TOKYO - From October, a new policy has come into effect requiring some people aged 75 and over to pay 20% of their medical costs at the counter, doubling the previous burden for many elderly patients. For those living on pensions, the increased costs are squeezing already tight household budgets and fueling concern about how to manage daily life.
At a recycling warehouse in Niiza, Saitama Prefecture, 77-year-old Januma refurbishes used washing machines. He receives a pension of around 200,000 yen a month, supplemented by about 100,000 yen from his part-time work, giving him an income of roughly 300,000 yen in total. Yet even with this, he worries about the growing burden of healthcare costs. "So far it hasn’t been too heavy, but I know it’ll keep increasing as I get older and go to the hospital more often. It’s inevitable," he said while continuing to work.
The higher payments affect about 3.1 million people nationwide. Until now, most people aged 75 and over paid 10% of their medical bills, but since October 2022, those with certain income levels have been required to pay 20%. A temporary relief measure capped the increase at 3,000 yen per month, but this limit was abolished on October 1st, fully implementing the 20% co-payment for outpatient visits. For instance, someone with 50,000 yen in monthly medical costs previously paid 8,000 yen, but now pays 10,000 yen, a rise of 2,000 yen.
For Januma, whose favorite pastime is karaoke with friends, the impact feels personal. "If medical costs keep rising, there’s a chance I might have to give up going to karaoke," he said. "That would be really sad because singing is my main joy in life."
At local clinics, confusion was seen on October 1st as notices were posted informing patients that “consideration measures for the 20% co-payment have ended” and that “personal payment amounts may rise.” A 75-year-old woman visiting a clinic for persistent coughing said she had just learned her fees would increase that day. Her payment of 430 yen for a visit seemed small, but it was double what she paid before the reform. "It may not sound like much, but I go to the hospital many times a month. It adds up to around 5,000 or 6,000 yen. It’s quite tough," she said.
Doctors are also worried that rising costs could cause patients to avoid necessary care. "With prices rising everywhere, patients are anxious. Some skip tests or choose cheaper medicines to cut costs. We’re already seeing diabetic or hypertensive patients who’ve run out of essential prescriptions," said Ito, a physician.
Behind the reform lies a generational issue: roughly 40% of medical costs for those aged 75 and over are paid by the working-age population. As the baby-boom generation moves into the late-elderly bracket, this burden is increasing. To ease the strain on younger generations, a portion of seniors with higher income levels were asked to shoulder more.
Nomura, a policy analyst, said, "It’s important that we review waste in the healthcare system. We all have to share the responsibility fairly, but we also need to reduce unnecessary treatments and optimize costs."
In Tokyo’s Itabashi Ward, at the Takashimadaira housing complex, an 83-year-old man said his total monthly spending is about 250,000 yen. Rent and service fees for his assisted living apartment cost 150,000 yen, food expenses are 40,000 yen, and social expenses total 50,000 yen. Medical costs are around 5,000 yen a month but will now rise. "I’ll probably have to withdraw from my savings. I can’t really cut back on other things—I still want to enjoy life while I can," he said.
Others are choosing small sacrifices. "We try not to be extravagant," said one woman. "My husband loves eel, but now it’s just for special occasions. If we have to cut somewhere, it’ll be food. There’s no other way but to save."
Experts emphasize that the key lies in extending healthy life expectancy. "If seniors can stay active in society and continue social connections—whether through hobbies, volunteer work, or group activities—it helps maintain health and reduce long-term medical costs," said one gerontology specialist.
At a shopping street, an elderly woman affected by the new rule was seen buying discounted groceries during a senior sale. "I waited an hour in line to save money. The free local bus also helps, so I’m cutting costs wherever I can," she said. For many like her, saving on daily necessities has become essential to offset rising medical expenses.
The discussion now extends beyond healthcare to the entire social welfare system, as Japan faces the challenge of sustaining support for a rapidly aging population while ensuring that seniors can still live with dignity and enjoyment.
Source: FNN
