It’s February 11th, 2026. Three days after crashing with my friend on skis at Rusustsu Resort here in Hokkaido, Japan. I’ve been admitted to Shin-Sapporo Orthopedic Surgery Hospital near home here in Sapporo. Surgery is scheduled for tomorrow midday.
The hospital admission happened fast.
“Your ankle ligaments are torn. We can get you into surgery in two days time,” the doc said. “Tomorrow is a public holiday, so we need to get you admitted today in order to have you ready.”
It was 1pm on Tuesday.
A nurse hurried into the doctor’s office.
“In about 30 minutes, the afternoon consultation time will begin, so let’s get all your pre-admission tests done before then,” she said in a rushed tone.
Blood tests, chest x-ray, cardiogram, urine sample.
And then came the documents and requirements.
- Admission Treatment Plan
- Agreement To Be Admitted
- Agreement To Be Restrained
- Medical Costs Guarantor Details
Along with all the forms to fill out, I was given a stack of information documents.
First up was a pamphlet outlining costs of things like rental of pajamas and towels, plus other things that came in this ‘Admission Set’ (693yen per day).
The only gotcha here was that I had to have slip-on shoes, no laces allowed. “Crocs are fine, but for rehabilitation, we’d recommend something more sturdy,” the nurse advised.
So it was that I committed to the “Rehabilitation Shoes” the hospital provided (a one-time purchase of 3,200 yen), since I didn’t have anything else suitable for Haidee to bring from home.
With all this talk of costs, naturally my mind was starting to think, how much is all this going to cost?
Another piece of paper I was given answered that – a flyer explaining the Japan Medical Bill Cap system.
“You’re in the second-to-top income category, so the maximum you’d pay in a given month is 167,400yen plus a little bit more” explained a nurse.
This was something new to me. I’d heard of a maximum co-pay on the Japan National Health Insurance, but had never looked into the finer details.
Let’s break this down with an extreme example. Let’s say the hospital’s total medical bill for me for the month was 2,000,000yen (about US$13,000). This current stay and surgery are unlikely to go that high, but we’ll use it as an example.
If there were no Cap System, I’d pay 30% of that 2,000,000yen (600,000yen/US$4,000).
With the cap system, I’d pay:
167,400yen + ((2,000,000yen – 558,000yen) * 1%) = 181,820 yen (US$1,200)
While this is still a fair chunk of cash, it feels affordable, given my income.
Lower-income earners would max out at as low as 35,400yen a month.
It’s important to note that the Japan National Health System does not cover some things. Examples include meals during hospital stays (510yen per meal at this hospital – more about meals in the next post), and private rooms (up to 10,000yen per night).
Another ‘gotcha’ in this system is that it uses calendar months as time units, which means if your medical costs bridge two separate months, you can end up paying more. Here’s an example.
- Sally gets admitted to hospital on the 1st of March, and gets discharged two weeks later. She has two major surgeries, and racks up a total bill of 2,000,000yen for the month of March. If she’s on the same income bracket as me, she pays 181,820yen for the month.
- Sam gets admitted to hospital on the 25th of March, and gets discharged two weeks later. He also has two major surgeries, one in March, and one in the first week of April. Let’s say his total bill for each month is 1,000,000yen. If he’s in the same income bracket as both of us, he gets hit for 171,820 yen in March, and 171,820 yen in April.
- Sally and Sam’s overall total bill is the same (2,000,000yen) but they end up paying more in co-pays.
One last thing to be aware of with Max Monthly Medical Bill Caps, is that the caps above only apply to the first three months of paying them in any given calendar year. At the fourth month (if you’re unfortunate to have to keep up your medical care for more than three months total in one calendar year), the cap almost halves in the higher income brackets. In my case, it would drop to a fixed 93,000yen per month beyond three months of hitting that original higher cap. More details in English here.
Eventually, I was shown up to the ward where I’d be staying. Like the rest of the hospital, this felt brand new. Indeed, this hospital is only four years old.
I was given the option of a private room (for a non-insured extra sum), but I just went with the four-person shared room. Four spacious curtain- and wall-separated ‘cubicles’ with bed, table, refrigerator, TV (with HDMI port), drawers and cupboards…
Down the hall were spacious wheelchair accessible toilets, washing stations, and a small coin laundry.
After wheeling about exploring my new surroundings a little, I was called into the ward’s consultation room to have a chat with the surgeon who would be doing the surgery on my ankle in two days time.
Dr. Tsujino was a very animated chap. Loud, expressive, broad in his descriptions.
“You’ll have a scar only this big,” he proclaimed, thrusting his pinched fingers towards my face.
Later I’d discover he was also a prolific medical research author, with 90 published articles to his name. He has published a lot about ankle ligament reconstruction, tricky fractures around the foot/ankle—especially cases that involve weak bones, sports trauma injuries (e.g., ski-related tibial plateau fractures), and much more.
In our brief 15 minute consultation, he scribbled animatedly on an ankle diagram.
“This ligament in your ankle is totally torn, and so is this one. The fibrous connective tissue between your tibia and fibula is all ripped, all the way up to your fracture,” he exuded, scribbling with red ink.
The climax to his jesticulations was thrusting towards me a color copy of a product brochure for Arthrex Knotless Tightrope Syndemosis repair system (product details here and procedure animation here).
“Considering how active you are, and that we want to really want to make sure your ligaments heal perfectly, we’d put two or three of these in,” he said, scribbling large on the paper.
“Here’s a before and after done for someone else, using the same method,” he continued, showing me two x-ray images.
“On the left, you can see a large gap in the ankle joint, where the tibia and fibula join to the joint. That’s no good, and the ligaments won’t heal in an aligned way. On the right, you can see the joint closed up, in the optimal position to promote healing.”
“With this procedure, you’ll have two weeks in a splint, one week in a boot, and you’ll be walking without aids by the end of week three,” he said, scribbling and circling his notes at the bottom of the page.
“We can leave the fracture in the fibula, be! It’ll heal on its own, no need for fixation. Too close to nerves that would complicate things!”
“So what do you think?” he asked me. “Shall we go ahead with this?”
“Two strands, three strands, have at it,” I replied.
“OK then, sign this, and we’ll get you locked in for Thursday!” Dr. Tsujino said.
“Oh, and by the way,” Dr. Tsujino said, “I heard you were planning to get discharged the day after the surgery. That’s a no-go! I want you in the hospital for the full two weeks after the surgery. There’s a lot of rehab ahead of you. Do you realize how impossible it would be to try to get here every day from your apartment, in winter, with a foot you can’t put weight on? Crutches will be a nightmare in the snow, and you can count wheelchairs out!”
And so it was that I committed to my first-ever surgery, to be conducted under general anaesthetic – also a first for me.
And, two full weeks in hospital.
It was all becoming very real.
