Photo/Illutration St. Luke’s International Hospital is seen in Tokyo’s Chuo Ward on July 17. (Hiroshi Nakano)

As tourism to Japan surges, so too has the use of its world-class medical facilities for treatment and surgery. But not all patients pay their bills. 

St. Luke’s International Hospital in Tokyo’s Chuo Ward takes in more than 2,000 foreign emergency patients a year. About 30 of them will check out and disappear with bills unpaid.

Visitors to Japan must pay the full cost of medical treatment if they do not have a Japanese health insurance card.

“We want there to be an institutional arrangement that, for example, requires visitors to Japan to have an appropriate insurance policy when they enter the country,” a St. Luke’s official said.

St. Luke’s tries to get people to pay while they remain at the hospital, not later. Some refuse.

If the person has overseas insurance, the hospital then approaches the foreign insurer. But some overseas insurance companies are difficult to deal with. They typically dispute the cost and try to hammer it down, the officials said.

When a patient is uninsured, they are asked where they live. The hospital sends a bill to the address, but it is seldom paid.

There is no provision for hospitals to recoup losses from unpaid medical fees by overseas visitors. Most are shouldered by the hospital themselves.

BAD LOANS

St. Luke’s Hospital is tackling the problem with two approaches. Firstly, it has introduced a payments system that handles foreign currencies and gives a range of payment options. Staff also tell patients in advance how much their medical treatment is likely to cost.

A survey by the Japan Tourism Agency between October last year and February showed that nearly 30 percent of visitors to Japan are uninsured here.

Nationwide, hospitals and clinics are counting the cost. In fiscal 2022, the health ministry asked medical institutions if they had encountered problems of this kind.

Nearly 30 percent of respondents reported unpaid bills by non-Japanese patients, although the category could include foreign residents as well as tourists.

In all, about 880 million yen ($5.63 million) was owed by foreigners, a significant sum although only about 1.4 percent of the total when Japanese defaulters are included.

The numbers of tourists who check in for treatment is rising. In Tokyo in 2023, a total of 3,283 foreign visitors were taken to the hospital, up more than fivefold from 624 the previous year and up from 2,620 in pre-pandemic 2019.

The figures are supplied by the Tokyo Fire Department, which coordinates ambulance dispatches. The figures exclude Inagi and islands within the Tokyo administrative jurisdiction.

IMMIGRATION CHECKS

Arrears become bad loans if the treated patient leaves the country. In May 2021, the government began to address the problem by checking the names of visitors entering Japan against a list of defaulters with debts of 200,000 yen or more.

The health ministry collects that data from medical institutions and shares the information with the Immigration Services Agency.

Health ministry officials said 27 medical institutions have so far provided data on 52 non-Japanese people, who owe a collective 89 million yen.

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