Introduction

In May 2026, Kutchan Kosei Hospital in Hokkaido took an exceptionally early nationwide step by tripling medical fees for foreign visitors not enrolled in public health insurance. This news raises important questions about the management challenges faced by medical institutions in areas with thriving inbound tourism and the appropriate approach to accepting foreign patients.

As an administrative scrivener (gyoseishoshi) who assists with residence status applications and support for foreign employment, I view this news not as a simple “price increase,” but as a necessary step toward achieving both the sustainability of regional healthcare and the safety and security of foreign patients. This article provides a detailed explanation of the background, significance, and future prospects of this medical fee revision.

1. Background of Kutchan Kosei Hospital’s Medical Fee Tripling

1-1. The Niseko Area and Inbound Tourism

Kutchan Kosei Hospital is a public medical institution located in the Niseko area, a world-renowned ski resort. Niseko is popular among skiers from around the world, particularly Australia, due to the high quality of its powder snow, and a large number of foreign tourists visit during the winter season.

At the hospital, approximately 700 of the roughly 33,000 annual outpatient visitors are foreign visitors to Japan. The number of foreign patients seeking treatment for injuries or sudden illnesses increases sharply during the winter ski season.

1-2. The Burden and Cost of Medical Interpretation

Language barriers exist when treating foreign patients. In medical settings, accurate communication is essential for explaining symptoms, conveying diagnoses, and obtaining consent for treatment plans. To address this, the hospital has employed three medical interpreters during the winter season, incurring significant costs and effort.

Medical consultations conducted through interpreters require approximately three times the time and effort of standard consultations. However, under the previous system, only an additional ¥5,500 interpreter fee could be charged to patients, which was insufficient to cover actual costs.

1-3. Severe Financial Deficit

A combination of factors—declining local population, rising personnel costs, and the cost burden of treating foreign patients—led Kutchan Kosei Hospital to post a deficit of approximately ¥189 million in fiscal 2024. As a public hospital responsible for regional healthcare, sustainable management had become increasingly difficult.

2. Ministry of Health, Labour and Welfare’s Fee Revision and Nationwide First Implementation

2-1. New System from the Ministry of Health, Labour and Welfare

In response to this situation, the Ministry of Health, Labour and Welfare (MHLW) began allowing certain qualified social medical corporations to increase medical fees for foreign visitors not enrolled in public health insurance by up to three times, starting in fiscal 2026.

This system aims to appropriately reflect costs such as medical interpretation and multilingual support, support the management of regional medical institutions, and continue providing high-quality medical services to foreign patients.

2-2. Pioneering Implementation Nationwide

Kutchan Kosei Hospital implemented this system on May 1, 2026, ahead of the rest of the nation. The MHLW’s Medical Administration Bureau General Affairs Division also praised it as “an exceptionally early implementation nationwide.”

This fee increase is expected to improve the hospital’s finances by over ¥100 million annually, representing a significant step toward maintaining regional healthcare.

3. The Meaning and Impact of the Medical Fee Tripling

3-1. Securing Appropriate Compensation

This medical fee revision should be understood not as a “price increase,” but as “securing appropriate compensation” for medical services. Additional costs arise from treating foreign patients, including medical interpreter deployment, multilingual support, and extended consultation times. Receiving compensation commensurate with these costs is essential for the sustainable management of medical institutions.

3-2. Maintaining Regional Healthcare

Inbound tourism thrives for only four months during the winter season; during the rest of the year, the hospital serves elderly residents and local community members on a daily basis. If hospital management deteriorates due to the cost burden of treating foreign patients, medical services for local residents will also suffer.

By appropriately adjusting medical fees, the hospital can continue providing high-quality medical care to both local residents and foreign visitors.

3-3. Impact on Foreign Patients

The tripling of medical fees will indeed increase the financial burden on uninsured foreign patients. However, this also serves as an opportunity to reaffirm the importance of travel insurance and medical insurance enrollment. With appropriate insurance coverage, high medical costs can be covered by insurance, significantly reducing the burden on patients themselves.

4. Challenges and Recommendations from an Administrative Scrivener’s Perspective

4-1. Ensuring Travel and Medical Insurance Enrollment

As an administrative scrivener providing support for residence status applications and foreign employment, I often encounter cases where medical insurance enrollment is insufficient. It is increasingly important to ensure that foreign visitors to Japan enroll in travel insurance and that foreign residents in Japan enroll in National Health Insurance or social insurance.

4-2. Raising Awareness Among Corporate HR Personnel

Human resources personnel at companies employing foreign workers have a responsibility to verify that employees and their families are enrolled in appropriate medical insurance and to promptly support enrollment procedures for those who are not. It is also important to encourage short-term foreign staff to enroll in travel insurance.

4-3. Improving Multilingual Support and Medical Interpretation Quality

I hope that this medical fee revision will lead to improvements in multilingual support and the quality of medical interpretation at medical institutions. Environmental improvements are needed to enable foreign patients to receive medical care with peace of mind, including the introduction of AI-powered automatic translation systems and enhanced specialized training for medical interpreters.

4-4. Implementing Pre-Payment Systems

To prevent unpaid medical fees, implementing a pre-payment (authorization) system that secures a credit limit for medical expenses before treatment is also effective. This reduces the risk of non-payment for medical institutions while allowing foreign patients to receive treatment with confidence.

5. Toward the Coexistence of Inbound Tourism and Regional Healthcare

5-1. Building Sustainable Medical Infrastructure

In regions with thriving inbound tourism, establishing a system to accept foreign patients enhances the region’s attractiveness. However, if this puts pressure on medical institution management, it defeats the purpose. Balancing appropriate compensation with improved quality of medical services is essential for building sustainable medical infrastructure.

5-2. Coexistence of Local Residents and Foreign Visitors

Regional medical institutions serve as a source of safety and security for both local residents and foreign visitors. Accepting foreign patients promotes regional internationalization and contributes to the realization of a multicultural society. To achieve this, coordination among medical institutions, government, local communities, and professional experts like ourselves is crucial.

5-3. Future Outlook

Kutchan Kosei Hospital’s initiative will serve as a model case for medical institutions nationwide. I hope that advanced initiatives such as appropriate fee adjustments, enhanced multilingual support, and implementation of pre-payment systems will spread across the country.

6. Conclusion

The tripling of medical fees at Kutchan Kosei Hospital is not merely a “price increase,” but an important step toward achieving both the sustainability of regional healthcare and the safety and security of foreign patients. As an administrative scrivener engaged in supporting residence status applications and foreign employment, I would like to re-emphasize the following points:

  1. Ensuring Travel and Medical Insurance Enrollment: It is important to encourage foreign visitors and foreign residents to enroll in appropriate insurance.
  2. Corporate Social Responsibility: Companies employing foreign workers have a responsibility to support their employees’ insurance enrollment.
  3. Improving Medical Infrastructure: Environmental improvements are needed, including multilingual support, enhanced quality of medical interpretation, and implementation of pre-payment systems, to enable foreign patients to receive medical care with confidence.
  4. Maintaining Regional Healthcare: By securing appropriate compensation, high-quality medical care can continue to be provided to both local residents and foreign visitors.

The coexistence of inbound tourism and regional healthcare is by no means impossible. Taking this news as an opportunity, we professional experts also wish to actively work toward the realization of a better multicultural society.

If you have any questions regarding residence status applications, visa applications, or foreign employment, please feel free to contact us. We provide thorough support including assistance with establishing living foundations, including insurance enrollment.

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