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Japan is also 30% due at time of service, though prices are nothing like the US (that 30% also drops in retirement age). People can and often do get some kind of private insurance, usually bundled with their life insurance, to cover certain life-altering events. I imagine there's some sort of private health insurance like US folks would think of, but I don't know anyone who carries it. One can do certain procedures off insurance and pay (still cheaper than US prices) here as well if they want.