Annual household out-of-pocket payment, current USD per capita (2019): $563

Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed June 8, 2022.

Current Health Expenditure Per Capita (USD) (2019): $4,360

Source: Global Health Observatory. Current health expenditure (CHE) per capita in US$. Geneva: World Health Organization. Last accessed July 26, 2022.

Out-Of-Pocket Expenditure As Percentage Of Current Health Expenditure (2019): 12.91%

Source: Global Health Observatory. Out-of-pocket expenditure as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed July 26, 2022.

Out-Of-Pocket Expenditure Per Capita (USD) (2019): $562.8

Source: Global Health Observatory. Out-of-pocket expenditure (OOP) per capita in US$. Geneva: World Health Organization. Last accessed July 26, 2022.

Out-of-Pocket Spending as Share of Final Household Consumption (%) (2019): 2.6%

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

“Although the OOP rate is set at 30% for those under the age of 70, 20% for those aged 70–74 and 10% for those aged 75 and over, only 11.7% of health spending was paid directly by patients in Japan in 2014. The reasons include a lower OOP rate for children and the elderly, capped-payment for higher health expenditure (see more details in Section 3.4.2) and free health expenditure for certain conditions (see details in Section 5.14).”

Source: Sakamoto H, Rahman M, Nomura S, Okamoto E, Koike S, Yasunaga H et al. Japan Health System Review. Vol. 8 No. 1. New Delhi: World Health Organization, Regional Office for South-East Asia, 2018.

“The cost-sharing rate of 30% is relatively high by international standards, but there is a monthly and annual cap on the OOP payment for individuals and households. This cap is metered to the income of a beneficiary or a household. For example, for beneficiaries younger than 70 years, with no taxable income, the monthly cap is set at US$ 312. Beneficiaries are required to pay 30% of costs up to the cap every calendar month, but only are required to pay the cap amount plus 1% of health expenditure if the cap is exceeded. This cap is further lowered starting from the fourth month in which the cap is reached during the most recent 12-month period. For example, if a beneficiary reached the cap in February, June and November of a given year, the beneficiary will qualify for a reduced cap starting in December.

“Once the cap is reduced, it becomes easier for the beneficiaries to fulfil the requirement (of reaching the cap in at least three months during the most recent 12 month period), and they will be able to enjoy the reduced cap longer. This is advantageous for patients with chronic conditions in mitigating OOP payments. For certain chronic conditions, such as dialysis, the monthly cap is even further reduced. The policy of imposing relatively heavy cost-sharing (30%) for all beneficiaries at the point of visit while limiting the cost-sharing metered to one’s income is an effective way of protecting households financially. However, as the patient needs to temporarily pay the total amount of health-care expenditure (the difference between actual health expenditure and the cap payment is reimbursed a few months later), this cap system favours the rich rather than poor, and heavy cost-sharing will prevent abuse of services.”

Source: Sakamoto H, Rahman M, Nomura S, Okamoto E, Koike S, Yasunaga H et al. Japan Health System Review. Vol. 8 No. 1. New Delhi: World Health Organization, Regional Office for South-East Asia, 2018.

“The burden of OOP health spending can be measured either as a share of total consumption expenditure or of total household income. On average in OECD countries, the OOP payment as a proportion of total household consumption, was around 2.8%. The average share varied substantially across OECD countries in 2013, from the lowest value in Turkey (1.2%) to the highest in the Republic of Korea (4.7%). In Japan, 2.2% of total household consumption was spent on OOP payment for health services, slightly lower than the OECD average. The low burden of OOP payments in Japan is due to low co-payments and caps on maximum OOP payment size, which is known as the high-cost medical expense benefit. High-cost medical expense benefits started in 1973 in order to prevent patients from impoverishment because of health care expenditure. The MHLW [Ministry of Health, Labor, and Welfare] sets the maximum co-payment per household based on household income on a monthly basis (see more details in Section 3.4.1).”

Source: Sakamoto H, Rahman M, Nomura S, Okamoto E, Koike S, Yasunaga H et al. Japan Health System Review. Vol. 8 No. 1. New Delhi: World Health Organization, Regional Office for South-East Asia, 2018.

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.

Page last updated Oct. 13, 2022 by Doug McVay, Editor.