By Akihiko Kano / Yomiuri Shimbun Staff WriterThe sharp rise in foreign tourists visiting Japan has put an unexpected and heavy burden on medical institutions nationwide. The problems include unpaid medical treatment fees and language barriers.
The government, which has set a goal of attracting 40 million visitors to Japan for the 2020 Tokyo Olympic and Paralympic Games, plans to compile comprehensive measures to tackle the issue by the end of this month at the earliest.
However, many challenges remain.
No travel insurance
Wanwisa Jaijan from Thailand suddenly collapsed with ischemic heart failure while on a tour of Tokyo in January 2017. The 29-year-old received medical treatment five times, including surgery, at Tokyo Medical and Dental University Medical Hospital in Bunkyo Ward, Tokyo.
She survived as a result of the treatment, and said she felt grateful to the hospital.
However, a problem arose when she was faced with ¥15 million in medical bills.
The Japanese public insurance system does not cover foreign visitors to Japan, and she also had not purchased private travel insurance.
The Thai Embassy paid ¥8 million to the hospital on her behalf, and she is trying to pay back the debt little by little. But the hospital has been left with a large amount of unpaid charges.
“By all means, we want [foreign visitors] to buy travel insurance before coming to Japan,” said the hospital’s head, Atsushi Okawa.
The number of foreign visitors to Japan in 2017 hit a record high of 28.69 million — as much as 3.4 times more than in 2012, when 8.36 million visited.
According to a 2017-2018 survey by the Japan Tourism Agency, 6 percent of foreign visitors to Japan got sick or injured during their trip. This put an excessive strain on some medical institutions.
Of 1,378 medical institutions that received foreign visitors to Japan and foreign nationals living in Japan, 35 percent said they had patients who have not paid their medical bills for a year, according to a 2016 survey by the Health, Labor and Welfare Ministry.
Another survey by the ministry found that one of the hospitals was left with more than ¥90 million in unpaid bills.
App takes time
Language barriers are adding to the strain.
In summer last year, a Southeast Asian male grimaced in pain as he showed his smartphone to a doctor at Motobu Noge Hospital in Okinawa Prefecture. He was using an app that translated his words into Japanese. The screen read, “Please have a look at me.”
The conversation via the app — which included questions like, “Do you feel pain?” — continued for more than 20 minutes. The doctor usually takes about five minutes to see a patient. The conversation meant more than 20 Japanese patients had to wait longer at the hospital, located near the Okinawa Churaumi Aquarium.
According to the Okinawa Medical Association, other hospitals in the prefecture have also experienced increased workloads, including emergency transportation of patients to their home countries and communicating with consulates.
Extra costs mounting
The cost of dealing with foreign visitors is also an issue. According to a provisional calculation by the health ministry, midsized hospitals spend about ¥18 million to ¥26 million annually on medical interpreters and other matters related to foreign patients. Such expenses are supposed to be paid by the patients.
However, of 1,456 medical institutions that accepted foreign patients, 83 percent said they only charged for medical fees — which cost the same as medical services provided under public insurance — and did not add extra costs for such things as interpretation, according to a 2016 health ministry survey.
Medical institutions are believed to be unfamiliar with the medical service system that applies to patients without public health insurance. Under it, they are allowed to determine medical fees on their own.
More than 1,900 hospitals nationwide are given corporate tax breaks due to their highly public nature, but they are not allowed by law to independently set medical fees.
Kutchan Kosei General Hospital in Hokkaido is one such hospital. During the ski season from 2016 to 2017, about 1,600 foreign visitors to Japan went to that hospital. Personnel costs for interpreters and other matters related to foreign patients set the hospital back ¥10 million every ski season. The hospital, however, is only allowed to charge medical fees, which costs the same as medical services provided under public insurance.