Sick in Japan? What No One Tells Foreigners About Medical Care

Japan's medical system is world-class but built for Japanese speakers. Clinic vs hospital, the ¥7,000 referral fee, intake forms, pharmacy flow, and how to find a doctor who actually speaks English.

Bottom line: Japan has one of the best healthcare systems in the world — but it's built for Japanese speakers who already know the rules. Foreigners walk into the wrong facility, skip the referral letter, can't read the intake form, and end up paying more or waiting longer than they should. This guide walks you through how the system actually works, from choosing between a clinic and a hospital to understanding your bill — written by someone who spent years helping foreign patients navigate it from the inside.

Information current as of March 2026 based on MHLW, municipal government, and hospital administration sources. I'm the founder of LO-PAL, and before that I worked as a Medical Coordinator for Foreign Patients at a hospital in Osaka. I sat with patients at reception, translated between doctors and confused families, and watched people make the same avoidable mistakes over and over. This guide is everything I wish I could have handed them on day one.

The biggest mistake: going to a hospital when you need a clinic

In most countries, "go to the hospital" is the default advice when you're sick. In Japan, that's wrong — and it can cost you.

Japan deliberately separates medical care into two tiers:

	Clinic (クリニック / 診療所)	Hospital (病院)
Size	Under 20 beds (most have 0)	20+ beds
Role	First-line care: colds, fevers, minor injuries, prescriptions, routine checkups	Specialist care: surgery, complex diagnosis, inpatient treatment
Referral needed?	No — walk in	Large hospitals (200+ beds) charge an extra fee without a referral letter
Extra fee without referral	None	¥7,000+ (選定療養費) at hospitals with 200+ beds
Wait time	Usually 15–60 min	Often 2–4 hours without an appointment
English availability	Rare outside major cities	Some have international departments

I once saw a foreign resident come to the neurosurgery department of our hospital in Osaka — for a common cold. He waited three hours, paid the extra referral fee, and was told to go to a local clinic. A 5-minute visit to a neighborhood clinic would have cost ¥2,000–3,000 with insurance and taken 30 minutes total.

For a detailed breakdown of when to choose which, and a decision flowchart, see our clinic vs. hospital guide.

How to find a doctor who actually speaks English

This is where I need to be honest, because the official picture is misleading.

Japan's government maintains lists of "multilingual medical institutions." Prefectures and cities register hospitals and clinics that claim to offer foreign-language support. The problem: many of these registrations are aspirational, not operational.

At the hospital where I worked in Osaka, we were registered as "English-capable." In reality, when I wasn't there, the staff couldn't handle an English-speaking patient. This is not unusual — it's the norm. Unless a hospital has a dedicated international department (国際診療部) with full-time multilingual staff, "multilingual support" usually means "we have one person who studied English in college and they might be available."

How to actually verify before you go

Call ahead and ask in English. If they can't handle the phone call, they can't handle your appointment. This is the single best test.
Look for hospitals with a dedicated international department (国際診療部 / 国際医療部). These have full-time staff whose job is to handle foreign patients. Examples include Rinku General Medical Center in Osaka and St. Luke's International Hospital in Tokyo.
Use AMDA International Medical Information Center (03-6233-9266, Mon–Fri 10:00–16:00) — a free multilingual hotline that can help you find an appropriate facility. Languages: English, Chinese, Korean, Portuguese, Spanish, Thai, Vietnamese, Filipino.
In Tokyo: Use HIMAWARI (03-5285-8181) — Tokyo Metropolitan Health and Medical Information Center, available in English daily.

If calling in Japanese is the barrier — and for most people it is — that's exactly what LO-PAL is for. Post your question and a local Japanese helper can call the clinic, confirm they can actually see you in English, and even book the appointment.

For Osaka specifically, where there's no equivalent of HIMAWARI, see our guide to finding English-speaking doctors in Osaka.

What happens when you walk into a Japanese clinic

Knowing the flow removes 80% of the anxiety. Here's what to expect:

Step 1: Reception (受付 / uketsuke)

Hand over your insurance card (or Myna Hokensho / Shikaku Kakuninsho — see our Myna Hokensho guide). If it's your first visit, you'll be given an intake questionnaire.

Step 2: The intake questionnaire (問診票 / monshin-hyō)

This is the part that terrifies people. It's a paper form — usually only in Japanese — asking about your symptoms, medical history, allergies, and current medications. Some larger hospitals offer English versions, but most clinics don't.

We've created a Medical Japanese cheat sheet with a full translation of every common questionnaire item, so you can fill it out correctly even without Japanese ability.

Step 3: Wait

Japanese clinics operate mostly on a first-come, first-served basis. Some accept reservations. Expect 15–60 minutes at a clinic, longer at hospitals.

Step 4: Examination (診察 / shinsatsu)

The doctor will review your questionnaire and ask follow-up questions. Japanese medical consultations tend to be shorter than in Western countries — 5–10 minutes is normal. This doesn't mean you're being rushed; it's the standard pace. If you need more time, ask.

Step 5: Payment (会計 / kaikei)

After the exam, return to the reception area and wait for your name to be called at the payment counter. With insurance, a typical clinic visit costs ¥2,000–5,000 (your 30% copay). You'll receive a receipt (領収書 / ryōshūsho) and a prescription (処方箋 / shohōsen) if medication was prescribed.

Step 6: Pharmacy (薬局 / yakkyoku)

In Japan, the pharmacy is almost always a separate building from the clinic — usually right next door or across the street. Hand over your prescription, wait 10–20 minutes, pay for your medication (also 30% copay), and you're done.

See our prescription guide for details on refills, bringing medication from abroad, and what to do when your home country's medication isn't available in Japan.

Emergency care: when to call 119

For genuine emergencies — chest pain, difficulty breathing, severe injury, loss of consciousness, stroke symptoms — call 119 (fire and ambulance). The ambulance is free in Japan.

What happens after you call:

The dispatcher will ask your location, symptoms, and name. They may have limited English — speak slowly and clearly.
An ambulance arrives (average response time: ~8 minutes nationally).
Paramedics assess you on-site and contact hospitals to find one that can accept you. This can take 10–30 minutes — the ambulance may sit outside while they call around. This is normal in Japan, not a sign of neglect.
You're transported to the accepting hospital's emergency department.

Important: Japanese emergency rooms are for genuine emergencies. Using the ER for a fever, cold, or minor injury will result in a long wait and potentially the extra non-referral fee. For after-hours non-emergencies, see our urgent care guide.

For a complete guide to emergency numbers including police (110) and the English-language emergency hotline, see our emergency numbers guide.

How much does it actually cost?

With insurance (30% copay), typical costs:

Visit type	Your cost (30% copay)	Notes
Clinic visit (cold, fever)	¥2,000–3,000	Consultation + basic tests
Clinic visit + medication	¥3,000–5,000	Including pharmacy
Hospital outpatient (with referral)	¥3,000–10,000	Depends on tests/specialist
Hospital outpatient (no referral)	+ ¥7,000 extra	選定療養費 at 200+ bed hospitals
Emergency room visit	¥5,000–20,000	Higher at night/weekends; plus extra fee if non-emergency
Hospital stay (per day)	¥5,000–15,000	Standard shared room; private room adds ¥5,000–30,000+
Ambulance	Free	Always free in Japan

Without insurance: You pay 100% — multiply the above by roughly 3.3x. A clinic visit becomes ¥7,000–10,000. An ER visit can be ¥20,000–60,000+. This is why enrolling in health insurance is critical.

If you face a large hospital bill, Japan's 高額療養費制度 (kōgaku ryōyōhi seido) caps your monthly out-of-pocket at roughly ¥80,000–90,000 depending on income. See our guide to capping hospital bills.

The referral letter system (紹介状 / shōkaijō)

If a clinic doctor decides you need specialist care at a hospital, they'll write a referral letter (紹介状). This letter:

Waives the ¥7,000+ extra fee at large hospitals
Gets you a faster appointment (often days instead of weeks)
Includes your medical history and test results so the hospital isn't starting from scratch

The referral letter itself costs about ¥750 (30% of ¥2,500). Compared to the ¥7,000+ you'd pay without it, it's always worth getting.

Can you go straight to a hospital without a referral? Yes — nobody will turn you away. But at hospitals with 200+ beds, you'll pay the 選定療養費 on top of your normal copay. Small hospitals (under 200 beds) don't charge this fee.

What foreigners specifically need to know

Bring your residence card (在留カード) to every medical visit. Some facilities ask for it alongside your insurance card for identification.
Medications from your home country may not be available. Some common drugs abroad are restricted or banned in Japan (notably certain stimulant ADHD medications and some opioid painkillers). Bring a doctor's letter listing your current medications with generic names. See our prescription guide.
Mental health care works differently here. Psychiatry (精神科) is covered by insurance; standalone counseling with psychologists usually isn't. The system distinguishes between psychosomatic medicine (心療内科, shinryō naika) and psychiatry (精神科, seishin-ka). For details, see our mental health guide.
Dental care is covered but limited. Basic fillings and extractions are covered; implants, ceramics, and orthodontics are not. See our guide to what insurance doesn't cover.
After-hours and weekend care: Most clinics close by 6–7pm and are closed Sundays. For non-emergencies outside business hours, many cities have designated night clinics (夜間急病診療所). See our urgent care guide for how to find them.

Useful Japanese at the clinic

English	Japanese	Romaji
This is my first visit	初めてです	Hajimete desu
I have insurance	保険があります	Hoken ga arimasu
Where is the reception?	受付はどこですか？	Uketsuke wa doko desu ka?
I have a fever	熱があります	Netsu ga arimasu
It hurts here (point)	ここが痛いです	Koko ga itai desu
I'm allergic to [medicine]	[薬]にアレルギーがあります	[kusuri] ni arerugī ga arimasu
I take this medication daily	毎日この薬を飲んでいます	Mainichi kono kusuri o nonde imasu
Do you have an English intake form?	英語の問診票はありますか？	Eigo no monshin-hyō wa arimasu ka?
I need a referral letter	紹介状をお願いします	Shōkaijō o onegai shimasu
Where is the pharmacy?	薬局はどこですか？	Yakkyoku wa doko desu ka?
Can I pay by credit card?	クレジットカードで払えますか？	Kurejitto kādo de haraemasu ka?

For a comprehensive list of 50+ medical Japanese phrases — including how to fill out the intake questionnaire — see our Medical Japanese cheat sheet.

Need help navigating a medical visit in Japan? Post your question on LO-PAL for free — a local Japanese helper can call the clinic to confirm English availability, accompany you to the appointment, or help you understand your diagnosis and prescription.