Abstract
BackgroundJapan provides universal health insurance to all legal residents. Prior research has suggested that immigrants to Japan disproportionately lack health insurance coverage, but no prior study has used rigorous methodology to examine this issue among Latin American immigrants in Japan. The aim of our study, therefore, was to assess the pattern of health insurance coverage and predictors of uninsurance among documented Latin American immigrants in Japan.MethodsWe used a cross sectional, mixed method approach using a probability proportional to estimated size sampling procedure. Of 1052 eligible Latin American residents mapped through extensive fieldwork in selected clusters, 400 immigrant residents living in Nagahama City, Japan were randomly selected for our study. Data were collected through face-to-face interviews using a structured questionnaire developed from qualitative interviews.ResultsOur response rate was 70.5% (n = 282). Respondents were mainly from Brazil (69.9%), under 40 years of age (64.5%) and had lived in Japan for 9.45 years (SE 0.44; median, 8.00). We found a high prevalence of uninsurance (19.8%) among our sample compared with the estimated national average of 1.3% in the general population. Among the insured full time workers (n = 209), 55.5% were not covered by the Employee's Health Insurance. Many immigrants cited financial trade-offs as the main reasons for uninsurance. Lacking of knowledge that health insurance is mandatory in Japan, not having a chronic disease, and having one or no children were strong predictors of uninsurance.ConclusionsLack of health insurance for immigrants in Japan is a serious concern for this population as well as for the Japanese health care system. Appropriate measures should be taken to facilitate access to health insurance for this vulnerable population.
Highlights
Japan provides universal health insurance to all legal residents
Of the 400 Latin American immigrants who were selected for the study, 57 (14.3%) were not at home, 47 (11.8%) had moved out, 2 (0.5%) were excluded from our study because they overstayed their visas and 12 refused to participate
Regarding the correlates of uninsurance (Table 4), multiple logistic regression analysis showed that not having a chronic disease was the strongest predictor of uninsurance (AOR = 12.10). Those who do not know that health insurance is mandatory in Japan (AOR = 6.36), have one or no children (AOR = 2.58, 5.23), or have less education (AOR = 3.72) were significantly more likely to be uninsured. To our knowledge, this is the first study using rigorous methodology that demonstrates the pattern of health insurance coverage and the predictors of uninsurance among documented Latin American immigrants in Japan
Summary
Japan provides universal health insurance to all legal residents. Prior research has suggested that immigrants to Japan disproportionately lack health insurance coverage, but no prior study has used rigorous methodology to examine this issue among Latin American immigrants in Japan. The aim of our study, was to assess the pattern of health insurance coverage and predictors of uninsurance among documented Latin American immigrants in Japan. Japan provides universal health insurance and all citizens, including foreigners who stay for a year or more are required to enroll in one of the public health insurance schemes [1,2]. Health insurance coverage remains one of the most important ways to ensure access to health services [3]. Immigrants are a vulnerable population and their access to insurance. The revision of the Immigration Law in 1990 led to a large influx of descendants of Japanese emigrants from Brazil and Peru
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