Subarachnoid Hemorrhage (SAH) requires advanced, time-sensitive treatments like Coil Embolization and Clipping Surgery, leading to total medical costs potentially reaching several million yen. This financial aspect can be a significant source of anxiety for patients and their families.
Treatment Costs and Medical Fee Estimates for SAH (Japan, Current as of 2025)
The treatment costs for SAH, primarily for ruptured cerebral aneurysms (Coiling or Clipping), vary significantly based on the duration of hospitalization, severity, and complications (vasospasm or hydrocephalus). The Japanese public health insurance system applies, with patient co-pay being 10% to 30% (depending on income). The High-Cost Medical Care Benefits (Kōgaku Ryōyōhi) system caps the monthly out-of-pocket maximum (e.g., approx. ¥80,000 for standard income earners), which significantly alleviates the actual burden. While total medical expenses are in the millions of yen, the self-pay amount is limited. Below are estimates based on 2025 data, which are averages and subject to regional and hospital variation.
1. Estimated Hospitalization and Treatment Costs (Assuming 30% Patient Co-Pay)
The average hospital stay is approx. 2–4 months (Acute + Recovery Phase). Total medical expenses are typically between ¥2.0M and ¥5.0M, but the effective burden is capped at around ¥80,000 per month by the High-Cost Medical Care Benefits.
| Severity / Content | Est. Hospital Stay | Total Medical Expenses (Before Insurance) | Est. Out-of-Pocket (After High-Cost Benefits) | Notes (Current as of 2025) |
| Mild (Grade 1–2, Coiling, Small bleed) | 2–6 Weeks | ¥1.5M∼¥2.5M | ¥100,000∼¥250,000(≈¥80,000/month×2–3 months) | Focus on short-term stay. Rehab adds +¥50,000∼¥100,000. |
| Moderate (Grade 3, Coiling, Clear consciousness) | 2–4 Months | ¥2.5M∼¥4.0M | ¥200,000∼¥400,000(≈¥80,000/month×3–5 months) | Increased costs due to transfer to a recovery/rehab hospital. Rehab is ≈¥3,000per session (30% co-pay). |
| Severe (Grade 4–5, Impaired consciousness, Complications) | 4–10 Months | Over ¥4.0M | ¥300,000∼¥600,000(≈¥80,000/month×6+ months) | Clipping surgery adds +¥200,000. ICU stay adds +¥300,000. |
| Clipping Surgery(Craniotomy) | 3–5 Months | ¥3.0M∼¥5.0M | ¥250,000∼¥500,000 | Longer stay and higher cost than Coiling. |
| Complication(Vasospasm/Hydrocephalus) | +1–3 MonthsExtension | Over +¥1.0M | +¥100,000∼¥200,000 | VP Shunt surgery adds +¥100,000. |
Example Breakdown (Moderate Case, 3-Month Stay, 30% Co-pay):
- Basic Hospitalization Fee: ≈¥400,000 (≈¥4,000/day×90 days, 30% co-pay).
- Tests (CT/MRI/Angiography): ¥100,000∼¥150,000.
- Medication/Procedures (Eril infusion, etc.): ¥150,000∼¥250,000.
- Surgery (Coil Embolization): ¥500,000∼¥1,000,000.
- Rehabilitation (PT/OT/ST, 3 hours/day): ¥200,000∼¥300,000.
High-Cost Medical Care Benefits: The amount exceeding the monthly cap is reimbursed (application mandatory). The cap is even lower for those aged 70+ (max ≈¥50,000∼¥60,000/month). Note: In 2025, there is a slight decreasing trend in testing costs due to mandatory electronic health record sharing (Medical DX promotion). Many use private medical insurance for supplementary coverage.
2. Main Medical Fee Points (Shiryō Hōshū) (April 2025 Revision)
The medical fee point system is where 1 point=10 yen. The patient’s co-pay is 10% to 30% of the total points billed to the insurer by the hospital. Below are key items related to SAH (based on MHLW fee schedules). Note that after June 2025, more items require specific facility criteria (e.g., for acute care add-ons).
| Service Item | Points (Est. per day) | Estimated Cost (¥10 per point) | Applicable Conditions/Notes |
| Basic Hospitalization Fee(7:1, Stroke Response) | 1,844 points | ¥18,440 | Acute care hospital. Add-ons available if stroke patient ratio is ≥20%. |
| Acute Care Enhancement Add-on | 500∼1,000 points | ¥5,000∼¥10,000 | Severe SAH. Post-June 2025: Introduction of an emergency summary is mandatory. |
| Emergency/Life-Saving Ward Fee | 1,790 points | ¥17,900 | Required for ICU admission. Essential for severe SAH. |
| Cerebral Aneurysm Coil Embolization | ≈50,000∼80,000points (per procedure) | ¥500,000∼¥800,000 | Catheter treatment. 30% co-pay is ¥150,000∼¥240,000. |
| Cerebral Aneurysm Clipping Surgery | ≈60,000∼100,000points (per procedure) | ¥600,000∼¥1,000,000 | Craniotomy. 30% co-pay is ¥180,000∼¥300,000. |
| Ventricular Drainage | 5,000∼10,000 points (per procedure) | ¥50,000∼¥100,000 | For concomitant hydrocephalus. |
| Rehabilitation Fee (PT) | 360 points (20 min) | ¥3,600 | ≥3 units per day possible. Focus in recovery phase. |
| Neurological Tests(CT/MRI) | 1,000∼3,000 points | ¥10,000∼¥30,000 | For diagnosis. |
Total Example: A moderate case for 1 month is ≈150,000∼250,000 points (¥1.5M∼¥2.5M). Varies based on hospital classification (DPC status). 2025 Revision Point: Enhanced add-ons (+0.5 to 1%) for electronic prescriptions and shared medical records due to Medical DX. Slight increase in fees for BP management and endovascular treatment based on revised stroke guidelines. Rehabilitation points show a +2% trend in the maintenance phase.
Tips for Reducing the Financial Burden
- Public Support: Utilize the High-Cost Medical Care Benefits + Certificate of Application for Ceiling Amount(apply beforehand to cap the window payment).
- Private Insurance: A daily hospitalization benefit of ≈¥5,000 can cover the monthly out-of-pocket maximum. Critical Illness riders can provide a lump sum of ¥500,000∼¥1,000,000.
- Consultation: Speak to the hospital’s Medical Social Worker (MSW). Seek advice beforehand if there is a family history of SAH.
