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Changes in “Payment” to medical clinics starting in April


The medical fee paid to hospitals and clinics is determined uniformly throughout the country in the case of insured medical treatment.
For example, it is determined that 282 points (2820 yen) are “initial medical examination” that occurs the first time you go to a hospital or clinic for a certain illness. This is the same nationwide for any hospital or clinic in Japan. Other than that, regarding how much it costs to perform certain tests and so forth, the insurance medical menu and price are determined one by one.
Medical fee is revised once every two years

This “medical menu and price” is revised once every two years, and this year is the year of medical treatment fee revision.
Although the terminology “medical treatment fee revision” may not be familiar to the general public, it takes place once every two years, and this year is especially attracting attention because it also overlaps a “revision of nursing care fee” which takes place once every three years.

Revised medical fees will be applied starting in April.
Therefore, even if you receive the same treatment from the hospital or clinic that you go to, the amount you pay may have changed from the past.
If you wondered “why?”, please ask at the reception desk.

Without a referral letter to large hospital, visit will be 5000 yen higher

By the way, “282 points (2820 yen)” of the first visit fee charged at the initial visit will not change after April.
However, the subject of the rule was expanded. “If you visit as an outpatient at a large hospital ‘without referral letters’, they will ask for a surcharge of 5000 yen or more in addition to the first visit medical examination expenses”.


Until now, it was

●”Specific Function Hospital” (Main Hospital of University Hospital etc.)
● “Regional care medical hospital” of 500 beds or more
(A facility that has been approved as a hospital that conducts medical care to referral patients to protect regional medical care)

The “large hospital” was subject to the above rule.
Starting in April, this objective has been expanded to “over 400 beds” rather than over 500 beds.

Additional cost for follow-up examination at a large hospital

By the way, in the past, when a patient who does not have a referral letter visited a large hospital (a hospital with 200 or more general hospital beds), it was ruled that “a large hospital can request the patient to pay the amount determined by each hospital.” Therefore, some hospitals requested the fee separately, and some hospitals did not.
However, starting in 2016, when patients without referral letters came to the hospital’s outpatient clinic, it was required to seek a surcharge of 5000 yen or more in addition to the initial medical examination fee.
(Of course, please be assured that emergency treatment is different)

Furthermore, if you were referred to other hospitals and clinics but nevertheless went to the same large hospital for follow-up, you must pay a special fee of 2500 yen or more.

Hospitals, clinics have strong / weak points

If you go to a large hospital without a referral letter, it costs 5000 yen or more in addition to the consultation fee.
The country is recommending to not go to a large hospital, but rather a clinic or a small- to medium-sized hospital nearby except in an emergency.
As a patient, you may think that “it’s the patient’s freedom of choice as to where to visit”.
Certainly it is the patient’s prerogative, but there are pro and con factors depending on the hospital.
The large hospital is good at high-expertise treatment.
On the other hand, it is the role of family clinics and small- and medium-sized hospitals to determine whether or not highly specialized treatment is needed by looking at the patient as a whole, which clinics and small and medium hospitals are good at.
Even if it’s the same medical speciality, I hope you will choose and be aware that each clinic and hospital have their own role and area at which they excel.

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