Japan to Revamp Entry Rules for Tourists: What’s Changing

Japan has outlined plans which will require all incoming tourists to have private health insurance. The move aims to curb a growing problem: foreign visitors receiving medical treatment and leaving the country without paying.

The proposed rules, expected to be included in the government’s next economic policy package, are part of a broader overhaul of how Japan manages foreign tourists.

The health ministry says the goal is to ensure that all visitors can cover unexpected medical expenses, similar to existing rules in places like the Schengen area, the UAE, Turkey, Morocco and Jordan.

What Does This Entail?

Officials have said the new immigration and residency rules could eventually tie visa renewals to proof of insurance and tax compliance. Defaulters may also be barred from re-entry.

Under the proposed system:

• Tourists without proof of insurance may be denied entry.
• Immigration officers could access a list of past medical debt defaulters.
• Visitors with unpaid medical bills may be barred from re-entering the country.
• Hospitals could report outstanding charges to immigration authorities.

The policy shift follows growing concern among hospital administrators and policymakers about the financial strain on Japan’s healthcare system. Medical institutions are increasingly unable to recover costs when uninsured tourists leave without paying.

However, it’s not yet clear when the plan will roll out or what it will look like in practice.

The Strain on Healthcare

Japan saw a record 36.8 million visitors in 2024, the government hopes to receive 60 million tourists  annually by 2030. But the influx has brought new challenges, especially for urban hospitals seeing higher volumes of emergency care requests from non-residents.

In September 2024 alone, more than 11,000 foreign visitors received medical treatment at around 5,500 hospitals nationwide. According to the health ministry, about 0.8% of those patients, roughly 90 people, left without paying their bills, resulting in more than JPY61 million ($425,000) in unpaid charges.

A separate survey by the Japan Tourism Agency, conducted between October 2023 and February 2024, found that nearly 30% of foreign visitors to Japan did not have insurance.

The trend is not new. In fiscal 2022, nearly 30% of surveyed medical institutions reported cases of unpaid bills from foreign patients, including both short-term tourists and long-term residents. That year, unpaid charges from non-Japanese patients totaled about $5.63 million — 1.4% of all unpaid medical fees in Japan.

Hospitals currently have limited options for recovering payments once a visitor leaves the country. Collecting from overseas patients is often impossible without upfront insurance coverage.

Foreign Residents Also Under Scrutiny

The focus isn’t only on tourists. Foreign residents are also facing more pressure to contribute to Japan’s National Health Insurance (NHI) system.

A government survey of 150 municipalities, conducted between April and December 2024, found that only 63% of eligible non-Japanese residents were enrolled in NHI, this is far below the 93% participation rate among Japanese citizens.

Some Other Changes for Tourists

In a related move, Japan is will also be revising its tax-free shopping program. Starting Nov. 1, 2026, visitors will pay the standard 10% consumption tax at the time of purchase and apply for a refund before departure. This will replace the current point-of-sale exemption system.

Additionally, from April 1 this year, purchases sent abroad via international parcel delivery will no longer qualify for tax exemption. Tourists will be required to present the tax-free items at customs during customs examination if requested.

Earlier this year, Japan also announced that the country’s electronic travel authorization system will be implemented earlier than the initial target of 2030.  The Japanese Electronic System for Travel Authorization would be applicable for travelers from 71 visa-exempt countries, including the U.S., U.K., Australia, Canada, Singapore, and France.

Latest Tourism Figures

Japan’s tourism numbers continue to rise. In April 2025, the number of foreign visitors reached a record 3.91 million, up 28.5% from a year earlier, according to the Japan National Tourism Organization.

The cherry blossom season and the timing of Easter holidays contributed to the surge, with increased demand from Asia, Europe, the United States and Australia, JNTO said. The previous single-month record was 3.78 million in January 2025.

In the first four months of 2025, Japan welcomed 14.4 million visitors — a 24.5% increase year over year.

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