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Japan’s Annual Health Checks: The good, the bad and the problematic

“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.

Annual Health Check Japan

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?

Do you get an annual health check? Is it free or arranged for by the government? Or is health considered an individual concern where you're from? Let us know in the comments!

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RJ Eddystone

Saturday 8th of February 2020

I've worked in two different workplaces in Japan.The first had an on-site check and the second let us arrange our own appointment, using a company form. (I brought it with me to make the reservation and they made a copy for preparation purposes ahead of time.) For the on-site test, I arrived early and put my name on a sign-in sheet so I got to get through it pretty early. For the hospital test, I made an appointment ahead of time and gave a copy of the company's healthcheck form to them so they knew what to test for.

In both cases, I could ask for additional checks through the paperwork filled out ahead of time. For the on-site test there was a packet everyone submitted beforehand. For hospital checks, there was a form filled out the day of. At the end of both I had a few minutes to talk to a physician about any other concerns (like weight gain, pain, etc.) and get recommendations for followup if necessary. For this portion, I wrote out my concerns in Japanese and English and brought copies for us both and that helped with the language barrier. Most doctors I've met in Japan know a little English, so if I'm upfront about my language skills (or lack thereof) they simplify their speech to accomodate or even pull out a translation app.

So far as confidentiality goes, my first year, my supervisor filled out the paperwork with me, but in years after I checked the list myself. (I photocopied the first application and my translation notes so I could reuse it.) The paperwork was all in Japanese, but by then I had friends I could ask about any difficulties and had picked up enough Japanese to go through the exam myself. The packet was put in an envelope and sealed, then given to the examination team. The on-site results arrived at work several weeks later in a sealed envelope. I was told I didn't have to show them to anyone. The grading system was easy to understand and there were spaces for notes in each section if anything was out of the ordinary. These notes would include the doctor's instructions for any followup. I only needed a followup once, and my supervisor insisted on not asking for details to maintain privacy. They helped me call a local doctor though. I showed that doctor the results page at the appointment. Granted, I'm not sure every employer respects privacy like this, I'm just saying what happened to me.

As for the radiation from the x-ray test for TB, there is an option to do a sputum test at the hospital instead. On-site exams might only have the x-ray truck, but even then I had a coworker who was undergoing chemo at the time and they were allowed to go to the hospital and get the sputum test instead.

Basically, a lot of the inconveniences can be resolved with some foreplanning, which for foreigners might be harder than for locals, so getting these options may just be a matter of speaking up. Like I said, I'm not sure this will apply to every company's health check, but it was very helpful as a foreigner to know how to prepare.

Samurai Surfing Shonan

Wednesday 27th of November 2019

There is a difference between National Health and Pension (Kokuminnenkin Hoken/Kenko Hoken) and health and pension insurance issued through larger businesses known as Kyosai nenkin/Kenko hoken such as Shigakukyosai (Private Schools Mutual Benefit association).

Nothing is free. Costs for the pension and health insurance aspects are based on your annual salary from the year before. So if you quit, you will still pay the same premiums as the year before and if you use Shigakukyosai as a teacher in a private school, you will still only pay the 50% you paid as before and not the 100% you would automatically think you would be obligated to as the company/school paid in 50%.

You mentioned you pay about $800 a month...is that at 100% for health or does that include pension payments as well? Are those Australian dollar or US dollars? I was paying ¥90,000 a month for both the pension/health which amounts to 50% as the company/school paid the same.

I just retired so know the system with the regular national pension, the kyosai nenkin, and kakyunenkin materials pretty well. If you ever need advice, just ask.

By the way, each city and prefecture have their own way with offering free services. I live in Yamato-shi in Kanagawa-ken and am 65. At age 65 you start getting these offered for free this and that as they consider us elderly. I don't feel elderly as I surf all the time, walk and work out.

Be safe. Health care here is great.

John

Wednesday 30th of October 2019

I can understand if a company wants to screen against illegal drug use, etc, but they have no right to tell employees to submit to a general health test. The only obligation they should have is providing a health test for free if wanted by an employee.

Many people (non-Japanese) in my company refuse to take the medical exam. Although the company claims its policy and "law", the so called law has no teeth.

Recently, my company has been telling non-Japanese employees it is strongly recommended to take the medical tests.

Enough of the Big Brother stuff. Let people choose and have privacy.

Stand up for yourself if you dont want to take the medical exam.

Cheers!

Steven Nefarino

Friday 16th of August 2019

Hi, I'd like to find a job in Japan as software developer or maybe italian language teacher (I know, 2 different kind of job). I'm really scared about blood test... I never did it before in my life because I'm afraid of needles!

Even reading this article, I almost fainted when I read "several viles", and I had to take some sugar for come back to my normal state (I'm not joking).

Can I ask to the employers if I can refuse the blood test before start working for them? Is it possible to find a job without blood test because of my phobia?

It's sad to say "no" to the Japan only for this, but I don't know how to do... if you just say blood test, I start faint after few seconds without any reason... and I can't stop it...

Simon

Monday 22nd of July 2019

Could someone tell me how much does it cost for a medical check-up in Japan?

«Required Item of Medical Check-up» Personal medical history report Examination of height, weight, abdominal girth, eyesight and hearing Examination of chest X-ray Measurement of blood pressure Anemia test (red cell count, hemoglobin content) Liver function test (GOT, GPT, γ-GTP) Blood fat test (LDL cholesterol, HDL cholesterol, serum triglyceride) Blood glucose test (HbA1c is also available) Urine test (level of sugar and protein) Electrocardiographic test Electrocardiographic test

thanks guys

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