Due to liberalized immigration policies in recent years, the number of foreign residents in Japan has surged. However, the issue of some foreign residents lacking public health insurance persists. This situation can negatively impact their future utility and may also generate negative externalities for the public health system due to their inability to access timely medical services, thereby leading to broader social and economic uncertainties.
Given that the payment method for National Health Insurance essentially makes it a voluntary system, this study is the first to utilize nationwide microdata to investigate the factors that prevent foreign residents from enrolling in National Health Insurance. This study offers several new insights. Specifically, in companies where enrollment in Employees’ Health Insurance is not mandatory, foreign residents working as regular full-time employees are significantly less likely to enroll in National Health Insurance. Additionally, individuals who are job-seeking or unemployed, those engaged in other forms of employment including family workers and trainees, and those who have no concerns about their own health status all exhibit a significantly lower likelihood of enrollment. In the analysis of non-full-time regular employee samples, the economic conditions of the prefecture of residence, and whether the individuals country of nationality has implemented universal health insurance significantly affect enrollment in National Health Insurance. Furthermore, our analysis suggests that, compared to the large number of new cases following the prolonged spread of the pandemic, the initial panic caused by the outbreak may have served as a significant incentive for foreign residents in Japan to enroll in National Health Insurance.