National / Social Issues | Deep Dive

Travelers without insurance cause headaches for Japan’s hospitals

by Mizuho Aoki

Staff Writer

Are you insured?

As Japan sees a record-breaking number of foreign visitors, a major hospital near Narita airport is struggling to deal with an increasing number of uninsured patients who can’t pay for the medical treatment they’ve received.

“Most of the foreign visitors we treat are emergency patients, coming directly from the airport. . . . In many cases, they are not covered with by insurance,” said Tomomi Asaka, a surgeon who is also chief of the International Medical Center at Japanese Red Cross Narita Hospital.

Emergency treatment can cost several million yen. When patients can’t pay, the hospital tries several ways to collect, such as by contacting their relatives to ask them to shoulder the cost, proposing installment plans or calling embassies for help. But when all these attempts fail, the hospital has no choice but to absorb the cost.

Although the Narita hospital declined to disclose how many unpaid medical bills it has, Asaka said it is “a lot.”

“When we have such troubled foreign patients, it’s really, really tough for us to deal with,” Asaka said.

Sometimes patients decline to receive necessary treatment after learning how much it will cost, she said.

“I believe many of these problems would have been solved if they had purchased travel insurance,” she said.

Asaka said the patients should have purchased travel insurance. But she also said they are not the only ones to blame.

“Many, in my understanding, do not have the knowledge or custom of buying a policy when traveling. And that is partly the responsibility of their countries as well as Japan, which is campaigning hard to draw foreign visitors,” Asaka said.

According to records, the hospital treated 409 foreign visitors who could not speak Japanese in 2017. Although it does not have any previous data for comparison, the number definitely has increased in recent years, Asaka said.

To better cater to complex cases presented by foreign patients, the hospital set up the International Medical Center in April last year with three fully bilingual staffers — Asaka and two medical clerks.

The center gets a phone call when a foreign patient who doesn’t have insurance or Japanese ability seeks help at the hospital. Many of the cases are complicated by linguistic, visa and cultural differences that can take days to sort.

The center recently dealt with a man in his 70s who was suffering from arrhythmia and was brought to the hospital from the airport.

The patient, whose name and nationality were not disclosed for privacy reasons, had a temporary pacemaker inserted. That cost ¥600,000. He also needed to undergo another operation to replace the pacemaker with a permanent one, a procedure that would set him back another ¥7 million.

The man, transiting through Narita on his way home, had no travel insurance.

“He was old and was living on a pension. He did not have any savings and he was single, and his siblings also couldn’t pay the cost,” she said.

He insisted on flying back to his country where he said he could get free treatment at a veterans’ hospital. But the man’s condition was too unstable to let him return by himself. After mulling several options, Asaka and a nurse decided to fly back with him to his country.

If a private company was asked to dispatch doctors to accompany a patient on an international flight, it would cost several million yen, Asaka said. But by doing it themselves, they were able to spare the patient the cost, she said.

“In the past year alone, there were three such cases where we had no option but to accompany patients ourselves and take them back to their home countries,” Asaka said.

Japan’s legal obligation to provide medical treatment to anyone on request also places a heavy psychological burden on doctors.

“We are trained to focus on treating patients without thinking of the bills. . . . So it’s very stressful for doctors to discharge or provide minimum treatment to patients with financial troubles. It’s ethically hard to swallow,” Asaka said.

“The government is trying to further increase the number of foreign visitors. But when they fall ill and can’t pay medical bills we are the ones left to shoulder the cost because we have the legal obligation to provide treatment. That’s unreasonable,” Asaka said. “I hope the government creates a legal system that matches today’s environment.”