Japan Tightens Rules: Crackdown on Unpaid Medical Bills and National Health Insurance Non-Payment by Foreign Nationals
The Japanese government has finalized a policy to significantly strengthen measures against two growing issues: unpaid medical bills incurred by foreign visitors and non-payment of National Health Insurance (NHI) premiums by foreign residents. This comprehensive approach will be included in the upcoming “Basic Policy on Economic and Fiscal Management” (honebuto hōshin) and will have a major impact on residence and entry screening.
Strict Enforcement on NHI Premium Non-Payment (Starting June 2027)
Foreign nationals residing in Japan for over three months are legally obligated to enroll in the National Health Insurance (NHI) program. To address low compliance rates, the government is preparing a powerful new mechanism:
Impact on Visa Status
Minister of Health, Labour and Welfare Kenichiro Ueno announced that preparations are underway to begin denying changes or renewals of residence status (visa) for foreign residents who are delinquent on NHI premiums, starting around June 2027.
Information Sharing
The new policy will explicitly state the effective utilization of “cooperation between non-payment information and medical fee non-payment information for residence screening.” This means that failing to pay NHI premiums will now directly jeopardize a foreigner’s ability to remain in Japan.
Expanded Measures Against Unpaid Medical Bills
Measures against unpaid medical costs are being expanded to cover both short-term visitors and mid- to long-term residents.
For Foreign Visitors (Short-term Stays)
Tighter Entry Screening
The Ministry of Health, Labour and Welfare (MHLW) will share information on visitors who have a history of unpaid medical bills above a certain threshold (currently a cumulative balance of over ¥200,000) with the Immigration Services Agency (ISA). This will enable the ISA to implement more stringent entry screening.
Lowering the Threshold
The ruling Liberal Democratic Party (LDP) has advocated for considering a reduction in this monetary threshold, meaning even smaller unpaid amounts could trigger a stricter entry review.
Mandatory Private Insurance
The government is also moving forward with discussions on making it mandatory for foreign visitors to purchase private medical insurance prior to entering Japan.
For Mid- to Long-term Residents
The existing measure of sharing unpaid medical bill information with the ISA, which has been primarily focused on short-term visitors, will be expanded to include mid- to long-term residents, with the data used to inform their residence status assessments.
Promoting an “Orderly Coexistence Society”
These strengthened measures are framed not as punitive actions, but as a commitment to ensuring the fairness and sustainability of Japan’s social security system.
As Minister Ueno stated, the goal is to “promote the proper use of the social security system from the perspective of realizing an orderly society of coexistence where Japanese nationals and foreign nationals mutually respect each other and can live with peace of mind.”
By requiring all residents to fulfill their public obligations, the government aims to strengthen the foundation of the healthcare system for everyone. Attention now turns to the concrete design and implementation of these new rules, which will significantly redefine the responsibilities of foreigners living in or visiting Japan.
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