Ibaraki Introduces New Ambulance Fee System for Non-Urgent Cases

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Some Japanese municipalities are now charging patients for ambulance services when there is no urgent medical need. With the growing number of ambulance dispatches nationwide, the goal is to reduce pressure on the system. Early results show a noticeable decrease in the number of patients with mild conditions calling for an ambulance.

However, experts warn that this could discourage people with genuine medical emergencies from calling for help. They stress the importance of clear communication and improved consultation systems to help people make informed decisions.

Ibaraki Prefecture Leads the Way

On December 2, Ibaraki Prefecture became the first in Japan to implement this system at the prefectural level. Under the new policy, patients transported to large hospitals (with more than 200 beds) without a referral will be charged if no urgent medical need is identified. Fees vary by hospital, with a maximum charge of ¥13,200 JPY (about $80 USD).

Patients will incur a fee for non-urgent conditions such as minor cuts, mild fever (below 37.4°C, about 99.3°F), or chronic pain (e.g., back pain or toothache).

However, if a patient is found to have a potentially urgent condition, such as difficulty breathing, loss of consciousness, or sudden severe pain, no charge will apply. This is even if the condition is later diagnosed as mild after further examination at the hospital.

According to Ibaraki's medical policy division, more than 60% of emergency transports in the prefecture are to large hospitals. However, about half of these cases involve mild conditions or low urgency. The division explains that the aim is to reduce strain on emergency services and ensure that resources remain available for critical patients.

Rising Strain on Emergency Medical Services

The number of ambulance dispatches nationwide has been steadily rising. Preliminary data from Japan's fire department show that in 2023, the total number of ambulance dispatches increased by 5.6% from 2022, reaching 7,637,967. The number of patients transported rose by 6.8%, reaching a new record of 6,639,959.

Additionally, ambulance response times have increased, with the national average rising by 0.9 minutes to approximately 10.3 minutes in 2022 compared to 2021.

Positive Impact Seen in Matsusaka City

Matsusaka City in Mie Prefecture was one of the first to implement a similar system, starting in June 2024. The city charges ¥7,700 (about $50) for non-urgent patients transported to one of the city's three main hospitals who do not require hospitalization.

In the three months after the system was introduced, ambulance dispatches fell by 20% compared to the same period in 2023, totaling 3,604 dispatches. The percentage of mildly injured patients decreased by 6.5 percentage points, to 52.9%.

Of those who called an ambulance, 7.4% (278 patients) had non-urgent conditions, such as bruises, dizziness, or gastroenteritis, and were charged.

A city representative noted that, while the overall impact is still being assessed, the system has encouraged more appropriate use of hospital services, contributing to the sustainability of emergency medical systems.

Concerns and Challenges

More municipalities may consider adopting similar systems. However, there are concerns that charging ambulance fees could deter people who genuinely need emergency care.

To address this, municipalities that have implemented the system are encouraging residents to consult phone help centers to assess whether an ambulance is necessary.

Reiji Goto, secretary-general of the Japan Conveyance Society, warned that the public may misunderstand the system and believe they will be charged in all cases.

He emphasized, "Some patients may hesitate to consult by phone. There is a need for an improved consultation system, such as through smartphone apps."

The Tokyo Fire Department offers an online consultation tool in Japanese and English. By answering a series of questions, you can receive guidance on whether an ambulance is necessary.

Author: Norihiro Akiyama, The Sankei Shimbun

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