Photo/Illutration Yuichiro Tamaki, a key member of the Democratic Party for the People, speaks to reporters at the Diet on Dec. 18. (Nozomi Matsui)

An opposition party leader sparked cries of xenophobia by claiming that measures are needed to prevent foreigners from exploiting medical fee caps under the national health insurance program.

Yuichiro Tamaki, head of the Democratic Party for the People, not only pushed for a review of the High-Cost Medical Expense Benefit system to prevent abuse by foreigners, but he also suggested that social insurance premiums be used only for Japanese patients.

The system sets ceilings for monthly medical expenses that patients pay depending on their incomes, and it refunds portions exceeding the maximum amounts to reduce the financial burden.

The government requires all people domiciled in Japan, regardless of nationality, to subscribe to the national health insurance program.

“Mid- to long-term residents,” who are working or studying in Japan for more than three months, and “special permanent residents” are eligible for medical fee caps if they pay insurance premiums.

Speaking on a TV program on Feb. 15, Tamaki said Japanese people who pay taxes and social insurance premiums would be unhappy if foreign nationals staying in Japan only for three months can receive 160 million yen ($1 million) in medical treatment by paying tens of thousands of yen.

He wrote on social media platform X the same day that social insurance premiums paid with the hard-earned money of the working-age population must be used, in principle, for treating illnesses and injuries of Japanese people.

In a YouTube video posted on Feb. 16, Tamaki brushed aside criticism that his view is xenophobic.

But he said people must look more critically at foreigners coming to Japan to receive expensive treatment cheaply.

Tamaki’s remarks have spread on social media, drawing both praise and criticism.

Health ministry data show that foreigners account for a small fraction of expenditures under the High-Cost Medical Expense Benefit system.

The government paid out 960.6 billion yen during the 12 months through February 2023. Foreigners received 11.1 billion yen, or 1.15 percent, of the total.

The percentage was even lower than the ratio of foreigners among subscribers of the national health insurance program, which stands at 3.6 percent.

In 2018, the health ministry started a system in which local governments notify the Immigration Services Agency about suspected health insurance abuses by foreigners who subscribed to the national health insurance program within a year.

The ministry investigates cases where foreigners are suspected of staying in Japan for improper therapeutic purposes, for example.

According to the ministry, 34 reports were filed between January 2018 and May 2023.

However, there were no instances in which the ministry sought to revoke visas or demanded refunds of benefit expenses during the period.

Reo Takaku, a professor of health economics at Hitotsubashi University, said it is a “leap in logic” to argue that only Japanese should be eligible for medical services covered by health insurance because premiums are paid by Japanese.

He said medical services are funded not only by social insurance premiums but also by a large amount of taxes, which are partly paid by foreigners.

“Foreigners account for an extremely small percentage of overall medical expenses,” said Takaku, an expert on insurance systems. “One cannot alleviate the (premium) burden on the working-age population by reducing benefits to foreigners.”

A reform of the High-Cost Medical Expense Benefit system, which the government says is necessary to reduce the burden on the working-age population, has been a key issue in Diet debate on the government budget for fiscal 2025.

Prime Minister Shigeru Ishiba on March 7 shelved plans to raise ceiling amounts starting from fiscal 2025 after facing criticism from ruling and opposition parties as well as patients’ organizations.

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