NTT Medical Center Tokyo, a hub for accepting foreign patients, is pictured in Tokyo's Shinagawa Ward on Aug. 2, 2019. (Mainichi/Go Kumagai)

TOKYO -- While Japan has seen increases in the numbers of foreign workers and people visiting the country, some medical facilities have started to impose strict conditions for seeing non-Japanese patients.

In at least one case, a facility serving as a hub for receiving foreign patients announced that it could turn foreigners away if it couldn't confirm their residence status. Although non-Japanese could provide a new source of income for medical facilities, it appears that some hospitals are concerned about the risk of medical accidents stemming from language problems, as well as issues including the nonpayment of fees.

In the Gotanda district of Tokyo, which has many foreign embassies and ambassadorial residences, the NTT Medical Center Tokyo has made an effort to ensure foreign residents can see doctors with peace of mind, providing interpreters and coordinators. As of fiscal 2018, it was just one of 31 medical facilities in Japan designated by the central government as a hub for receiving foreign patients. The hospital received 8.88 million yen in subsidies from the central government over the three years up until that fiscal year amid expectations it could provide advice to nearby medical facilities. The hospital actively welcomes foreign patients arriving in Japan for medical treatment.

One notice at this facility, however, emerged as a problem. Messages on its website and inside the hospital stated that when confirming the identity of patients, if their status of residence couldn't be confirmed, then it could refuse to see them, with the exception of emergency cases. It requested that foreigners present not only their health insurance card, but their residence cards as well.

The Medical Practitioners Act forbids doctors from refusing any request for examination or treatment without just cause. The Tokyo Metropolitan Government is in charge of instructing health care facilities in the capital, and a metropolitan government official questioned the hospital about its notice at the beginning of this year. Suggesting that it was too harsh, the official asked," What would happen if a person forgot their residence card?" The hospital explained it could suggest that the patient go back to get it. Eventually, the hospital took the message down from its website in June on the grounds it could cause misunderstanding, and removed the notice inside the hospital in August.

A hospital representative told the Mainichi Shimbun, "We strive to enhance our identification of patients, partly for medical safety. We perceived that having foreigners present their residence cards or passports, which they are required to carry, would be the best way." The hospital says it also checks the identity of Japanese patients through their driver's licenses or other official documents.

In Tokyo's Shinjuku Ward, which has the highest concentration of foreign residents among the capital's 23 wards, at over 10 percent, one maternity clinic stated on its website that it limited patients to those who could speak a conversational level of Japanese. The reason was that misunderstandings over explanations on treatment could lead to serious medical accidents. The clinic says it turns away those without sufficient language proficiency even if they have an interpreter with them.

Yoneyuki Kobayashi, president of the AMDA International Medical Information Center, a nonprofit organization that provides medical information to foreigners in Japan by telephone, commented, "Foreigners in Japan account for over 2 percent of the population, and it's difficult now for them to receive treatment only at specified medical institutions. We first need to adopt a stance of accepting them at any medical institution, like Japanese people."

As a general rule in Japan, a country with a universal health insurance system, people are supposed to be able to receive the same treatment at any medical facility in the country at a flat rate. While this has stabilized the finances of medical institutions, it has also restricted them. Accordingly, inbound tourists and other foreigners who do not fall under the system and can be charged more are viewed as an appealing source of income -- though some health care facilities see them as a risk.

Bringing foreign visitors to Japan is a pillar of the government's growth strategy, and this includes medial tourism, with the country offering a high level of comprehensive medical examinations and tests. In March this year, the Ministry of Health, Labor and Welfare made it clear that medical facilities could freely charge foreign tourists and other visitors for providing interpretation and medical treatment services.

In a survey the ministry conducted last year, it found that about 30 percent of 178 medical facilities that handled large numbers of foreign patients billed them for at least twice the amount people would normally pay for insured visits -- and there is a possibility that the number of such hospitals could increase in the future.

"Hospitals do not operate merely on the amount covered by patients alone, but on subsidies provided by administrative bodies. It is likely also for the benefit of local residents that they charge foreign tourists, who do not shoulder the tax burden, a higher amount in consultation fees," commented one official at a hospital in the capital.

At the same time, there have been cases in which foreigners have returned to their countries without paying their medical bills. A survey the Ministry of Health, Labor and Welfare conducted for the month of October last year found that of 1,965 medical institutions that accepted foreign patients including permanent residents, 372, or nearly 20 percent of them, reported outstanding fees. The causes were not analyzed, but it is believed there were cases in which those without travel insurance were unable to pay large medical bills, and where hospitals didn't sufficiently explain the costs involved.

Even in the case of foreigners with health insurance cards, debate has arisen in Japan that measures are needed to prevent impersonation, as the cards do not carry photos. At the end of last year, a working group of the ruling Liberal Democratic Party suggested that medical providers ask for documentation besides health cards alone to confirm the identity of patients if necessary.

However, sufficient consideration is needed from both the central government and medical institutions to ensure that foreigners are not subjected to discriminatory treatment or are refused medical examinations.

(Japanese original by Go Kumagai, Lifestyle and Medical News Department)