Municipal and prefectural governments across Japan are launching campaigns urging foreign visitors to buy travel insurance as a surge in unpaid medical bills puts pressure on hospitals’ budgets.

If uninsured travelers get injured or sick in Japan, they have to foot the bill for all medical expenses. Nearly 30 percent of all tourists arrive without any travel insurance at all, according to a government survey.

Government agencies are using various ways to nudge travelers toward buying insurance, including by placing flyers at tourist information centers in airports and hotels, and distributing cards listing the most expensive hospital treatments.

“Have you remembered to book your peace of mind?” a flyer printed in English reads at a tourist information center at Narita airport. Japan’s main international gateway has seen an increase in tourists seeking advice on whether to buy insurance .

The flyer, also available in Chinese, Korean and Thai, was created by the Japan Tourism Agency and distributed to airports nationwide to inform tourists they can quickly and easily buy insurance via smartphones or other devices even after arrival.

The issue is impacting Japan’s health system.

According to a Health, Labor and Welfare Ministry survey, roughly a fifth of all hospitals that have treated travelers to Japan have gotten stuck with the bill. One particular hospital racked up over ¥10 million ($92,000) in unpaid fees.

A JTO survey in fiscal 2018 showed 27 percent of foreign travelers arrive uninsured, 48 percent buy policies from travel agencies or insurers, and 23 percent enroll in travel insurance via credit card. Five percent fell ill or were injured while in Japan.

Based on the survey, the top reason for not taking out travel insurance was the belief that it is unnecessary. Others said they did not consider it at all or were simply unaware of insurance .

The JTO has tried various campaigns to find effective ways to get visitors to buy travel insurance in Japan, but without much success.

Sompo Japan Nipponkoa Insurance Inc. developed an insurance policy in cooperation with the tourism agency and started selling it in 2016 as tourism was climbing.

The company succeeded in keeping the price of the policy relatively low by cutting coverage for loss or damage of personal items and focusing instead on delivering medical coverage.

Since the launch, the major insurer has seen an increase in people taking out policies each year, they said.

Okinawa, which is popular for its beaches and warm weather, has been distributing cards and sticking up plasters, among other items, that promote travel insurance.

The cards list examples of the potential fees uninsured travelers can incur for medical treatment in Japan, such as “¥700,000 for heatstroke” and “¥3 million for a broken bone.”

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