healthcare System vs The US | Statistics & Cost Comparison

Japan has one of the healthiest, and longest living, populations in the world. Compared to America, in particular, the statistics are intriguing; on average, the population of Japan live 6 years longer than Americans, but spend 50% less than Americans on their health care.


So, what’s at play here?


In this article, we take a comparative look at Japan’s health system vs the US, providing all the statistics you need for a comprehensive overview.


A tale of two systems

Despite Japan also offering private health care as their predominant mode of health care, Japan spends $4,150 per capita on their health care services, whereas, America spends $9,451. That’s over double.


Having an understanding of the two systems can help us draw conclusions as to why Japan’s population spend less on healthcare.


How does America’s healthcare system work?


The American healthcare system is a complex and multi-faceted system that involves various stakeholders, including individuals, healthcare providers, insurers, and the government. Here, we’ve created a summarised explanation of how the system works.


Private and Public Insurance

Most Americans obtain health insurance coverage through private or public sources. Private health insurance is typically obtained through employers or purchased individually. Public insurance programs include Medicare for elderly and disabled individuals and Medicaid for low-income individuals and families.


Fee-for-Service Model 

The predominant payment model in the U.S. is fee-for-service, where healthcare providers are reimbursed based on the services they provide. This can create incentives for providers to deliver more services, which contributes to rising healthcare costs.



Access to Care

Access to healthcare in the U.S. can vary depending on factors such as insurance coverage, geographic location, and socioeconomic status. While many individuals have access to quality care, there are disparities in access and affordability, particularly for those without insurance or with limited resources.


Regulatory Framework

The healthcare system in the U.S. is subject to a complex regulatory framework. Government agencies such as the Food and Drug Administration (FDA) oversee the safety and efficacy of drugs and medical devices, while other agencies regulate healthcare quality, privacy, and insurance practices.


Ongoing Challenges

The American healthcare system faces ongoing challenges, including rising healthcare costs, unequal access to care, and concerns about the quality of care. Efforts to address these challenges involve ongoing debates and discussions about healthcare reform, including potential changes to insurance coverage, payment models, and the overall structure of the system.


It’s important to note that this summary provides a general overview, and the intricacies of the American healthcare system can vary depending on individual circumstances and specific policies at the state and local levels.


How does Japan’s healthcare system work?


Japan’s healthcare system is known for providing universal coverage and maintaining relatively low healthcare costs compared to other developed countries, like the US. Ultimately, the focus of Japan’s healthcare system is providing universal coverage, promoting accessibility, and emphasising preventive care.


Here is a summarised explanation of how Japan’s system works:


Universal Health Insurance

Japan has a system of universal health insurance, known as the National Health Insurance (NHI). It covers nearly all residents of Japan, including citizens, foreigners with long-term visas, and even short-term visitors.



Social Health Insurance

The NHI is primarily funded through social health insurance contributions from individuals and their employers. The insurance premiums are based on income and are affordable for most individuals. The government also subsidises premiums for low-income individuals and exempts certain vulnerable populations from payment.


Comprehensive Coverage

The NHI provides comprehensive coverage for a wide range of medical services, including hospital care, outpatient visits, medications, preventive care, and some dental treatments. The government sets the fees for medical services to ensure affordability and prevent excessive charges.


“My wife was in hospital [in Japan] for a month a few years back, and the total cost, after insurance, was about $800 USD.” — Brian McDonough, Consultant at Interac.


Accessibility and Choice

Patients in Japan have freedom of choice when it comes to healthcare providers. They can visit any registered healthcare facility or doctor of their choice without needing a referral. This promotes competition among healthcare providers and ensures accessibility for patients. However, if a person wants to go to a large hospital, the hospital with typically charge an “intake fee”.


Regional Health Insurance Societies

The NHI is administered by local authorities, who establish Regional Health Insurance Societies. These societies handle enrolment, premium collection, and reimbursement of healthcare costs. The central government provides oversight and sets guidelines for the system.


Although, those employed by companies and large businesses will typically have their premiums take out of their salary. Others, who are self-employed, for example, can set up payments with their local city hall.


Health Promotion and Prevention

Japan places a strong emphasis on health promotion and disease prevention. Regular health check-ups are encouraged, and there are public health campaigns to raise awareness about healthy lifestyles and preventive measures.



Japan has a separate system for pricing and regulating pharmaceuticals. The government plays a significant role in negotiating drug prices and ensuring their affordability. The maximum profit that a drug company in Japan is allowed to charge on any drug under the NHI is 17%.



By maintaining a balance between cost control and quality of care, Japan has achieved impressive health outcomes while keeping healthcare expenditures relatively low.


Comparative statistics

So, not only do Japanese citizens spend 50% less on their healthcare, they also live 6 years longer than Americans.


How do they do it?


Well, as we outlined in the section above, Japanese culture places a strong emphasis on promoting healthy lifestyles, and preventing disease. Once you get into the statistics, this becomes a lot clearer.


Part of this healthier lifestyle is maintained by the fact that Japan is home to a wider scale of public transportation, and an overall lack of car ownership in big cities, when compared to the US. This means that Japanese people tend to achieve more daily steps than their American counterparts.


Although the Japanese smoke more, on average, than Americans:


Smoking Rate: Japan vs USA (as of 2020)



The real difference is in the obesity rates:


Prevalence of Obesity: Japan vs USA (as of 2022)



In America, the leading cause of death is heart disease, followed by cancer. One of the leading causes of heart disease is obesity, which affects high blood pressure, high cholesterol, and diabetes – also leading causes of heart disease.


It’s also been well documented that the cost of obesity on healthcare systems is overwhelming. According to World Obesity, the global economic impact of obesity is set to surpass $4 trillion, annually, by 2035 if prevention measures do not improve. That’s comparable with the economic impact of COVID-19 in 2020.


How Japan side-stepped the obesity epidemic



Obesity is a complex, nuanced issue. However, we know that one factor obesity correlates with is rich countries; the richer the country is, the more prevalent obesity is in the population. And, yet, despite Japan being a wealthy country, they are an exception to the rule.


Don’t get us wrong, the Japanese are foodies, they love to eat. Take Dōtonbori, Osaka’s food and entertainment capital, for instance; the phrase ‘kuidaore’ (食い倒れ) is found a lot in restaurant advertisements, and area guides, translating as “to eat until you’re bankrupt”. One could also argue that part of what makes Hayao Miyazaki’s films so mesmerising, is the frequent emphasis, detail, and artistry placed on depicting mouthwatering meals and banquets.


The difference lies in their cultural attitude towards food and exercise. Plus, there is a nation-wide importance placed on eating fresh fruit and vegetables, often whichever fruits and vegetables are in season, and a lower consumption of animal fats, meat, and dairy.


Japanese Food Culture: Schools, the Home, and Wider Society


According to Mairi McLaren, a teacher, writer, and translator living in Japan, this healthy attitude towards food is encouraged from a young age,


“Earlier this year, my youngest child started public daycare [a government/state subsidised daycare]. As part of the enrolment process, I was given a list of foods my child had to have tried before being allowed to eat the nursery’s lunches. No fewer than 40 different types of fruit and vegetable were on the list, plus a wide variety of fish and seaweeds.


… Most elementary school children and even junior high school children eat lunches at school that are prepared on site using fresh local ingredients and planned by qualified experts in nutrition.”Mairi McLaren, 2022.




A lot of Japanese food culture is also based within familial or social bonding. Mairi goes on to say that, when at home “Often, the “sozai” [side dishes] are shared plates placed in the centre of the table so that everyone can try a selection of dishes. Children are taught to eat a little from each plate in order, encouraging nutritional balance and mindfulness.  They are also taught from a young age to eat only until they are “hara hachi bu”—or 80% full.”


However, Japan is not without its junk food, with big fast-food chains, like McDonalds and KFC, stationed in its cities, and sweets and confectionery offered at convenience stores and independent bakeries alike.  


In the US, ultra-processed food is readily available, convenient, cheap, marketed to consumers as “healthy”, and makes up around 80% of the American diet. Not to mention, American fast food chains offer portion sizes of up to 100% larger than their British counterparts.


On the other hand, in Japan, portion sizes of junk foods are usually much smaller, making it difficult (and expensive) to overeat. Plus, junk food is considered to be something that’s enjoyed occasionally in moderation, as part of a balanced diet, resulting in societal disapproval if you’re seen to be over indulging in junk food. Correspondingly, the Japanese population eat approximately 200 calories less per day, and derive the calories they do consume from nutritionally rich foods.


Daifuku at a Tokyo market


Final thoughts


When you look at the facts, there’s no doubt that not only is Japan’s healthcare system more affordable vs US health care, their population’s attitude to food is also a lot healthier, too. It’s one of the many things that Western people love about relocating to Japan, and go on to adopt those attitudes into their daily lives.


Western governments and policymakers could also stand to learn a thing or two from Japan’s food culture, to relieve the stress on their health care systems and tackle public health concerns, but that’s a complex topic for another time.


We hope you’ve gained some insightful takeaways from this article, and we have much more free information about Japanese culture for you to explore. If you’re interested in experiencing Japan first-hand, get in touch today to find out how you can discover Japan whilst earning a living.

About the Author

Brian McDonough is a consultant at Interac, Japan’s largest provider of ALTs (Assistant Language Teachers). Originally from the US, Brian has lived in Japan for over 25 years, giving him a unique perspective on the cultural differences and challenges people face when moving to Japan. He has first-hand experience of working in Japan as an American.