Foreign residents in Japan are navigating significant changes to the healthcare system as the country transitions to a new insurance card system while facing critical shortages of life-saving medical devices. These developments have important implications for how expats access medical care and highlight systemic challenges within Japan's healthcare infrastructure. As of December 2, 2024, Japan has fundamentally changed how residents present health insurance information at medical facilities. According to NHK, the traditional paper health insurance cards (kenkou hoken-sho) have reached their expiration dates, and medical institutions and pharmacies now primarily use the My Number Health Insurance Card, known as "Mynaportal insurance card" or "My Number hoken-sho." This digital card integrates health insurance information with the My Number identification system that all residents, including foreign nationals, are required to have. The transition represents a major digitalization push by the Japanese government, aiming to streamline healthcare administration and reduce paperwork. For expats, this means the physical insurance cards previously issued by employers or the National Health Insurance system are being phased out in favor of using the My Number Card at medical facilities. The Ministry of Health, Labour and Welfare has indicated that while the My Number insurance card is now the standard, there will be a grace period until the end of March 2025 for those still using traditional cards. This transition period is crucial for foreign residents to understand. If you haven't yet obtained your My Number Card, now is the time to apply through your local municipal office. The application process typically takes several weeks, so expats should not wait until their current insurance card expires. Medical facilities are equipped with card readers that can access your insurance information directly from the My Number Card, eliminating the need to carry a separate insurance document. However, the government has acknowledged that not all residents have made the switch. For those without a My Number Card, alternative arrangements are being made, though the specifics of these measures extend only through March 2025. Foreign residents planning to remain in Japan should prioritize obtaining their My Number Card to ensure uninterrupted access to healthcare services. While administrative changes dominate headlines, a more troubling development has emerged regarding medical device availability. According to NHK's investigation, four children with severe heart conditions died over the past five years because ventricular assist devices (VADs) were unavailable when needed. These devices, which pump blood throughout the body for patients with serious heart disease, are in critically short supply. The shortage of pediatric ventricular assist devices reveals a systemic problem in Japan's medical infrastructure. Unlike administrative changes that can be implemented through policy, medical device shortages reflect deeper issues including limited manufacturing capacity, regulatory challenges, and resource allocation within the healthcare system. For expats with children or family members requiring specialized medical care, this shortage underscores the importance of understanding the limitations of Japan's healthcare system, despite its generally high quality. These parallel developments—one administrative, one clinical—paint a complex picture of Japan's healthcare landscape. While the country modernizes its insurance system through digitalization, it simultaneously struggles with critical shortages of life-saving equipment. Foreign residents should stay informed about both aspects, as they affect different dimensions of healthcare access. For expats, the immediate action items are clear: obtain your My Number Card before the March 2025 deadline, ensure your insurance information is properly registered, and be aware that certain specialized medical resources may face availability constraints. Those with chronic conditions or children requiring specialized care should discuss backup plans with their healthcare providers and understand referral procedures to facilities with appropriate resources. Japan's healthcare system remains among the world's best, but these recent developments remind foreign residents to stay proactive about administrative requirements and informed about system limitations.