- Introduction: The Growing Number of Foreign Patients and Healthcare Challenges
- What Is Happening in Healthcare Settings?
- The Reality of Non-Payment Issues: “Misunderstanding” Rather Than Malice
- Hospital Response Measures: Sharing Cases and Issues and Creating Fee Schedules
- Government’s Strengthened Measures: Stricter Non-Payment Standards
- An Immigration Specialist’s Perspective: Impact on Visas and Residence Status
- Response Measures Companies Should Take
- Message to Foreign Nationals
- Conclusion: The Gap in Understanding Can Be Bridged
Introduction: The Growing Number of Foreign Patients and Healthcare Challenges
The number of foreign residents in Japan has been increasing year by year, and accordingly, the number of foreign patients visiting medical institutions has been increasing rapidly. According to a survey by the Ministry of Health, Labour and Welfare, approximately 144,000 foreign nationals visited medical institutions in fiscal year 2024, highlighting the challenges faced by healthcare providers.
On April 11, 2026, Nippon TV NEWS reported on “Medical Fee Non-Payment Issues… Hospitals Facing ‘A Significant Gap in Understanding’ with Increasing Foreign Patients,” which highlighted the current situation and challenges in accepting foreign patients, focusing on Tokyo Metropolitan Hiroo Hospital. In this article, from the perspective of an immigration specialist (gyoseishoshi) who handles visa applications and residence status procedures, this article explains the impact of medical fee non-payment issues on residence status and the response measures that companies should take.
What Is Happening in Healthcare Settings?
Hospitals Accepting Patients from 151 Countries and Regions
Tokyo Metropolitan Hiroo Hospital has accepted patients from 151 countries and regions to date. The hospital has multilingual signage throughout the facility and medical interpreters are available. The news report featured an American man who visited the hospital with a sore throat, accompanied by a medical interpreter who was interpreting complex medical terminology.
While the language barrier is certainly a significant issue, Dr. Masamitsu Shirokawa, Director of the Department of Emergency Medicine at Tokyo Metropolitan Hiroo Hospital, points out that an even more serious problem is “a significant gap in understanding how to access medical care.”
Confusion Over the “Post-Payment” System
At Japanese medical institutions, it is common to pay after receiving medical care—a “post-payment” system. However, in many countries overseas, patients pay before receiving care—a “pre-payment” system—which can be confusing for foreign patients.
“In some countries, patients must pay in advance before they can receive medical consultations, examinations, or prescriptions,” explains Dr. Shirokawa. These differences in systems have contributed to the problem of unpaid medical fees.
The Misunderstanding of “Fraudulent Use of Health Insurance Cards”
An even more serious issue is the attempted use of someone else’s health insurance card, known as fraudulent use of health insurance cards. According to the report, there was an example where “a patient attempted to use the National Health Insurance card of a third party, a Chinese resident of Saitama, when receiving medical care.”
This sometimes occurs because the person mistakenly believes that the health insurance card is “a discount voucher for medical costs.” The underlying issue is a lack of understanding about the nature of health insurance cards and Japan’s public health insurance system.
The Reality of Non-Payment Issues: “Misunderstanding” Rather Than Malice
Importantly, at Tokyo Metropolitan Hiroo Hospital, there are only about two cases per year of intentional non-payment where patients deliberately attempt to evade payment.
On the other hand, there are many cases where misunderstandings such as “I wasn’t informed” or “It was more expensive than I expected” lead to disputes. In other words, most non-payment issues arise not from malice but from “lack of understanding of the system” or “insufficient explanation.”
Hospital Response Measures: Sharing Cases and Issues and Creating Fee Schedules
Tokyo Metropolitan Hiroo Hospital has been actively implementing measures to address these problems.
Monthly Meetings to Share Cases and Issues
The hospital holds monthly meetings to share cases and issues of medical fee non-payment and fraudulent use of health insurance cards. Based on opinions raised at these meetings, specific countermeasures are implemented.
Providing Multilingual Fee Schedules
To address the non-payment issue, the hospital has created multilingual fee schedules for medical services and presents them to patients in advance. This helps prevent misunderstandings such as “I wasn’t informed” or “It was more expensive than I expected.”
Effectiveness of Countermeasures: Significant Improvement in Unpaid Amounts
As a result of these efforts, unpaid amounts have significantly decreased, and recently, monthly unpaid amounts have sometimes fallen below 10,000 yen. These steady efforts to bridge the gap in understanding are producing tangible results.
Government’s Strengthened Measures: Stricter Non-Payment Standards
Significant Tightening of Entry Screening Standards
The government has also taken serious action regarding medical fee non-payment issues involving foreign patients. Previously, entry could be denied to those with unpaid medical fees of 200,000 yen or more, but from April 1, 2025, this threshold has been significantly lowered to 10,000 yen or more, making the standard much stricter.
This change is a significant policy shift that directly affects the entry and re-entry of foreign nationals.
Impact on Residence Status
Non-payment of medical fees can also adversely affect the renewal or change of residence status. The Immigration Services Agency emphasizes the “good conduct” requirement when reviewing residence status applications, and medical fee non-payment may be considered evidence of poor conduct.
Particularly if unpaid medical fees of 10,000 yen or more exist, re-entry may be denied, making this a very serious issue for foreign nationals.
An Immigration Specialist’s Perspective: Impact on Visas and Residence Status
“Good Conduct” Requirement in Residence Status Review
When renewing or changing residence status, the “good conduct” requirement is an important review criterion. Non-payment of medical fees may violate this good conduct requirement.
Particularly for permanent residence permit applications or naturalization applications, the good conduct requirement is examined more strictly, so medical fee non-payment can be a critically disadvantageous factor.
Re-Entry Permit and Medical Fee Non-Payment
Under the new standards from April 1, 2026, re-entry may be denied if unpaid medical fees of 10,000 yen or more exist. This has a significant impact on foreign nationals who frequently make temporary returns to their home countries or business trips abroad.
Employment Risks for Companies
If a foreign employee is unable to renew their residence status due to medical fee non-payment, the company will lose a valuable human resource. Additionally, recruitment costs and training costs will be wasted.
Response Measures Companies Should Take
Explaining the Healthcare System at the Time of Hiring
When hiring foreign employees, it is important to clearly explain Japan’s healthcare system. In particular, clearly communicate the following points:
- Japanese medical institutions operate on a “post-payment” system
- Health insurance cards can only be used by the cardholder and lending them to others is illegal
- Non-payment of medical fees can affect residence status and re-entry
Ensuring Health Insurance Enrollment
Verify that foreign employees are properly enrolled in health insurance. If the company is enrolled in social insurance, foreign employees are also required to enroll in health insurance.
If enrollment in National Health Insurance is necessary (such as for part-time workers), assist with the procedures at the municipal office.
Conducting Regular Training Sessions
In addition to orientation at the time of hiring, it is recommended to conduct regular training sessions on the healthcare system. Including the following content is particularly effective:
- How to visit a hospital (bringing your health insurance card, check-in procedures, etc.)
- Approximate medical costs and payment methods
- Emergency response (how to call an ambulance, night and holiday medical care, etc.)
- Risks of medical fee non-payment (impact on residence status, etc.)
Providing Information on Medical Interpreter Services
For foreign employees who do not speak sufficient Japanese, provide information on medical interpreter services. Some medical institutions, like Tokyo Metropolitan Hiroo Hospital, have on-site medical interpreters.
Additionally, an increasing number of medical institutions offer remote medical interpreter services (interpretation via telephone or tablet devices).
Consultation Services for Issues
It is also effective to establish an in-house consultation service that employees can access immediately if issues arise regarding medical fee payment. The HR or general affairs department can serve as the contact point and, when necessary, connect employees to specialists such as immigration specialists or attorneys.
Message to Foreign Nationals
Always Pay Your Medical Fees
At Japanese medical institutions, it is common to pay after consultation—a “post-payment” system. Always complete the payment process and always pay your medical fees.
Non-payment of medical fees adversely affects residence status renewal and re-entry. From April 1, 2026, re-entry may be denied if unpaid medical fees of 10,000 yen or more exist.
Health Insurance Cards Can Only Be Used by the Cardholder
Health insurance cards can only be used by the person to whom they are issued. Using someone else’s health insurance card for medical consultation (fraudulent use of health insurance cards) is illegal and subject to criminal penalties.
Similarly, lending your health insurance card to others is also illegal. Never do this under any circumstances.
Seek Advice When in Difficulty
If you have difficulty paying medical fees or have questions about the healthcare system, seek advice immediately. Possible consultation sources include:
- Your company’s HR or general affairs department
- Medical institution consultation services (such as medical social workers)
- Municipal foreign resident consultation services
- Specialists such as immigration specialists or attorneys
Conclusion: The Gap in Understanding Can Be Bridged
The issue of medical fee non-payment by foreign patients is caused not only by language barriers but also by a gap in understanding regarding the healthcare system. However, as the example of Tokyo Metropolitan Hiroo Hospital demonstrates, this gap can certainly be bridged through appropriate explanation and thoughtful measures.
We ask HR personnel at companies to provide clear explanations about the healthcare system and ongoing support so that foreign employees can live and work in Japan with peace of mind.
As immigration specialists (gyoseishoshi), we contribute to creating an environment where foreign nationals can live in Japan with confidence through support for visa and residence status applications. If you have any questions or concerns about the impact of medical fee non-payment on residence status or response measures that companies should take, please feel free to contact us.
Let us work together to build a society where global talent can work and live in Japan with confidence.
Reference Article:
“Medical Fee Non-Payment Issues… Hospitals Facing ‘A Significant Gap in Understanding’ with Increasing Foreign Patients,” Nippon TV NEWS NNN (April 11, 2025)
https://news.yahoo.co.jp/articles/4602f7ff098100f2df05200368bee6cc9112a056
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For consultations regarding visa applications and residence status, please feel free to contact our office. We provide comprehensive support for foreign nationals’ lives in Japan.
