Tokyo Grapples with Rising Unpaid Medical Bills from Foreigners

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Amid nationwide concerns over unpaid medical bills by foreign nationals in Japan, multiple sources reported that Tokyo Metropolitan Hospitals alone recorded unpaid bills totaling ¥171.55 million JPY ($1.13 million USD) in fiscal year 2024.

This number is up from ¥153.77 million ($1 million) from the previous fiscal year.

Private hospitals outside the metropolitan system are facing similar challenges, placing additional strain on their operations. In fiscal year 2024, Tokyo used public funds to cover part of the unpaid bills, providing ¥13.187 million ($87,000) to 36 hospitals and clinics across the city.

Based on the total number of unpaid bills, it's estimated that around 1,000 cases involved foreign nationals in 2024 alone. In principle, those without medical insurance are required to cover the full cost of their treatment out of pocket.

Sources say that foreigners in Tokyo who entered the country without proper documentation, overstayed their visas, or otherwise became illegal residents are not eligible for public assistance under the Public Assistance Act, yet hospitals and clinics that receive them as emergency patients cannot refuse treatment.

Public Funds Aid Hospitals

As unpaid bills continue to accumulate, these patients pose an increasing risk to the financial stability of hospitals that treat them.

To address this, Tokyo operates a program that partially reimburses medical institutions for unpaid fees incurred by foreign nationals.

According to the Tokyo Welfare and Health Foundation, which administers the program on behalf of the city's health policy division, hospitals and clinics can apply for reimbursement when a patient has received treatment at the same institution. The unpaid fees are then covered with public funds, up to a maximum of ¥2 million ($13,000) per year.

Tokyo's health policy division emphasized that "the payment is made strictly to the medical institution that provided the treatment, not to the foreign patient."

The program reportedly began in October 1994. In fiscal year 2022, about ¥9.25 million ($70,000) was paid to 38 facilities across Tokyo, and in fiscal year 2023, roughly ¥8.14 million ($59,000) was distributed to 33 facilities.

A National Issue

Similar public fund expenditures have been in place in neighboring Saitama Prefecture since 1994. Just as in Tokyo, the costs are shared equally between the prefecture and its municipalities.

Saitama's medical services division says this support applies only when hospitals have made collection efforts for over a year but remain unable to recover the unpaid bills. In fiscal year 2024, the prefecture provided ¥4.1 million ($27,100) in public funds to eight medical institutions for 11 cases.

"To prevent hospital operations from being strained and disruptions to regional healthcare, we reluctantly cover part of the costs with public funds," the division said.

"Since 2017, the prefecture has repeatedly requested the national government to implement measures to address these unpaid bills. It appears the national government is gradually recognizing this as an issue."

These unpaid bills are not limited to foreigners, however. When Japanese nationals are included, the total rises even higher.

In Tokyo alone, it reached ¥706.33 million ($5.04 million) at the end of fiscal year 2023 and ¥684.17 million ($4.52 million) at the end of fiscal year 2024.