Fuchu City National Health Insurance "Number One in Japan" Goes Viral — The Real Financial Burden Residents Feel

The Shock of "Number One in Japan" Spreading Online

"Fuchu City's national health insurance premiums are the highest in Japan, apparently." That post spread across social media, gathering over 180 likes.
The comments filled with reactions like "I can't believe it," "I'm thinking of moving," and "Why has it gotten this high?"
National health insurance premiums are a major monthly expense for self-employed workers, freelancers, and retirees — anyone outside the company employee system.
The shock of hearing "number one in Japan" was anything but distant for residents living in Fuchu.

What Are Fuchu City's National Health Insurance Premiums, Really?

National health insurance premiums are calculated based on the previous year's income, number of enrollees, and household size.
Fuchu City uses a three-part formula — "income-based portion," "equal per-person portion," and "equal per-household portion" — meaning higher incomes lead to higher premiums.
According to Fuchu City's official website (National Health Insurance Tax), a tax rate revision was made in fiscal year 2024 as part of a financial stabilization plan aimed at eliminating the deficit.
For example, a single person aged under 40 with an annual income of 4 million yen would pay approximately 230,000 yen per year based on the city's current rates — a significant burden compared to company-managed health insurance.
Unlike employee health insurance, national health insurance receives no employer contribution, making the effective burden heavier for those with equivalent incomes.

Why Have Premiums Gotten So High?

The structural problem of national health insurance lies in its enrollee demographics.
Unlike employer-managed health insurance, the national health insurance pool includes self-employed workers, non-regular employees, unemployed residents, and the elderly — groups that tend to use more medical care.
In other words, the financial structure is skewed: more people drawing benefits, fewer people who can afford to pay in.
Fuchu City faces the dual challenge of rising medical costs driven by an aging population, alongside declining premium revenue as the working-age population shrinks.
This is not unique to Fuchu City — it is a challenge shared by municipalities across Japan.

The Reality of Deficit Funding and Premium Increases

Fuchu City is said to have historically used transfers from its general budget — known as "extraordinary subsidies" — to cover the national health insurance deficit and keep premiums in check.
At the time of the fiscal year 2022 accounts, those transfers were said to have reached approximately 2.8 billion yen.
However, a 2018 reform transferred fiscal responsibility for national health insurance to Tokyo Metropolitan Government — a shift known as "prefecturalization."
Under this system, municipalities running deficits are required to develop financial stabilization plans and systematically eliminate those deficits.
The gradual premium increases are, in part, a response to this regulatory change.

What Fuchu Residents Can Do

When facing high premiums, the first thing to check is the availability of reduction programs.
National health insurance offers a system that reduces the equal per-person and equal per-household portions by 20%, 50%, or 70% for households below certain income thresholds.
There is also a "reduction application" program that lets you apply for a reduction if your income has dropped significantly from the previous year.
Details are available at Fuchu City's official website (National Health Insurance).
If the process feels confusing, visiting the city hall's national health insurance counter directly is the most reliable approach.

What to Watch Going Forward

The accuracy of the "number one in Japan" claim circulating on social media still requires further verification.
That said, the sense that premiums have become a real burden is backed up by the numbers.
Under Tokyo Metropolitan Government's financial stabilization framework, Fuchu City's premium levels are expected to continue being gradually revised.
The national health insurance tax notice that arrives every June or July is not just a bill — it is also an opportunity to understand how the system has changed.
Taking a moment to read how your premium is calculated is well worth the effort.