In its “Tourism Vision to Support the Future of Japan,” the Japanese government aims to achieve 60 million inbound visitors by 2030, with a target of accepting 500,000 foreign patients annually as part of becoming a leading tourism nation.
However, in fiscal year 2023, the number of medical stay visas issued (which allows a stay of up to six months, but requires hospitalization for stays longer than 90 days) was only 2,295. Even when including those who travel for medical purposes using tourist visas, the total is estimated to be only several tens of thousands. This figure is significantly lower than in other Asian countries where the medical tourism market is expanding, such as Thailand (3.5 million per year) and South Korea (600,000 per year). This article explains the reasons behind the sluggish growth in the number of patients coming to Japan for medical care and proposes possible solutions.
Reasons for the Slow Growth in Patient Numbers
A major factor behind the stagnation is believed to be a “mismatch between quality and cost.” For example, the cost of coronary artery bypass surgery in Japan is three times higher than in Thailand. Patients who do not perceive the high quality of Japanese medical care as added value are more likely to choose Thailand. Although the quality of care varies by country and disease, Japan maintains one of the world’s highest five-year survival rates for stomach cancer at 71.5%, demonstrating its technological superiority. However, because both the price and quality are high, Japan is less likely to be chosen by patients who prioritize price.
Other fundamental reasons for the sluggish acceptance of foreign patients, beyond cost, include language and cultural barriers due to Japan’s relatively homogeneous society, the lengthy process for obtaining a stay visa, and the lack of experience in dealing with foreign patients at medical institutions.
1. Language and Cultural Barriers in Medical Institutions
According to a 2019 survey by the Ministry of Health, Labour and Welfare, only about 30% of medical institutions with experience accepting foreign patients had established interpreter systems. The lack of translation and interpretation for medical documents puts Japan at a disadvantage compared to countries where multiple languages are official or where language support is well developed.
In addition to language, special consideration for cultural backgrounds is sometimes necessary, such as religious dietary restrictions or gender-specific care during examinations. For example, Muslims cannot eat pork and have daily prayer times. However, Japanese medical staff are often unfamiliar with such customs, and 43% of facilities reported that patients felt there was insufficient consideration for their needs.
2. Institutional Inefficiencies
Japan’s public health insurance system is based on universal coverage for citizens, and the pricing of private medical care varies by institution. The lack of transparency regarding these prices can lead to distrust among foreign patients. For example, a single dose of a certain anti-cancer drug may cost 180,000 yen for domestic patients but 500,000 yen for foreign patients. The absence of clear explanations for such price differences is a reason some foreign patients avoid Japanese hospitals. It is important for medical institutions to clearly explain the costs before treatment and the differences between cases covered by public insurance and those that are not, so that foreign patients can make informed decisions.
Additionally, it takes an average of 28 days to obtain a medical stay visa for Japan, which is much longer than in South Korea (3 days) or Singapore (7 days) (Japan Tourism Agency, 2023). Only 15% of facilities can directly process overseas insurance claims, meaning many patients must pay in cash, which increases dissatisfaction. To avoid problems with unpaid medical bills, institutions need systems such as requiring deposits before treatment, accepting travel insurance, or enabling credit card payments. If prepayment is difficult, institutions may need to refuse acceptance to avoid non-payment issues.
3. Initial Response Costs at Medical Institutions
Since most patients at Japanese medical institutions are Japanese, staff are often inexperienced in dealing with foreign patients, leading to increased costs. For example, at a general hospital in Tokyo, the average interview time for a foreign patient is 40 minutes (three times longer than for Japanese patients), and arranging interpreters and preparing documents requires an additional 1.5 hours of administrative work. For 300 foreign patients per year, this results in an additional labor cost of approximately 24 million yen. This extra cost can be a major concern, especially for small and medium-sized hospitals.
Because Japan is a relatively homogeneous society, many medical staff find it challenging when their usual approach does not work with foreign patients. In practice, preparing for foreign patients requires not only translation and interpretation but also staff training. Some institutions, especially those with a small number of foreign patients, outsource initial reception tasks to reduce the burden on their staff.
Rethinking the Purpose of Medical Inbound: From Quantity to Quality
Given these challenges, it is urgent to shift from a strategy focused on increasing patient numbers to one that emphasizes high value-added medical care. Japan has competitive advantages in the following three areas:
- Advanced Cancer Treatment:
Japan ranks second in the world for the number of proton therapy procedures (International Particle Therapy Association, 2023). - Regenerative Medicine:
Japan boasts world-first achievements, such as retinal transplants using iPS cells. - Preventive Medicine:
The early cancer detection rate in Japanese health checkups is twice that of Western countries (Japan Society of Comprehensive Medical Checkups, 2022).
In these fields, Japan can set premium prices based on its technological strengths. For example, the advanced medical program at the University of Tokyo Hospital generates an average revenue of 8.5 million yen per case (Annual Report, 2023), demonstrating the effectiveness of a quality-focused model.
Concrete Proposals for Solving Issues
1. Outsourcing Initial Reception Tasks
At Yokohama City University Hospital, outsourcing reception, interpretation, and insurance procedures to a specialized company reduced staff workload by 63% and increased the number of foreign patients accepted annually by 2.8 times (Case Study, 2023). To promote this model nationwide, the Ministry of Health, Labour and Welfare established a subsidy in 2024 to cover up to 50% of outsourcing costs for interpreter platform development.
2. Utilization of Digital Technology
St. Luke’s International Hospital introduced AI interpreter tablets that support English, Chinese, and Arabic, successfully reducing interview times by an average of 15 minutes (Hospital Report, 2024).
3. Building Regional Collaboration Models
In Beppu City, Oita Prefecture, a “treatment plus recuperation package” was developed in cooperation with hot spring facilities. By combining post-surgical rehabilitation with hot spring use, the average length of stay increased from 7 to 14 days, and the economic ripple effect reached 1.2 billion yen per year (Oita Prefecture Tourism Bureau, 2023).
Future Prospects
To ensure the sustainable growth of medical tourism in Japan, several measures are being considered. For example, the Ministry of Health, Labour and Welfare aims to increase the number of JCI-accredited hospitals from the current 26 to 100 by 2030. Additionally, setting international standards for crisis management, such as adopting compensation systems for medical accidents that are consistent with those in ASEAN countries, could make procedures easier to understand for foreign patients.
When foreign patients consider Japan as a destination for medical tourism, it is essential to emphasize the quality of care that matches or exceeds the high fees. It is also important to ensure that patients can spend their time at medical institutions without stress. In addition to Japan’s renowned hospitality, staff training in language skills and cultural and religious sensitivity is necessary.
Through these measures, Japan has the potential to establish itself as the “medical hub of Asia.” The key is to differentiate Japanese medical care by focusing on innovation and optimizing the patient experience, rather than simply increasing patient numbers.
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