Japan (JP)

Japan does not have a formal GP gatekeeper system — patients can visit any specialist directly without a referral. However, large hospitals (大病院 / daibyo-in) with 200+ beds charge a mandatory first-visit fee (初診料 / shoshinryo) of ¥1,000–7,400 as a "non-referral surcharge" to encourage patients to start with clinics (クリニック / kurinikku) and smaller hospitals (中小病院). Most expats use nearby clinics (GP-equivalent) for everyday care and obtain referrals for specialists from there. English-speaking GP clinics exist in major cities.

Referral (紹介状 / shokaijō) is technically optional but strongly encouraged. Without a referral letter, large hospitals charge an extra fee (¥5,500–11,000) and you may wait longer. With a referral from a clinic, processing is faster and the surcharge is waived. Most clinics can refer to appropriate specialists in the public hospital network.

119 for ambulance (救急車 / kyūkyūsha). Emergency rooms (救急外来 / kyūkyū gairai) at public hospitals. Emergency treatment costs are covered by NHI/Shakai Hoken. Note: ambulances in Japan are free of charge to use. Non-life-threatening visits to the ER may be triaged with long waits — the #7119 medical advice line helps determine urgency.

#7119 (Kyūkyū Anshin Center) for medical advice outside clinic hours — available 24/7 in major prefectures. Hospital emergency departments operate 24/7. Some clinics have extended evening hours (夜間外来). Night-only clinics (夜間クリニック) exist in major cities.

Prescriptions (処方箋 / shohosen) are typically written by the treating doctor and filled at a separate pharmacy (薬局 / yakkyoku). Separation of prescribing and dispensing was formalized to reduce overprescription. Pharmacies are abundant — most are near clinics and hospitals. Generic drugs (後発医薬品 / generic) are encouraged and cheaper. Over-the-counter medications (OTC) are available at pharmacies and even in convenience stores for basic remedies.

Basic dental care is covered by NHI (30% co-pay): examinations, fillings (silver amalgam or composite for front teeth), root canals, extractions. Dental implants, crowns in tooth-coloured materials, orthodontics, whitening, and cosmetic procedures are not covered and can be expensive (implants ¥300,000–500,000 per tooth). Dental clinics (歯医者 / haisha) are plentiful — appointment required. Annual dental check-up is recommended and partially covered.

Mental health (精神科 / seishinka or 心療内科 / shinryonaika) is covered by NHI/Shakai Hoken at a 30% co-pay. Psychiatry (精神科) handles serious mental illness; psychosomatic medicine (心療内科) handles stress, anxiety, and mild depression — most expats start with the latter. Stigma around mental health remains significant in Japan — many people avoid treatment. University hospitals and public hospitals have psychiatric departments with shorter waits than private clinics. Long waits for non-emergency psychiatric care (2–6 weeks). English-speaking therapists are available through TELL Community Services, iNPsychome, and the Japan International Counselors Association.

Prenatal care is largely funded through municipal Maternity Health Books (母子健康手帳 / Boshi Kenkō Techō) issued free at ward offices — includes vouchers for free prenatal check-ups (14 check-ups subsidised). Childbirth is not covered by NHI as insurance (classified as a natural event, not illness) but the Childbirth Lump-Sum Grant (出産育児一時金) provides ¥500,000 per birth paid directly to hospitals. Most hospital births cost ¥450,000–600,000 total before the grant, making net cost minimal or zero at many facilities. Midwife-led birthing centres (助産院) and home births are options but less common.