Extra charge without referral letter, for hospitals with more than 200 beds
The medical fee is revised once every two years, and some of the medical expenses and rules will
change as of April 1. This revision of medical fees is a notice from the government to medical
institutions to “Please provide medical care in this manner,” and a notice to the public to “Please
obtain medical care in this manner.”
Additional fee for going to a large hospital without a letter of referral
If you visit a large hospital without a referral letter, a special fee of 5,000 yen or more, separate from
the consultation fee, for the initial visit (dental department charges more than 3,000 yen for initial
visit),will be charged as a “selected medical treatment fee”,and 2,500 yen or more for re-examination
(dental department charges 1,500 yen or more). You must pay the amount specified by each
This part is entirely your own expense.
You might consider that “expensive”, but for a large hospital, it is their responsibility to collect this
medical expense for “the initial visit fee and the revisit fee as selected .”
The extra charge without a referral letter is implemented for hospitals with “200 beds or more”
When you say “big hospitals”, it formerly referred to specific function hospitals and regional medical
support hospitals with 400 or more beds. In this revision, it is now expanded to “specific function
hospitals” and “regional medical support hospitals with 200 or more beds ” as of April.
In other words, if you do not provide a referral letter to a special function hospital or a regional
medical support hospital with more than 200 beds, you will be charged an additional fee of 5,000 yen
or more for the first consultation and 2,500 yen or more for the re-examination.
By the way, special function hospitals are hospitals that have the role of developing advanced
medical care, training, and medical technology, designated university hospitals, and cancer centers
On the other hand, regional medical support hospitals are hospitals that support family doctors and
dentists, and provide specialized outpatient, inpatient, and emergency medical care . In other words,
a hospital that is at the core of the region.
First, go to your “Family doctor”
Since 2016, a flat-rate fee was set for visiting a large hospital without a referral letter. Initially, it was
charged at specific function hospitals and regional medical hospitals with 500 beds or more. Then it
was changed to specific function hospitals and regional medical support hospitals with 400 or more
beds. This time, it has been expanded to specific function hospitals and regional medical support
hospitals with 200 or more beds in the region..
This is the notice from the government telling you to see a family doctor first first. In case you need
more specialized testing and treatment, then go to the hospital as a way to obtain medical treatment,
and make it a practice.
However, there are some exceptions .
For example, this would not apply if you suddenly get sick and are transported by ambulance to the
hospital. However, if you only have a mild illness, you might have to pay a selective medical
In addition, if you are in a different department of the same hospital, and you are instructed to get a
detailed examination during a medical checkup or cancer checkup, you may not need to pay for the
selective medical treatment expense at the time of the first visit or re-examination. Please contact
each hospital, as the interpretation differs depending on the hospital.
In any case, visiting a family doctor to begin with is the first step in receiving medical treatment.