Japan to Tighten Immigration Rules Over Unpaid Medical and Insurance Bills

By Barrier Free Japan

June 12 2025

TOKYO – The Japanese government is moving forward with plans to tighten its immigration screening system, introducing new rules that would deny visa renewals to mid- and long-term foreign residents who have failed to properly pay medical expenses, taxes, or social insurance premiums. The proposed “rigorous screening” system is expected to be implemented by June 2027, with amendments to ministerial ordinances currently under consideration.

Under the revised policy, the Immigration Services Agency and the Ministry of Health, Labour and Welfare are working to establish mechanisms for sharing relevant financial information, including records of unpaid medical bills. These efforts will be part of the government’s broader “basic policies for economic and fiscal management and reform,” which are expected to be approved by the Cabinet on June 13. The policy framework emphasizes maintaining “an orderly and harmonious society with foreign nationals” and calls for the “effective use of information” related to nonpayment in residency decisions.

Until now, the screening process for certain visa types, such as the “specified technical skill visa,” has included checks on social insurance premium payments, while unpaid medical bills were considered primarily for short-term stays. The proposed changes would extend this scrutiny to medium- and long-term visas, including categories like “student” and “family.” Permanent residents can already lose their status for willfully failing to pay taxes or social insurance premiums, under a revised immigration law set to take full effect within two years.

Prime Minister Shigeru Ishiba addressed the changes at a Cabinet meeting on June 6, citing concerns about “incidents of crime, disorderly behavior and inappropriate use of various systems” associated with the growing number of foreign workers and tourists. “We will take action in a rigorous way against those who do not follow the rules,” Ishiba said, while also announcing the creation of a new Cabinet Secretariat division to oversee cross-ministry immigration policy.

According to the Ministry of Health, Labour and Welfare, foreign residents in Japan are required to join the national health insurance system unless already covered by workplace insurance. However, no national-level data exists on payment compliance. A ministry survey of 150 municipalities found a 93% overall collection rate for insurance premiums, but just 63% among foreign residents. Some municipalities have shared the names of foreign nationals in arrears with immigration authorities. Since 2020, a trial program involving about 30 local governments has resulted in the rejection of 27 visa applications from individuals behind on their payments.

Medical debt is also a growing focus. A 2024 survey by the ministry found that 65.3% of medical institutions that accepted foreign patients had unpaid bills, with foreign nationals accounting for 29.3% of those in debt, though their share of the total amount owed was only 1.4%. Foreign residents comprise just 1% of those insured for hospital expenses and high-cost care payments. Since 2021, hospitals have been encouraged to report cases in which foreign patients owe 200,000 yen (approximately $1,380) or more, though participation remains voluntary.

Justice Minister Keisuke Suzuki has linked the changes to broader public safety concerns. In May, he unveiled a seven-point plan aimed at achieving “zero” illegal immigration, asserting that “the safety and security of the people are being threatened by foreigners who do not follow the rules.” The government has acknowledged that media reports have influenced its stricter stance.

While special committees of the ruling Liberal Democratic Party have backed the proposed changes, groups that support foreign residents have raised concerns, noting that there is little objective data proving that foreigners are more likely to break laws or abuse public systems. Critics warn that the new policies could contribute to public anxiety and negative sentiment toward foreign nationals.