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As Japan’s social contract comes under strain, Sanae Takaichi is moving swiftly on a campaign promise to make foreign residents shoulder their fair share of the health and pensions burden. The proposed reforms, set in motion just weeks after Takaichi’s historic appointment as the country’s first female prime minister, aim to address mounting public concern about inequality and the sustainability of its ageing welfare state. At her first ministerial meeting dedicated to issues regarding foreign nationals, Takaichi on Tuesday directed cabinet members to develop concrete policy proposals for stricter enforcement by January. The government’s initial focus will be on permanent foreign residents who have not paid the required health insurance premiums or pension contributions, which officials say will help shore up a system under strain from demographic decline. Foreign residents contributed just 49.7 per cent of the required pension payments and 63 per cent of health insurance premiums in the financial year ending March 2025, according to Japan’s health and welfare ministry – far below the overall payment rate, including Japanese nationals, of 93 per cent. “A situation has arisen in which the public feels uneasy and perceives unfairness regarding illegal actions and rule violations by some foreigners,” Takaichi told her cabinet on Tuesday, vowing to pursue “orderly coexistence” by ensuring that all residents, regardless of nationality, observe Japan’s laws and social obligations. The reforms form part of a broader promise that helped propel Takaichi to the leadership of the ruling Liberal Democratic Party. After taking office on October 21, she underlined her commitment by appointing Kimi Onoda as the first minister for a “society of well-ordered and harmonious coexistence with foreign nationals”. Supporters argue the measures are overdue. “A policy like this has nothing to do with xenophobia or racism but is just designed to make sure that everyone living in Japan follows the same laws,” said Ken Kato, a Tokyo businessman. “I cannot think that any Japanese person would disagree with that policy.” Kato added that previous governments’ reluctance to pursue non-compliant foreigners for fear of accusations of racism “just means that Japan was seen as soft”, adding: “Not making people pay what they owe means that the rest of society has to pay more and that is simply wrong.” ‘Why so lax?’ Authorities are preparing technical changes to support the clampdown. The welfare ministry plans to establish an information-sharing system with the immigration bureau, expected to be operational in 2027. Under the new framework, foreign residents who have not paid their health insurance premiums would be unable to renew or amend their residence status when their visas expire. In parallel, the ministry is developing a database to identify those who have failed to pay medical bills, linking this information to residency permissions. Unpaid medical expenses are a growing concern for Japan’s hospitals, more than 83 per cent of which operated at a loss in the 2024 financial year, accumulating a combined debt of 395 billion yen (US$2.6 billion). “People not paying their bills has become a huge problem in a lot of US states and hospitals there have gone bankrupt, so we have to make sure the same thing does not happen here,” said Yoko Tsukamoto, a professor at the Health Sciences University of Hokkaido. I do not think it is fair to blame the problem entirely on foreigners Yoko Tsukamoto, professor of health sciences Tsukamoto acknowledged the complexity of the issue, noting that some Japanese hospitals had “too many beds” due to the country’s shrinking population. “But costs are also going up and it is becoming increasingly difficult to manage a hospital, so ensuring that people pay their bills is critical,” she said. “I agree that patients should pay their health insurance premiums and for treatment, but I do not think it is fair to blame the problem entirely on foreigners as there are Japanese as well who do not pay.” That nuance has seemingly been lost among readers of the conservative-leaning Yomiuri newspaper, however, where some called in the comments section for an even swifter and more sweeping crackdown. “As soon as the Takaichi cabinet came into power, it immediately took action to address the issue of foreigners not paying their insurance premiums,” read one message. “With the number of foreigners increasing, this is a measure that I would like to see implemented quickly. I hope Takaichi will ensure this issue is not swept under the rug by left-wing groups and political parties that are making claims about ‘human rights’ and ‘equality’. I hope that they will protect Japan to the end.” Suggestions from the public have ranged from requiring foreign residents to obtain private health coverage to draconian proposals for direct bank withdrawals or detaining those in arrears at airports. “Why is Japan’s system so lax?” asked another commenter. “They are taking too long to implement measures. It’s a complete dereliction of duty. The authorities are strict on Japanese citizens but lax on foreign residents, which is why foreigners tend to take advantage of Japan.”
