Understanding Japan’s Health Insurance

Shakai Hoken vs Kokumin Kenko Hoken

When people start working in Japan, one of the first areas of confusion is the health insurance system.

Japan mainly has two systems:

• Shakai Hoken (Social Insurance)
• Kokumin Kenko Hoken (National Health Insurance)

Both systems reduce medical costs, but they differ in how people enroll, how contributions are calculated, and how family coverage works.

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1. Shakai Hoken

Shakai Hoken is the insurance system mainly used by company employees.

It includes:

• Health insurance
• Pension (Employees’ Pension)
• Long-term care insurance (depending on age)

The insurance cost is shared between the company and the employee.

In practice, the company pays roughly the same amount that is deducted from the worker’s salary.

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Dependent System

One major advantage of Shakai Hoken is the dependent coverage system.

Eligible family members may include:

• Spouse
• Children
• Parents
• Grandparents
• Siblings

An important point:

The contribution generally does not increase with the number of dependents.

This makes Shakai Hoken particularly advantageous for workers supporting a family.

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2. Kokumin Kenko Hoken

Kokumin Kenko Hoken is intended for people who are not covered by company insurance, such as:

• Self-employed individuals
• Freelancers
• Unemployed residents
• Workers in jobs without social insurance

This system is administered by local municipalities.

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Contribution Characteristics

Unlike Shakai Hoken, this insurance is calculated per household.

As a result:

The more family members there are, the higher the insurance cost may become.

There is also no dependent system comparable to Shakai Hoken.

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Conclusion

For company employees, Shakai Hoken is often more advantageous because:

1. The company pays part of the insurance

2. Dependents may be included

3. Pension benefits tend to be higher

Understanding which system you are under is an important step in planning life in Japan.