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Thirty percent, and why you start at a clinic
Everyone resident in Japan is in a health insurance scheme — through an employer, or the municipal 国民健康保険 — and for a working-age adult the share you pay at the counter is thirty percent of the bill, with the rest invoiced to the insurer. Children and the elderly pay less, and the 高額療養費制度 caps what any one month can cost you, which is the part of the system people only discover when something serious happens. Two features surprise newcomers. The first is that there is no gatekeeping by appointment: you can walk into almost any clinic and be seen the same day. The second is that this does not extend to the big hospitals — arrive at a major 総合病院 without a 紹介状 and you pay a surcharge on top of everything else, at the largest ones at least seven thousand yen, precisely to push routine cases back down to clinics. So the referral letter is not bureaucracy, it is the ticket. The other thing worth knowing is the one in this lesson: a 診断書 is not treatment, so insurance does not touch it. You pay the full price, it is usually a few thousand yen, and the clinic sets it. If your employer wants one, ask whether they will cover it, because somebody is going to.