Foreign visitors who do not possess Japanese health insurance sometimes pay more for medical services than insured local residents because they are subject to the medical institution’s at-will medical pricing (自由診療価格), which can be set higher than the standard fees used in Japan’s public insurance system. According to a 2019 survey, approximately 10% of medical institutions charged a higher multiple compared to the standardized rates for services, so expect this to be a higher percentage now.
There are a few reasons for this, but it’s not without controversy, with instances such as a foreigner who happened to be an asylum seeker being charged a 2x multiple for childbirth1 or other institutions turning away foreigners who don’t have Japanese National Health Insurance.
1. Lack of Public Insurance Coverage
Foreign visitors who stay less than 90 days, such as tourists, are typically not covered by Japan’s public medical insurance, which is mandatory for most long-term residents. Since they are uninsured, their medical fees are 100% self-pay.
For Japanese residents who are insured, medical fees are based on the standard fee schedule (診療報酬点数表), where one point usually equals ¥10. Insured patients typically pay only 10% to 30% of that total cost2.
However, for uninsured foreign patients seeking free practice care, Japanese law does not mandate a specific fee, allowing institutions to set their own prices. While about 80% of hospitals charge the standard ¥10 per point for all uninsured patients, some institutions implement higher rates. For example, institutions have been documented charging 20 yen per point (twice the standard rate) or even 30 yen per point (three times the standard rate).
2. Operational Costs
Medical institutions cite the need to cover the additional time and resources required to treat foreign patients.
- Communication Barriers: Hospitals often incur costs related to providing interpreters or utilizing translation services.
- Extended Consultation Time: Treating foreign patients generally takes longer than treating Japanese patients due to communication needs and unfamiliarity with the Japanese medical culture. One hospital found that uninsured foreign patients took an average of 23 minutes for consultation compared to 10 minutes for Japanese patients.
3. Financial Risk of Unpaid Bills
A significant factor contributing to higher pricing is the heightened risk of uncollected medical fees (未収金のリスク). When patients are 100% self-pay and may leave the country shortly after treatment, hospitals face the possibility of never receiving payment.
According to a 2023 survey, 18.3% of hospitals reported experiencing unpaid bills from foreign patients in a single month. Medical fees that cannot be collected are a major concern for institutions receiving foreign patients.
In Conclusion
Overall, the higher pricing for foreign visitors without insurance is intended to offset the increased administrative effort, communication costs, and the financial risk inherent in providing care to patients who do not participate in the national insurance system and whose debt collection is challenging once they return home. If you want to find out what your medical care will cost beforehand, all you need to do is ask, as Japanese medical institutions are transparent with their pricing. You can also ask if they charge the standardized pricing or a multiple (2x or 3x), and if you want to receive standardized pricing or a lower multiple, you can shop around.