Japan is considering a major change to rules for foreign visitors

Japan is planning to tighten its immigration rules to crack down on the issue of foreign tourists leaving without paying their medical bills, according to media reports.

The new policy could force visitors to get private medical insurance and allow immigration authorities to screen tourists for any history of unpaid bills, local media outlets reported citing government sources.

The government’s upcoming annual economic and fiscal policy review is expected to clearly state that the matter of insurance coverage for foreign visits will be addressed, Kyodo News reported.

As part of the tougher rules, the ministry of health, labour and welfare is likely to share information on foreign visitors with large unpaid medical bills with the Immigration Services Agency, enabling stricter entry screenings.

A nationwide survey by the ministry, covering around 5,500 medical institutions, found that 11,372 foreign visitors received medical treatment in Japan in September 2024. Of these, 0.8 per cent did not pay, resulting in unpaid bills amounting to roughly 61.35 million Yen ($427,000), Mainichi reported.

International tourism to Japan has surged in recent years, partly due to the weakening yen, and local hospitals and clinics are increasingly seeing a strain on their resources due to uninsured tourists visiting the country.

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Last year, Asahi Shimbun reported that as tourism to Japan rises, more foreign visitors were using the country’s top-tier medical facilities – yet a number of them leave without paying their bills.

For example, at Tokyo’s St Luke’s International Hospital, about 30 out of 2,000 foreign emergency patients annually fail to pay, the report said.

In 2024, a survey by the Japan Tourism Agency conducted from October 2023 to February 2024 found that nearly 30 per cent of visitors to Japan did not have insurance while in the country.

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In 2022, the health ministry asked medical facilities if they had faced such issues. Almost 30 per cent of those surveyed said they had unpaid bills from non-Japanese patients, a group that may include both foreign residents and tourists.

Foreigners residing in Japan for more than three months are generally required to enrol in the National Health Insurance programme – a system designed for the self-employed and unemployed – unless they are covered by another form of public health insurance.

The government is also considering measures to prevent foreign residents from defaulting on national insurance premiums, with such steps likely to be included in the upcoming annual policy.