Correspondence

Global Health & Medicine. 2024; 6(4):256-258.
DOI: 10.35772/ghm.2023.01126

The future of inbound medical care as gauged from the foreigners
undergoing complete medical examinations in Japan
Jun Lu1,*, Sachiko Kubo1, Makiko Hashimoto1, Yuko Hayashi1, Erika Masuda1, Hiroshi Kajio1, Masayuki Shimoda2
1
2

Medical Examination Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan;
Department of Pancreatic Islet Cell Transplantation, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo Japan.

Abstract: Complete medical examinations are a system of preventive medicine unique to Japan. In recent years,
Japanese and foreigners have been aware of complete medical examinations. However, the extent to which thisconcept of comprehensive medical checkup is recognized in different counties is unknown. The National Center
for Global Health and Medicine (NCGM) is a facility that has been performing complete medical examinations on
inbound visitors since May 2016, and more than 3,500 inbound visitors have been received to date. Based on thistrack record, the current study analyzed trends in foreigners' demand for medical checkups in Japan. From August2020 to July 2023, 471 foreign residents in Japan from 22 countries were received. A certain proportion of examinees(approximately 30%) underwent examinations multiple times at a frequency of once a year. In addition, inboundmedical visitors resumed starting in January 2023, and 158 inbound examinees were received. Of these, 15.2% ofexaminees had undergone a complete medical examination at the NCGM before the COVID-19 pandemic. Thissuggests that inbound medical visitors and foreign residents may regularly undergo complete medical examinations.
In order to continue to meet this demand, Japanese medical facilities should enhance their system for receiving suchexaminees.
Keywords: complete medical examinations, inbound medical care, foreigner, foreign residents

Introduction
Complete medical examinations are a system of
preventive medicine unique to Japan that contribute tohealth maintenance and early detection of diseases (1).
Moreover, as Japanese people's awareness of healthhas increased in recent years, demand has increased not
only for medical checkups at schools and companies but
also for comprehensive checkups that allow for moredetailed medical examinations (2). That said, inboundvisitors underwent medical checkups in Japan (1) even
before the COVID-19 outbreak (3). Japanese medical
facilities have also identified a business opportunity, andthe number of facilities that have prepared systems toaccept those visitors has increased in recent years (1,4).
However, the extent to which this concept of a complete
medical examination is recognized in different countries
is unknown.
The National Center for Global Health and Medicine(NCGM) is a medical facility that has been receiving
inbound visitors since May 2016, and more than 3,500
inbound visitors have been received to date. Based on
this track record, the current study analyzed trends inforeigners' demand for medical checkups in Japan.

Trends in and characteristics of foreigners' demand
for medical checkups in Japan: Data from the NCGM
Based on the Japanese Government's inbound tourism
policy, the NCGM has been actively receiving many
inbound medical visitors since 2016 (1,5). However,inbound demand ceased due to the COVID-19 pandemic(6). Foreigners mainly from China and Vietnam werealready aware of the NCGM, but in response to thepandemic the facility immediately changed its policy
to actively receive foreigners living in Japan (1,5). By
providing free medical interpreting services, a newsystem was created to meet the needs of foreigners living
in Japan who cannot speak Japanese.
As a result, foreign residents in Japan from a totalof 22 countries accounted for 471 (5.1%) of 9,299 total
medical check-ups from August 2020 to July 2023.
The breakdown included 314 Chinese, 66 Koreans,
15 Vietnamese, 12 Americans, 10 British, 9 French,
6 Filipinos, 5 Canadians, 5 Thais, 5 Bangladeshis,
5 Germans, 4 Kenyans, 4 Israelis, 4 Mongolians, 2Bulgarians, 2 Brazilians, 2 Myanmarese, 1 Swiss, 1Singaporean, 1 Peruvian, 1 Russian, and 1 Swede. There
were 150 people (31.8%) who needed language support,(256)Global Health & Medicine. 2024; 6(4):256-258.

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Figure 1. Characteristics of examinees from 2021-2022. Foreign residents in Japan accounted for a higher proportion of female
examinees than did Japanese, and the average age of both men and women was about 10 years younger.

and the main languages were Chinese, English, andVietnamese.
The current study compared data from 2021 and 2022
and analyzed the state of foreign examinees residing
in Japan (5). Results indicated that the total number ofpeople undergoing a complete medical examination
increased 13.8%. In contrast, the number of foreign
residents undergoing a complete medical examination
increased markedly (64.3%). By country, there was anotable increase in Chinese and Koreans.
The characteristics of foreign residents in Japan
were similar to those in 2021, as were previously
reported (5). In 2022, a higher percentage of foreign
residents receiving medical checkups were femalecompared to Japanese examinees, and the average ageof both men and women was about 10 years younger(Figure 1). Moreover, results revealed that a certain
number (approximately 30%) of examinees undergo
examinations multiple times, and the frequency of such
visits is once a year. In Japan, annual checkups such ascheckups at schools and companies are compulsory, andthis seems to have become a cultural habit. Similarly, theconcept of medical checkups, which involves not only
single checkups but also regular checkups, is spreading
among foreign residents in Japan (Figure 2).
With the end of the COVID-19 pandemic, complete
medical examinations for inbound medical visitors
resumed at the NCGM starting in January 2023. There
were 158 inbound examinees (38.2% Vietnamese, 61.7%
Chinese) in total, 24 (15.2%) of whom had previously
undergone medical checkups at the NCGM before theCOVID-19 outbreak (Figure 2). Accordingly, medicalcheckups in Japan for inbound medical tourists seem tobe more than a fashionable experience and are instead
becoming more common as a regular checkup, just like

Figure 2. Awareness of medical checkups among foreigners.
In recent years, Japanese and foreigners have been aware ofcomplete medical examinations. A certain number of foreigners
undergo repeat checkups at the same facility performing
complete medical examinations.

for foreigners residing in Japan. Thus, analyzing thetrends in medical examinations undergone by foreigners
residing in Japan and inbound visitors will help to predictinbound medical tourists undergoing medical checkups
on a regular basis, and that information will be extremely
useful when considering the state of medical checkups in
the future.
The future of inbound medical care as gauged from theforeigners undergoing complete medical examinationsin Japan
Based on the current results, awareness of checkups
appears to be widespread among both foreign residents
and inbound tourists. The average level of medicalcare in Japan, based on universal health insurance (7),is higher than in other countries (8), and as long as(257)Global Health & Medicine. 2024; 6(4):256-258.

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this situation continues, demand from foreigners forcheckups such as complete medical examinations inJapan will continue to increase. This has the potential to
become a major pillar supporting the Japanese economy.
New economic benefits are expected not only for thosereceiving medical care and hospitals but also in various
areas including food, clothing, and housing as a result of
their arrival in Japan.
In order to continue meeting this demand in thefuture, the hope is that medical facilities receiving
foreigners will enhance their system for doing so.
Inbound medical tourists may experience problems
during examinations, financial troubles, and various othercomplaints due to language and cultural differences.
As a countermeasure, the NCGM started an innovative
medical interpreter registration system in October 2020
to assist inbound visitors. As of July 2023, a total of
103 interviews were conducted, a total of 198 medicalinterpreters who have passed Level N1 of the Japanese
Language Proficiency Test have been registered (9),and 84 companies have been certified by the NCGM.
This system allows patients to be accompanied by aninterpreter with a wealth of medical knowledge who
understands hospital rules and Japanese culture througha company that is highly skilled in dealing with inboundtourists. This ensures the quality of interpreting, allows
the hospital to receive accurate health information fromthe patient in a short period of time, and allows thepatient to appropriately communicate the purpose of theexamination, method of testing, and results. Building
such a mutually beneficial relationship should help
ensure that checkups satisfy both the examinees and theexaminers. Currently, the NCGM has resumed checkups
and continues to accept inbound visitors without any
trouble, and this system for quality assurance has
been effective. Therefore, this seems to be one of theimportant factors that has allowed the NCGM to growinto one of the most successful facilities performing
complete medical examinations for inbound visitors toJapan both before and after the COVID-19 pandemic.
Based on the above achievements and experiences,
we would like to point out the problems and points
that need to be reformed in Japan's current system ofinbound medical care. First, given that the demandfor inbound medical care is expected to continue toincrease, hospitals currently have difficulty allocating
staff to handle inbound visitors. Therefore, the NCGM'ssystem, in which some of these tasks are outsourced tocertified companies and medical interpreters and thehospital coordinates them, is one way to accommodate
the increasing number of inbound medical tourists.
In addition, Japan's inbound medical care is broadly
divided into four categories: (A) disease treatment, (B)checkups such as complete medical examinations, (C)cosmetic treatments such as plastic surgery, and (D)life-prolonging care such as stem cell injections andblood purification. In areas such as (D), where there areissues with implementation standards and evidence ofeffectiveness, if the development is delayed, then (A),(B), and (C) may also be adversely affected. We believethat there is an urgent need for interventions such as
management of certification by the department in chargeof medical care.
Funding: This work was supported in part by JSPS
KAKENHI grant number JP20K07439 to Jun Lu.
Conflict of Interest: The authors have no conflicts ofinterest to disclose.
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---Received December 6, 2023; Revised May 22, 2024; Accepted
June 10, 2024.
Released online in J-STAGE as advance publication June 16,2024.
*Address correspondence to:
Jun Lu, Medical Examination Center, Center Hospital of
the National Center for Global Health and Medicine, 1-21-1
Toyama, Shinjuku-Ku, Tokyo, Japan 162-8655.
E-mail: j-lu@hosp.ncgm.go.jp(258)