Photo/IllutrationThrough an interpreter, far left, a foreign patient, foreground, receives a diagnosis in a hospital in Kyoto. (Asahi Shimbun file photo)

The health ministry plans to limit use of public health insurance by foreign workers to family members living in Japan in anticipation of an increasing number of such workers entering the country.

While the current system allows family members living abroad to use such programs, the ministry is concerned that the government's financial burden could balloon with a further influx of non-Japanese workers.

Regardless of nationality, people working in companies in Japan join “kenkohoken-kumiai” health insurance societies, or “kyokai-kenpo,” a program for smaller companies that do not have their own health insurance society, and pay premiums.

Spouses, parents, children and grandchildren living on money earned by such workers can use the health insurance programs, even if they are living abroad.

In cases where they come to Japan to receive medical treatment, they pay just 30 percent of the total medical cost, in principle.

In cases where they receive medical treatment abroad, they temporarily pay the entire cost, but can later be reimbursed.

Medical treatment fees in Japan totaled about 42 trillion yen ($368 billion) in fiscal 2017, ending in March 2018, though the health ministry does not know how much of that was spent on foreign workers' family members.

Despite this, there have been growing calls within the ruling Liberal Democratic Party for a review of the current system after the government announced its plan to expand acceptance of foreign workers from April 2019 by revising the Immigration Control Law.

The ministry therefore plans to limit use of public health insurance to foreign workers' family members living in Japan. It aims to submit revisions to the Health Insurance Law to the ordinary Diet session next year.

Exceptions to the restriction will include children of foreign workers studying in foreign countries, and family members who joined foreign workers dispatched abroad.

However, it is not clear yet whether family members who remain in foreign countries after such foreign workers return to Japan would be covered.

Also, as technical intern trainees or No. 1 category "specified skills" workers are not permitted to bring family members to Japan from their home countries, their children would never go abroad from Japan or they would never take their family members from Japan to a foreign country.

Such foreign workers would thus not be treated equally, despite paying the same premiums for the insurance programs.

Hideki Nitta, a social security law professor at Chuo University, said that public health insurance programs must treat subscribers equally irrespective of their nationalities.

He also pointed out that it would be problematic if implementation of the insurance programs produced differences between Japanese and foreigners.

"Caution should be taken during discussions to ensure there is no discrimination," Nitta said.

Speaking in the Diet on Nov. 7, Democratic Party for the People lawmaker Shinya Adachi asked Prime Minister Shinzo Abe about whether foreign workers' family members would be able to use a system under public health insurance programs whereby medical fees over a certain amount are refunded depending on the subscriber's age and annual income.

The system is called "kogaku-ryoyohi-seido" (hefty sum medical treatment costs system).

"There are cases in which a person used the system immediately after coming to Japan. Such use is different from the intended purpose," Abe said. "When the government discussed revisions (to the Immigration Control Law), I instructed officials to identify problems with the system."