There is a Japanese proverb that says, “Bigger covers smaller.”
It means that larger things usually have enough capacity to handle smaller needs, so if you have a choice, you should choose the bigger option.
However, this way of thinking does not always apply.
Choosing a hospital in Japan is one such case.
When travelers get sick in Japan, many of them think the same thing:
“A big hospital looks well-equipped and reliable, so that should be the safest choice.”
This assumption is understandable.
Many English-language travel websites even recommend going to a “big hospital.”
But in Japan, this choice is often not the best one.
At university hospitals and large general hospitals, patients who visit without a referral are typically charged an additional fee, separate from normal consultation and treatment costs.
This system is commonly known as an extra first-visit charge.
If you are unaware of this rule, you may find yourself thinking:
“Why am I being charged this much?”
without a clear explanation.
In this article, I’ll explain a common misunderstanding about Japan’s medical system—and show travelers the most practical way to seek medical care without unnecessary surprises.
1. What Happens If You Go Straight to a Big Hospital
You’re not feeling well.
With what little energy you have left, you pull out your phone and search for nearby hospitals.
There’s a small clinic close by.
But in a foreign country, where you don’t speak the language, that feels risky.
So you choose a university hospital a bit farther away—one that looks well-equipped and reliable.
You call a taxi, struggle through the unfamiliar process, and finally make it there.
At the reception desk, you show your passport, fill out a medical form, and wait.
So far, nothing feels strange.
The lobby is large.
The staff look experienced and efficient.
You might even think, “I made the right choice.”
After the consultation, you head to the payment counter.
That’s when you notice something feels off.
The total is higher than you expected.
Ten thousand yen—for what felt like a simple cold?
You look at the breakdown.
Alongside the consultation fees, there’s an unfamiliar charge.
It’s labeled something like “first-visit surcharge” or “special medical service fee.”
The amount is usually around ¥7,000.
An unexpected expense, especially for a minor health issue.
In many cases, this fee isn’t clearly explained in advance.
It may be mentioned only in small print at the reception desk, or with a brief question like,
“Do you have a referral letter?”
You start to wonder if this extra charge is because you’re a foreigner.
But you’re not feeling well, and the language barrier makes it hard to ask questions.
So you let it go.
In the end, what you’re left with is the payment—and a lingering question about why it happened.
In Japan, going straight to a big hospital can itself create unnecessary costs.
2. How Japan’s Medical System Actually Works
(Why Going Straight to a Big Hospital Can Cost You More)
Japan’s healthcare system is not designed around the idea of “go to a big hospital for everything.”
Instead, it follows a gatekeeper-style structure:
- First, you visit a local clinic or small hospital for initial care.
- If specialized treatment is needed, you are then referred to a larger hospital with a referral letter.
This flow is not just a recommendation—it is actively supported by policy.
2-1. The Extra Fee for Walk-Ins
At certain large hospitals, patients who visit without a referral letter are charged an additional fixed fee, separate from normal consultation costs.
This fee is commonly referred to as an extra first-visit charge or special medical service fee.
It applies regardless of nationality—Japanese patients are charged the same way.
Since October 2022, the minimum amounts set by policy are:
Minimum Extra Fees at Large Hospitals (Without a Referral)
| Visit Type | Medical | Dental |
|---|---|---|
| First visit | ¥7,000 or more | ¥5,000 or more |
| Return visit (without referral) | ¥3,000 or more | ¥1,900 or more |
Notes:
This extra charge is separate from consultation and treatment costs.
These amounts are minimums set by policy.
Actual fees may be higher depending on the hospital.
2-2. Which Hospitals Does This Apply To?
This extra charge does not apply to every hospital in Japan.
It mainly applies to large institutions that are expected to focus on advanced or specialized care, such as:
- University hospitals and other “advanced treatment hospitals”
- Large regional hospitals designated to accept patients primarily by referral
- Hospitals classified as referral-focused medical institutions
In short, this fee exists at hospitals that are not meant to be a first stop for routine medical issues.
2-3. Why This System Exists
From a policy perspective, the goal is straightforward:
- Prevent large hospitals from being overwhelmed by minor cases
- Reduce long waiting times
- Allow hospital doctors to focus on complex and specialized treatment
By encouraging patients to start at clinics, the system keeps care faster, more efficient, and more evenly distributed.
For travelers, the key takeaway is this:
- The extra fee is not a penalty for foreigners
- It’s a structural tool to control patient flow
- If you don’t know the system, it can feel like a sudden and unexplained charge
2-4. Are There Exceptions?
Yes. In certain situations—such as emergency cases or under specific public medical coverage programs—the extra fee may not apply.
However, these are exceptions, and they are not something travelers should assume they can rely on.
For practical purposes, it’s safest to remember this simple rule:
If you visit a large hospital in Japan as a walk-in without a referral, an extra charge may apply.
3. What Travelers Should Do Instead
At this point, you may be wondering what you should actually do if you get sick in Japan.
The answer is simple.
Start with a clinic.
This is the standard and safest approach in Japan.
If you’re looking for practical, step-by-step guidance on how to actually find a clinic,
buy medicine, or talk to staff when you have a cold in Japan,
this article covers that side in detail:
Got a Cold in Japan? How to Find Medicine — or a Doctor
3-1. Look for a Local Clinic First
For common issues like a cold, stomach trouble, or a mild fever,
a nearby clinic is usually more than sufficient.
Even if the building looks small, you don’t need to worry.
- The doctors are fully licensed medical professionals in Japan
- Medication is properly prescribed
(you receive a prescription and get the medicine at a nearby pharmacy)
A small clinic does not mean lower-quality care in Japan.
3-2. About Medical Costs
The key difference for travelers is not the treatment itself.
- At clinics, no extra fee is charged just for showing up without a referral
- At large hospitals, an additional first-visit charge may apply under certain conditions
So it’s not that clinics are “cheaper” in general—
it’s that they don’t trigger unnecessary extra charges.
3-3. If a Clinic Can’t Handle Your Case
If your condition is more serious, or beyond what a clinic can handle,
the doctor will issue a referral letter to a larger hospital.
With this referral letter,
the extra fee explained in Chapter 2 does not apply.
In other words:
- Clinic → referral → large hospital
This route allows you to reach the care you need without paying unnecessary extra costs.
3-4. What About Nights, Weekends, or Holidays?
Sometimes clinics are closed, especially at night or on holidays.
In those cases, your options include:
- Night or holiday clinics
- Emergency departments, if your condition is serious
However, going directly to a large hospital simply because it’s late or you’re anxious
can still result in a regular walk-in visit—and an extra charge.
If you’re unsure what to do, it’s often best to:
- Ask hotel staff for guidance
- Use a local medical advice hotline (such as #7119, depending on the area)
3-5. What to Remember
What’s important to remember is this Japan-specific approach to choosing hospitals:
Large hospitals are not places you go “just in case.”
They are places you go when you are referred and actually need them.
Knowing this alone can save you unnecessary costs—and a lot of confusion—when seeking medical care in Japan.
4. Final Thoughts
When you get sick in Japan, going straight to a large hospital just because it looks well-equipped is not always the best choice.
Japan’s medical system is built around a simple flow:
Clinic → referral if needed → large hospital
Knowing this alone can help you avoid unnecessary costs and confusion—and seek medical care with much more confidence.
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