title: Latin American immigrants have limited access to health insurance in Japan: a cross sectional study.
abstract: BACKGROUND
  Japan provides universal health insurance to all legal residents. Prior research has suggested that immigrants to Japan disproportionately lack health insurance coverage, but no prior study has used rigorous methodology to examine this issue among Latin American immigrants in Japan. The aim of our study, therefore, was to assess the pattern of health insurance coverage and predictors of uninsurance among documented Latin American immigrants in Japan.
  
  
  METHODS
  We used a cross sectional, mixed method approach using a probability proportional to estimated size sampling procedure. Of 1052 eligible Latin American residents mapped through extensive fieldwork in selected clusters, 400 immigrant residents living in Nagahama City, Japan were randomly selected for our study. Data were collected through face-to-face interviews using a structured questionnaire developed from qualitative interviews.
  
  
  RESULTS
  Our response rate was 70.5% (n = 282). Respondents were mainly from Brazil (69.9%), under 40 years of age (64.5%) and had lived in Japan for 9.45 years (SE 0.44; median, 8.00). We found a high prevalence of uninsurance (19.8%) among our sample compared with the estimated national average of 1.3% in the general population. Among the insured full time workers (n = 209), 55.5% were not covered by the Employee's Health Insurance. Many immigrants cited financial trade-offs as the main reasons for uninsurance. Lacking of knowledge that health insurance is mandatory in Japan, not having a chronic disease, and having one or no children were strong predictors of uninsurance.
  
  
  CONCLUSIONS
  Lack of health insurance for immigrants in Japan is a serious concern for this population as well as for the Japanese health care system. Appropriate measures should be taken to facilitate access to health insurance for this vulnerable population.
authors.affiliation: Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan. pilarsuguimoto@gmail.com
authors.forename: S Pilar
authors.initials: SP
authors.lastname: Suguimoto
authors.forename: Masako
authors.initials: M
authors.lastname: Ono-Kihara
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Feldman
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kihara
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D007407:Interviews as Topic; D007564:Japan; D007843:Latin America / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D055815:Young Adult