“I got all A's on my health check!” I called out to Hai as I opened my letter containing the results of this year's medical examination.
“What's new?” he called back, probably rolling his eyes at the same time. A friendly dig at the fact I did well in school.
Yes, in Japan we get assigned letter grades, A through F, on an annual basis that indicate the state of our health in a variety of areas, and track changes year on year. It's an interesting system that I haven't seen anywhere else, and today I thought I'd tell you a little about it.
So, let's get down to it.
Who has annual health checks in Japan?
Essentially everyone. Employers in Japan have a legal obligation to offer annual health screenings to their employees and most Japanese companies make taking such exams a requirement for entering their ranks and continuing employment.
For those who are not currently in employment, such as stay-at-home parents, or those not in a traditional company setting, like freelancers or small business owners, services are set up via your local city office to ensure you also have access to an annual health check-up. In such cases, whether you decide to take up the offer is entirely up to you. Although most people do, perhaps because annual health checks are such an ingrained part of Japanese society.
Whether you work for a company or not, this service is free to you as the patient. Although this is of course something that is funded through the taxes we pay.
How do you arrange a free health check in Japan?
If you work at a Japanese company, they will give you all the details. Some companies will have medical staff come to their offices or one of their own facilities, and employees will line up one-by-one to go through each of the checks.
Perhaps a more common method, however, is to simply give employees a list of “approved” hospitals and a timeframe, during which time they must arrange and have the health check done.
In our case, we get our free annual health check via the city office system. We get sent a letter every year that announces the health checks for the year. For us, the health checks are usually done in June. It's a popular time for many Japanese companies to have their employees do health checks too, since it gives enough time for things to settle down after the beginning of the new fiscal year in April and it's before August when many people head back to their hometowns for a week or so for Obon holidays. Alternatively, some companies do theirs around September or October, after the summer and before the New Year, another important holiday for the Japanese.
In our city, we can choose one of eight sessions over two weekends. If that doesn't work for your schedule, you can also claim your free health check by arranging a time at one of their participating medical facilities.
So far, we've always been able to make at least one of the time slots so we prefer to just go then, rather than having to make our own arrangements. There's a building adjacent to our city hall that has the necessary space and facilities for health checks to take place.
To confirm our attendance, we just need to select the date and time period (morning or afternoon) from the eight choices on a reply-paid postcard and pop it in the post box. There's no confirmation; we just need to show up with our ‘residence card' and a little slip of paper with our unique health check ID number and personal details (this slip is sent to us with the initial information).
What do you need to do before the health check?
Health checks usually require you to fast for a certain period beforehand. For us it is 3 hours. Those who are having other types of tests (as we'll talk about more below) may need to fast 12 hours, or however long is specified by the medical facility.
As such, you might notice that restaurants and cafes around testing centers and hospitals are more crowded than usual around health check “seasons,” as food is usually the first item on the agenda for most people after the tests.
What happens at an annual health check?
While there may be some variation across the country, generally an annual health check entails:
- a chest x-ray
- a urine test
- girth, height and weight measurements
- blood pressure check
- a blood test (several viles for various tests)
In addition to the physical tests and checks, you fill out a medical questionnaire that asks specific questions about lifestyle, such as how many cups of tea or coffee you drink a day and whether you have it with sugar, or how many hours of overtime you do per month. Here they also ask about any pains, ailments or worries you may have been experiencing.
The questionnaire will be looked over in a private booth by a nurse, who will ask about whether any serious conditions run in your family and whether there is anything you've been worried about in regards to your health, both of which may result in recommending further testing.
At the end of all the standard testing, you will be offered to consult with a doctor, who is waiting on site, should there be anything that you'd like looked at or investigated further.
In certain age brackets, some checks become routine and therefore unavoidable if you work for a Japanese company. For example, Japan has one of the highest rates of stomach cancer in the world so an endoscopy becomes part of your standard annual health check from 40 years of age.
Benefits of the annual health check
There are obvious benefits of having an annual health check-up. I think that simply by having one makes people pay closer attention to their health. And by making it an annual event that almost everyone participates in, and where medical practitioners are there at the ready to address your health concerns, means that people are less likely to put off important medical checks that potentially could save one's life.
I really like the fact that when you receive your health check results, it tracks them against your results for the previous year. This means that changes, both small and major, can be seen clearly. I know of a couple of Japanese people who have had cancer in its early stages detected through these health checks, before they have felt any physical symptoms whatsoever. As such, they were able to get treatment early and are now in full health.
The results also include information on what is considered a normal range for each test, of which BMI is taken into account when relevant. Whether abnormalities have been found is clearly stated, and the letter grades have a clear code as to when seeking further medical examinations is necessary or recommended.
Overall, and especially when many people around the world don't have access to health care and/or simply can't afford it, we must feel appreciative that such a system exists in Japan, and that it is free.
There are some aspects of the annual health check system in Japan, however, that may be considered downsides or at least problematic.
Let's take a look at some of them.
Disadvantages of the annual health check in Japan
Your company gets a copy of the results
Yep, if you work for a Japanese company, they will receive a copy of the results. The main purpose for making them mandatory for employees is to make sure there isn't something that's going to prevent you from doing your job effectively.
From all the Japanese company workers I've spoken to about this, they say the results are usually sent to the HR department. If your results are deemed “normal”, then they'll likely just be placed in your file and not spoken of again. If, however, any abnormalities do come up, or your test results are deemed less than ideal, expect to have a somewhat awkward conversation with HR, or even your boss, about follow-up examinations, what you're doing to address this health concern, and even your role within the company.
While some changes to your role may be indeed beneficial to you and your health, oftentimes the results are used simply for the benefit of the company. Sometimes the results can lead to discrimination and otherwise very fit people being passed up for promotions or other important roles.
The mandatory health check system of most Japanese companies makes it very difficult in many cases to keep your personal medical circumstances private.
The annual health check “cleanse”
Because the annual health check is a mandatory requirement for continued employment at most Japanese companies and due to the issues that may ensue if you perform poorly, many employees go on an active “diet” in preparation for the check. They do such things as eliminating fried foods and alcohol, and pay close attention to getting more sleep, usually for a month or so beforehand.
These lifestyle changes can of course be considered positive, but it really does little to solve the endemic issues that cause them in the first place, such as mandatory company drinking parties where workers are obligated to partake in less than healthy izakaya (Japanese pub) food and excessive drinking. And it's usually company overtime (most of which is not paid), that mean there is little time to rest in between working hours. Even at home or during free time, alcohol is highly consumed as a means to relax and unwind from the stresses of company life.
Until this business culture changes, a temporary, cold turkey lifestyle cleanse will do little to make real, long-term health changes. Oftentimes, once the health check is over, the month's restraint is more than made up for with a night out on the town.
Testing for the unnecessary
While some checks do little to no harm to have annually, it can be argued that some are unnecessary to have on such a regular basis, and can in fact be harmful, however small that risk may be.
The most contentious is the chest x-ray, since you are being exposed to small amounts of radiation each time. And if you haven't had any symptoms warranting one, it may be considered over-the-top to have it done annually.
The same can be said for the endoscopy. It's one thing to pee into a cup, but quite another to have a camera shoved down your throat and moving around some of your internal organs each and every year.
And then sometimes tests are repeated just for the sake of internal paperwork. For example, a friend of mine once started two different university lecturing jobs just a couple of weeks apart. He had to go to the very same hospital and do the very same tests twice within two weeks since both universities required it. The very recent results, at the same hospital no less, weren't enough to satisfy the requirements for the second position. For someone who has difficulty with blood tests, it wasn't a very fun prospect. He told me that the nurses remembered him from the first test though and knowing his squeamishness for blood tests, were very kind and accommodating.
Some people don't have issues with any of the tests and don't mind having them, but I do know a lot of people for whom the annual health check is something that they physically and mentally anguish over for about a good week or so beforehand.
A Japanese test applied to non-Japanese
An increasing issue with more and more non-Japanese living and working in Japan, is that this is a system designed for Japanese people. There is the obvious issue of language, and in our experience, all documentation including the results, and the examination itself is done in Japanese only. Although you may get lucky and encounter staff who can assist, at least somewhat, in English.
Language issues aside though, perhaps what is most pressing, especially for foreigners needing to “pass” to work for Japanese companies, is that the results and acceptable ranges for many of the tests are based on what is considered “normal” for a Japanese person. For those of different ethnicities, what is “normal” could vary significantly, but those differences are not accounted for in the results. This can make it difficult for people of a different ethnicity and even biracial Japanese to get through the bureaucracy of some of this required internal paperwork.
Furthermore, conditions that may be high-risk for your ethnicity or country of origin may not be flagged or checked for at all. For example, stomach cancer is considered of utmost importance to check for in Japan, but something like mole checks for skin cancer, are not. These complexities may need to be addressed further in order to provide health checks that apply better to Japan's growing foreign workforce.
As stated earlier, the Japanese annual health check system, even as it stands, would be considered a luxury in many places around the world, and I am grateful to have access to it. That said, I would love to hear your opinions about it and about the health care situation where you live?
Great article. A couple of points:
I have asked several office managers, HR staff and other company management on what kind of policy is in place to prevent abuse or limit the access to the medical records. To their knowledge and my own, there is no law, policy or guide from the government. It is left up to each company to set rules and policy. I find it a little crazy to have someone with no medical background reviewing the results in an attempt to determine if someone is healthy.
It is my own understanding that companies cannot use this to restrict promotions, reduce bonuses but are only to use this to encourage the employee to make good life choices. Certainly purging a month before the exam is not a good life choice and the results then do not reflect the reality of the rest of the year.
In the Tokyo area many clinics offer the reports in English and the doctors can provide some explanation in English or at least explain it in simple Japanese. I have been here long enough that I know what to ask, I can look at the reports and know what is a marker for cancer and ask about such results. I am concerned that there are several areas that are glossed over because they are rarer or require actual medical analysis which may be missed by the standard tests. For example, there is no check for prostate issues because they are not as common in Japan – or so I am led to believe.
Just to say thank you for writing about this, I work as an English instructor and proof-reader for Japanese clients. One of my regular clients wrote about how crowded it was at the annual health check, because it was the end of the fiscal year. This explains a lot!
I’m in the UK, where we thank God and Aneurin Bevan for the National Health Service.
Glad I was able to help explain it, Andrea!
In my home country, not only annual health checkups are free. We have a nice health care system, with most services free of charge. If there’s a medical emergency, in Japan still must pay, and ambulance workers can’t even give you an allergy shot, if you suddenly find out that you are allergic to something that you didn’t know.At home (and in most other countries, I believe), ambulance is really the emergency medical service, which can save your life, and is not a taxi.
Yes, ambulances are very much used as taxis here and they get called for the smallest of things. Many of them are dispatched from local fire stations, rather than hospitals. So once they arrive, they then usually have to call around as to which hospital is 1) open (I’ve never heard of hospitals closing in other countries) and 2) is willing to accept the patient with whatever medical issues they have. It’s an aspect of living in Japan that worries me should a serious medical situation arise.
Holy crap! Another strike against Japan for me, unfortunately. I don’t give blood for just anybody – ha ha!
But seriously. I’m surprised that they might ask questions about overtime. Surely Japanese employers don’t want to be reminded that being consistently overworked is bad for our health, do they?
And the discrimination based on health test results? Sickening (pun intended). I totally understand why an employer might not give a big promotion to somebody whose health is debatable if they might not be able to satisfy the job’s requirements, but it treads an ethical line in my books.
Hi Nora,
I think that those in a position where they are doing (often substantial) overtime (which is a huge chunk of the Japanese working population) are very aware of this anyway, to be honest. It’s their reality and many just feel numb to it, or consider it a matter of course, no matter how much they dislike the system itself.
As for employers getting the results, I agree wholeheartedly that it treads an ethical line. In some situations, some conditions may need to be taken into consideration for job positions. For example, if you’re operating heavy machinery and you have a condition which may jeopardize your safety and those around you. I think those are logical lines of inquiry.
But I think that is a separate issue entirely to “keeping a watch over” your workers and using those results to your own ends. Many people deal with underlying medical issues and we often don’t even know about it, because they are able to manage their condition and it doesn’t impact what they do at work. People shouldn’t have their careers unduly impacted because of this and it obviously opens the doors to all kinds of discrimination.
Fortunately for us, we aren’t in this kind of Japanese company setting so don’t have to deal with those things. But it is certainly a social issue that I think more people should be openly discussing here.
This is utterly fascinating! There is no such thing in France, nor in Mexico, as far as I know. I arrange for my medical checks myself every time I get back to France because I have social security there and am more trustful of doctors there than in Mexico (just a tiny bit biased on the subject, here, there might not be any reason to, but I’d rather see my regular doctor back home…). And although I have social security, it doesn’t pay for everythig nor reemburse me the whole of my expenses.
I find the Japanese health check system very interesting and am baffled that it is free for all. I believe you’re right, though, some specific characteristics are quite “strange” (for lack of a better word): I’d hate my employer to know all about my health and be able to judge my abilities to work well on such basis; I find it quite discriminating, whatever the issue is.
It was very interesting to read about the subject. I’m glad you had a better experience this year than last and handled the blood testing better!
Thank you for taking us through this very peculiar moment of your Japanese life!
Cheers and stay well!
xoxoxox
Jul’
Thanks for stopping by, Jul’! Yes, I think I just have to lay down for blood tests and that solves the problem for me, fortunately!
Yeah, the annual health checks are free, but for tests above and beyond that, or anything that happens in between, there is a fee. Japanese national health insurance coverage is pretty wide-ranging and covers 70% of your bill. Of course there are exceptions, such as anything that is considered an elective procedure.
Some sections of society can get 100% coverage for anything that falls under the national health insurance scheme. I was chatting with a pediatric nurse a couple of nights ago and she said that children in Tokyo are fully covered for any medical bills, including medication, until they are 15! She said there are different rules across the country but that generally kids are completely covered until they finish elementary school. It’s great for families, but she says that this often leads to parents bringing their kids to the ER for non-emergencies, simply because they don’t have to pay for it. They are trying to educate parents/guardians that minor ailments can be treated at home or by visiting non-emergency medical services, and to leave staff and facilities open for those who really need it. Unfortunately, they haven’t had much success in changing attitudes so far, she tells me.
Many Japanese opt to pay double health insurance by taking out private health insurance too to cover the 30% and to include procedures that may not be covered by the national health insurance system. I have no idea how they afford it though. We recently received our national health insurance bill and it’s so huge that it’s broken up into 9 installments to be completed by April next year! I guess most people who work with Japanese companies can get what is called ‘Employees’ Health Insurance’ so their company covers it.
So essentially, yes, we do get access to certain things like the annual health check for free and we only have to pay 30% of the bill when we visit a doctor, but you are actually paying for it, or your company is.
I absolutely feel the same way about employers having access to your health check results. Makes me feel glad that we don’t fall into that category here so only we see them, although I’m sure a copy is kept on file at the city hall, or at the very least with the medical service who conducts the tests. We are OK with that.
Thanks for reading and joining us on our journey through the (sometimes peculiar) ins and outs of Japanese life!
Great timing! I just had my health check here. We don’t get letter grades but we do get thorough documentation sent to us in the mail. All in Japanese of course, so if you want to read it but can’t read the lingo, you have to compromise your privacy. I’ve heard of people’s adventures in health checks ranging from yours (letter grades and whatnot) to having a check in a literal van outside of their public school!
Hi Stefanie, hope the health check went well! Yeah, I’d imagine there would be some variation in terms of how results are displayed too. You make a really good point about the issue of non-Japanese speakers (or should I say non-Japanese readers, because they are two very different skills!) needing to compromise their privacy if they want to make heads or tails of the results.
They could at the very least have an English translation. I know that not everyone understands English, but at least you could more easily type that into a translator and understand it in your own language. Where do you start with kanji if you don’t know its pronunciation or stroke order in the first place?
I have also heard of some non-Japanese needing to take their manager or one of their colleagues along to interpret for them during the health check itself. I’d find that a bit awkward and I’ve heard some people say that they sometimes don’t tell the truth or mention certain things that are worrying them because they don’t want to have to say it in front of someone they work with. Surely an English speaking nurse and doctor could be arranged in such cases, especially when visiting schools with non-Japanese staff.
Like I said in the article, I don’t want to sound like I am ungrateful for access to healthcare, that’s not the case. But there are a number of things that can and I think should be changed in the future, and I can certainly understand the difficulties from a non-Japanese perspective, and the struggle of trying to communicate and understand complex ideas and terminology in a foreign language.
Thanks for chiming in, Stefanie, and hope you are feeling OK today!