Japan Joins Chorus of Nations Pushing Back on Unpaid Tourist Healthcare

Struggling to cover unpaid medical bills from inbound tourists, Japanese municipal and prefectural governments have launched campaigns encouraging foreign tourists to buy travel insurance that includes health coverage.

According to local media reports, government agencies are placing flyers at tourist information centers in airports and hotels. (Short-term health insurance protection can be purchased upon arrival in Japan.)

One survey in 2018 estimated that 27% of foreign travelers arrived in the country uninsured and that 5% of inbound tourists fell ill or were injured during their stay in Japan.

Uninsured travelers to Japan who get injured or sick technically are responsible for all of their medical expenses, but many travelers exit the country leaving their medical bills unpaid. This trend is now undermining the finances of the country’s hospital system, Japanese officials say.

According to a recent Japan Health, Labor and Welfare Ministry survey, one out five hospitals reported they have treated tourists who left the country without paying their bill. One particular hospital was reported to have been stuck with nearly $100,000 in unpaid fees.

To encourage travel insurance purchases, some Japanese entities are distributing cards listing some of the country’s most expensive hospital treatments. For example, one card warned tourists that a heatstroke could cost them about 700,000 Japanese yen, or US$6,500. Setting a broken bone was listed at costing 3 million Japanese yen, about US$27,500.

“Have you remembered to book your peace of mind?” a flyer printed in English reads at a Narita airport tourist information center, according to a Japan Times story earlier this month. The flyers are also available in Chinese, Korean and Thai.

“We’ve heard concerns from medical institutions about possibly vast amounts of unpaid medical bills,” an official of the Okinawa Prefectural Government told the Japan Times. “We will continue our efforts to increase the number of people who buy insurance policies after they arrive in Okinawa.”

Uninsured travelers could be turned away
Having health insurance coverage in a travel protection plan is crucial to a tourist receiving care while traveling in Japan. “Because Japan has a national health insurance system that covers almost all the residents of the country, they are leery of treating foreign patients who don’t belong to this system,” InsideKyoto.com says on its website.

“Sadly, there have been many instances of clinics and hospitals turning away foreign patients who needed care, even some with life-threatening conditions. Having proof of insurance is usually enough to overcome any reluctance on the part of the clinic or hospital to give care.”

“The best reason to have valid travel insurance while traveling in Japan is so that you can show your proof of insurance to the people at a clinic or hospital where you hope to receive care,” InsideKyoto.com said.

The website called the price of medical procedures in Japan “a real bargain” compared to medical costs in the U.S., and that as “a general rule, it costs roughly the same as it would in Canada or Australia if you were to pay full costs in either of those countries.”

Thailand moves forward with compulsory tourist protection
While Japan joins the ranks of countries growing weary of the expense of caring for sick and injured tourists, it does not currently appear to be looking at laws to require travel insurance from tourists, as other nations have.

However, Thailand’s Tourism and Sports Ministry is considering making travel insurance mandatory for foreign visitors, including policies that would charge a 20-baht premium — (equivalent to less than US$1), according to the country’s Office of the Insurance Commission (OIC).

The move is in response to a string of foreign tourist tragedies last year, including two boats capsizing off Phuket in July 2018, claiming the lives of nearly 50 Chinese tourists.

The compulsory insurance will be available for purchase at immigration offices in airports, and the premium will be directed to an account to be held by Thailand’s Tourism Promotion Fund in the event of claims.

The Tourism and Sports Ministry forecasts more than 40 million tourists will visit Thailand this year, contributing 2.13 trillion baht in tourism revenue, approximately 18% of the country’s GDP.

Thailand’s OIC also is encouraging tour operators in Nakhon Nayok province to provide insurance to customers and tour guides. The region is being targeted for the pilot program because it is popular for higher risk activities, like rafting and climbing. Medical insurance would cover up to 500,000 baht in case of injury.