Unpaid Medical Fees and Low-Value Imports Face New Restrictions

The Japanese government is moving to tighten two areas of policy involving foreign visitors and overseas businesses: unpaid medical fees by foreign nationals and the tax treatment of low-value imported goods sold through major Chinese e-commerce platforms. Both steps aim to address growing imbalances and close loopholes affecting Japan's healthcare system and domestic retailers.

Lowering the Reporting Threshold for Unpaid Medical Bills

On November 26, it emerged that the Japanese government will significantly tighten measures against unpaid medical fees by foreign visitors. At present, hospitals only report cases in which a foreign national leaves behind unpaid bills of ¥200,000 JPY (about $1,300 USD) or more. That information is then shared between the Ministry of Health, Labour and Welfare (MHLW) and the Immigration Services Agency (ISA).

The government now plans to lower the reporting threshold to ¥10,000 ($65), dramatically expanding the number of cases that must be logged.

According to the MHLW, when a foreign patient fails to pay, medical institutions record the case in the ministry's system, and the information is subsequently provided to the ISA for use during immigration screening. The ministry will upgrade its system so that cases of ¥10,000 or more can be tracked from fiscal 2026. On November 4, Prime Minister Sanae Takaichi instructed relevant ministers to examine ways to strengthen these rules.

The government is also considering extending the reporting requirement beyond short-term visitors to include medium- and long-term foreign residents, reflecting concerns that unpaid medical bills are not limited to tourists.

Extending Consumption Tax Obligations to Overseas E-Commerce Sellers

On the same day, the government also moved forward with plans to require overseas e-commerce sellers, including large Chinese platforms, to pay consumption tax on low-value imported goods. Under the current system, imports priced at ¥10,000 or less are exempt from consumption tax. This allows foreign sellers to offer products at artificially low prices, while domestic retailers must charge the tax.

The proposed reform would shift the tax obligation to platform operators or intermediaries that handle the transactions, requiring them to file and remit consumption tax to Japan's tax authorities. One option under review would apply the new rule to businesses with more than ¥5 billion (about $32 million) in domestic sales, ensuring that major players are covered. The government aims to include the measure in the 2026 tax code revision, which will be finalized at the end of 2025.

According to the Ministry of Finance, imports defined as "low-value cargo," shipments worth ¥10,000 or less, reached about 170 million items in 2024, accounting for nearly 90% of all import clearances. Platforms such as SHEIN and Temu have rapidly expanded sales in Japan by taking advantage of the exemption.

The flood of small-package imports has also placed heavy pressure on customs operations, prompting concerns that enforcement against counterfeit goods and illicit drugs is being strained. Similar reforms are underway in the United States and the European Union, reflecting a global shift to eliminate tax loopholes benefiting overseas sellers.