Japan's healthcare system is entering a period of significant change as government officials and medical associations debate reforms to diagnosis fees and insurance coverage. For the estimated 3 million foreign residents relying on Japan's national health insurance, these discussions could affect both out-of-pocket costs and access to certain medications in 2026 and beyond. The central issue revolves around the biennial revision of diagnosis fees (shinryō hōshū), the standardized prices that medical institutions receive for treatments under Japan's universal healthcare system. Finance Minister Katayama stated on November 7 that his ministry would engage in data-driven discussions with the Ministry of Health, Labour and Welfare regarding next year's fee revisions, according to NHK. A key point of contention is the disparity between hospitals and clinics, with proposals suggesting different fee structures for each type of facility based on their operational realities. The Japan Medical Association has entered the debate with concerns about maintaining financial stability for healthcare providers. On November 6, the JMA president called for measures ensuring economic stability for both hospitals and clinics during the fee revision process, emphasizing that any changes must reflect the actual management conditions of medical facilities, NHK reported. This intervention highlights concerns that inadequate compensation could affect the quality and availability of medical services, particularly in rural areas where many clinics operate on thin margins. For foreign residents, the most immediately relevant development concerns over-the-counter (OTC) equivalent medications. Currently, many drugs available without prescription at pharmacies are also covered by national health insurance when prescribed by doctors. However, a Ministry of Health, Labour and Welfare subcommittee meeting on November 6 saw multiple participants advocate for reviewing insurance coverage of these OTC-similar drugs, according to NHK. This potential policy shift could significantly impact expats' healthcare costs. Medications for common conditions like allergies, pain relief, cold symptoms, and digestive issues might require full out-of-pocket payment if removed from insurance coverage. While this would reduce overall healthcare system costs, individual patients would bear the financial burden. The typical insurance coverage currently means patients pay only 30% of medication costs, so losing this benefit could triple expenses for affected medicines. The rationale behind reconsidering OTC drug coverage centers on healthcare system sustainability. Japan's rapidly aging population places increasing pressure on the national health insurance system, with medical expenditures reaching record levels annually. Policymakers argue that readily available over-the-counter alternatives make insurance coverage for these medications an inefficient use of limited resources. However, critics point out that removing insurance coverage could discourage people from seeking appropriate treatment, potentially leading to more serious health issues later. Additionally, prescribed medications often come in different strengths or formulations than their OTC counterparts, and doctors can monitor patient conditions more effectively through the prescription process. For expats navigating Japan's healthcare system, these developments warrant attention for several reasons. First, any changes to diagnosis fees could affect the cost of medical visits, though Japan's insurance system caps monthly out-of-pocket expenses. Second, if OTC-similar drugs lose insurance coverage, budgeting for healthcare costs will require adjustment, particularly for those managing chronic conditions with medications that might be reclassified. The timeline for these changes remains unclear, as diagnosis fee revisions typically take effect in April of even-numbered years, meaning April 2026 is the likely implementation date. The debate over OTC drug coverage may follow a longer timeline, as such policy changes require extensive deliberation and public input. Foreign residents should monitor these developments through official channels and consider discussing potential impacts with their healthcare providers. Understanding which medications might be affected and exploring alternatives could help minimize financial surprises. As Japan's healthcare system adapts to demographic and fiscal pressures, staying informed will be essential for managing both health and household budgets effectively.