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Medical institutions struggling to deal with foreigners unable to pay bills

A tablet computer with a translation application is seen at a medical institution in Edogawa Ward, Tokyo, on July 6, 2018. (Mainichi)

Medical institutions in Japan are finding it hard to deal with foreigners unable to pay large medical bills because the government has not established an appropriate system for providing medical treatment to foreign visitors who have recently surged in number.

The government is taking measures such as encouraging visitors to take out travel insurance policies and helping medical institutions to respond to foreign patients in various languages.

Iwai Orthopaedic Medical Hospital in Edogawa Ward, which has the largest population of Chinese residents of all 23 wards in central Tokyo, is a mid-sized facility that proactively accepts foreign patients. Hisashi Koga, a deputy director at the hospital, recently examined a Chinese man who was to undergo surgery. "Don't worry," Koga told the patient in Chinese. The man then smiled, looking relieved.

Tablet computers equipped with an interpretation application have been deployed to consultation rooms and exam rooms at the facility. The hospital also has a contract with an agency that offers interpretation via telephone and has even hired a Chinese nurse's aide.

According to hospital officials, many of its foreign patients are permanent residents, but there are also those who visit Japan for the purpose of undergoing surgery.

"Because of the population decline, it's difficult for hospitals to survive unless they accept foreign patients," Koga revealed to the Mainichi Shimbun.

In particular, the number of inbound tourists has been rapidly increasing in recent years. 2017 saw a 19 percent increase in their number from a year earlier to a total of 28.69 million visitors.

According to a survey conducted in 2016 by the Ministry of Health, Labor and Welfare, 35 percent of emergency hospitals across the country had medical fees unpaid for by foreign patients. This is largely because there are far too many hospitals that do not accept credit cards even though inbound tourists tend not to carry much cash.

The National Center for Global Health and Medicine in Tokyo's Shinjuku Ward makes sure to confirm the credit card details and contact information of foreign patients who have not taken out public medical insurance policies.

"We've reduced the amount of unpaid medical fees by foreign patients to below those who are covered by public medical insurance policies," said Norio Omagari, head of the facility's International Health Care Center.

In Okinawa Prefecture, where the number of inbound tourists from East Asia and other regions is rapidly rising, a twentysomething Taiwanese woman on her honeymoon in March of last year suddenly went into labor and was admitted to a local hospital where she gave birth to a boy seven months into her pregnancy. She had taken out a travel insurance policy but it did not cover the 8 million yen in medical expenses she incurred, and the bill was not an amount she and her husband could pay out of pocket.

Fortunately, people of Taiwanese descent living in Okinawa Prefecture who had been contacted to provide interpretation assistance called on the public to offer donations to the young couple, and raised 20 million yen.

However, relying on such goodwill has its limits. According to a survey conducted by the Japan Tourism Agency, roughly 30 percent of foreign visitors do not take out travel insurance policies.

"Japan calls itself a tourism-oriented country, but has not established a proper system for visitors," said Koichi Hagiuda, executive acting secretary-general of the ruling Liberal Democratic Party.

Following his recommendations, the government has begun efforts to encourage medical institutions to accept cashless payments and urge visitors to take out travel insurance policies.

(Japanese original by Go Kumagai, Medical Welfare News Department)

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