Photo/IllutrationPrime Minister Shinzo Abe replies to questions in the Upper House plenary session on Oct. 31. (Takeshi Iwashita)

Amid the heated debate over foreign workers in Japan, Diet members are pursuing stronger measures to prevent non-Japanese from misusing public health insurance programs, although no evidence exists that such cheating is widespread.

A resolution adopted by the health committee of the ruling Liberal Democratic Party on Oct. 29 demanded stricter government steps to prevent such misuse by foreigners, such as allowing other people to use their health insurance cards.

But the health ministry has already moved in that direction, and its methods have been criticized as a violation of human rights.

The Diet is now debating Prime Minister Shinzo Abe’s plan to introduce a new visa next year for skilled foreign workers who can help alleviate labor shortages in various sectors of Japan.

In the Upper House plenary session on Oct. 31, Kohei Otsuka, a member of the opposition Democratic Party for the People, asked the prime minister how foreigners are using public health insurance programs.

“We will examine measures so that they use the programs appropriately,” Abe replied.

Foreigners who stay in Japan for more than three months, including students and business owners, must join “kokumin-kenkohoken” (national health insurance program).

If foreigners are working for companies, they and their family members join the employers’ “kenkohoken-kumiai” (health insurance societies) or “kyokai-kenpo” (health insurance programs for employees of mid- and small-sized companies that do not have their own kenkohoken-kumiai).

The resolution adopted by the LDP’s health committee seeks stricter implementation of the insurance programs, revisions to related laws or strengthened cooperation among government organizations to prevent non-Japanese from misusing the programs.

However, the Ministry of Health, Labor and Welfare has already started taking measures for that purpose, despite having no data showing that defrauding the public health insurance programs has spread among foreigners.

In March 2017, the ministry looked into 1,597 cases over a one-year period from November 2015 in which foreigners used at least 800,000 yen ($7,088) in “expensive medical services” within six months of joining the national health insurance program.

Of the 1,597 cases, only two were deemed suspicious.

“We were almost unable to confirm any suspicious case,” the ministry concluded.

Still, the health ministry in January this year asked municipalities to instruct their employees to check if foreigners who have joined the national health insurance program are engaged in activities described in their visas.

The municipal workers ask personal questions at counter windows dealing with the insurance program and report suspicious cases to regional immigration bureaus.

If the bureaus find visa violations, the foreigners’ statuses to stay in Japan are nullified and the municipalities will ask them to return benefits paid from the insurance programs.

According to the ministry, the instructions were issued after staff at hospitals reported suspicious cases involving foreign members of health insurance programs.

In one case, hospital workers said a foreigner with a pre-existing disease came to Japan on a student visa and joined the national health insurance program, according to the ministry.

In another reported case, a foreign employee of a company took more than 10 supposed family members to hospitals for treatment under a public health insurance program.

Ippei Torii, the representative director of Solidarity Network with Migrants Japan, a nonprofit organization, said the practice of municipal officials in charge of the national health insurance program asking foreigners about their daily lives was “a violation of the human rights of foreigners.”

“The discussions have become emotional ones of ‘Don’t allow (foreigners) to use (public health insurance) for free,’” Torii said.

Hideki Nitta, a professor of social security law at Chuo University, said that if the government wants to prevent foreigners from disguising their resident statuses and joining public health insurance programs, it should take measures during their screening to enter Japan.

Such measures include having foreigners submit their latest health-check results, he said.

“If they join (insurance programs) appropriately, they must be basically treated equally with Japanese,” he said.