OBJECTIVES: In Japan, it is reported that, under the prolonged depression, economic inequality has widened significantly and there exists many households with zero asset. To assess the welfare, we need to investigate inequality not only from the viewpoint of income and asset but also from the viewpoint of expenditure on essential goods, especially on healthcare. Additionally, we shed light on the relationship between business cycles and healthcare inequality. METHODS: This research measures the inequality in healthcare expenditure in Japan from 2008 to 2013. Following the method of Doorslaer et.al (2000), we measure the difference between actual healthcare expenditure and estimated “adequate level of expenditure” (which is often called "needs") for each income class, and then, calculate the inequality index. Since the data source is JHPS (Japan Household Panel Survey), we can conduct panel analysis and time-series cross-sectional comparisons on more detailed data than the existing studies including Ohkusa and Honda (2003) and Watanabe and Hashimoto (2012). Because our sample periods are from 2008 to 2014 that includes so called “Lehman Shock” period, we can also show how the business cycles affects the medical inequality. This has been an open question in the existing literature. RESULTS: First, for households with annual income under 6 millions yen that are about the median, the “adequate level” exceeds the actual expenditure in most years. Second, the richest group (especially top 10%) pays considerably large amount on healthcare. Third, in the depression between 2009-2011, the healthcare inequality becomes large (inequality index is 0.345 in 2008 and 0.502 in 2010).  CONCLUSIONS: In Japan, healthcare inequality becomes higher in the depression. In addition, for even the median households, healthcare expenditure is hard to pay. For these people, the Japanese government needs to set the upper bound of high-cost medical care expenses according to income class.