Clinic vs. Hospital: The Two-Tier System
Japan clinic vs hospital is the first decision a new resident faces when seeking care. The rule is simple: start at a local clinic, move to a hospital only on referral or for emergencies.12
Procedures, fees, and requirements can change. Confirm current details at the Ministry of Health, Labour and Welfare (MHLW). This article is general information, not medical advice; for your specific condition, consult a licensed physician.
Overview
Japan divides medical institutions by law into clinics (19 or fewer inpatient beds, including zero) and hospitals (20 or more beds).1 The working pattern built on that split is clinic first for non-emergency issues, with a written referral carrying the patient to hospital care when specialist or inpatient treatment is needed.3
Patients may legally present at any facility without a referral. Qualifying large hospitals, however, must collect a fixed non-referral surcharge on top of the ordinary insured copay.45
Clinics: the default entry point
A 診療所 (shinryōjo, "medical clinic") is a physician- or dentist-operated facility with no inpatient beds or with beds for 19 or fewer patients.1 A クリニック (kurinikku, "clinic") and a 医院 (iin, "physician's office") are the same legal category under different names. The label is branding, not a separate class.1
Clinics center on outpatient care. They serve as the community かかりつけ医 (kakaritsuke-i, "family doctor or regular physician"): everyday illness and injury, chronic-disease follow-up, vaccinations, and onward referral when hospital-level care is needed.32
No non-referral surcharge exists at clinics. A patient there pays only the ordinary insured copay.5
What a clinic handles
Clinics are the first contact for non-emergency issues. Typical ground covers colds and flu, minor injuries, ongoing management of conditions such as hypertension or diabetes, routine checkups, and prescriptions.26
When the clinic physician judges that intensive or specialist care is needed, the clinic issues a written referral to a hospital.37 Preparing that referral document carries a service fee of 2,500 yen in total, of which a 30-percent-copay patient pays 750 yen (as of 2026-06; confirm current figures with the issuing clinic).7 Practitioner sources describe the sealed letter as not to be opened by the patient, though the reissue practice is inconsistently reported.
Hospitals: specialized and inpatient care
A 病院 (byōin, "hospital") has beds for 20 or more inpatients. It is organized around inpatient, highly specialized, emergency, and multi-department care.1 A facility with 20 beds or more counts as a hospital on size alone, so some small and medium hospitals sit just above the line while running sought-after specialties.7
Large general hospitals concentrate on outpatient services that need surgery, procedures, chemotherapy, radiation, or expensive equipment.4 That concentration is why they ask most first-visit patients to arrive with a referral rather than off the street.
Why hospitals encourage referrals
National policy divides functions between tiers. First-contact care belongs at community clinics and kakaritsuke-i, while advanced and specialist care belongs at hospitals with 200 or more beds.53
紹介受診重点医療機関 (shōkai jushin jūten iryō kikan, "referral-focus hospital") is the category weighted most explicitly toward referred patients.4 Walk-ins without referrals are still accepted at most such hospitals, but they wait behind appointment holders and pay extra.8
The referral flow: clinic first, hospital when needed
The standard flow has four steps.3 First, the patient visits the kakaritsuke-i. Second, the clinic issues a referral letter if specialist testing or treatment is needed.
Third, the patient visits the hospital with the letter. Fourth, after hospital care ends, the hospital writes a reverse referral back to the clinic for follow-up.3
The following chart shows the decision a new resident makes at each step:
A 紹介状 (shōkaijō, "referral letter") carries the referral purpose, diagnosis, history, and the clinic's examination course and test results.3 That head start lets the hospital proceed quickly instead of repeating the workup from zero.
What walk-ins pay: the non-referral surcharge
Since the October 2022 fee-schedule revision, three hospital groups must collect the fixed charge: advanced treatment hospitals, community medical support hospitals with 200 or more general beds, and referral-focus hospitals with 200 or more general beds (as of 2022-10-01; confirm current figures with the MHLW).5 Other hospitals with 200 or more beds may collect it at their option.5
The national floor amounts are 7,000 yen for a medical first visit and 5,000 yen for a dental first visit (as of 2022-10-01).5 Return visits draw 3,000 yen for medical and 1,900 yen for dental where the patient stays by choice after being offered an onward referral (as of 2022-10-01).5 Each figure is charged in addition to the ordinary insured copay.5
| Item | Amount (national floor) | As of | Notes |
|---|---|---|---|
| First visit, medical, no referral | ¥7,000 | 2022-10-015 | Charged beside the regular copay |
| First visit, dental, no referral | ¥5,000 | 2022-10-015 | Charged beside the regular copay |
| Return visit, medical, stayed by choice | ¥3,000 | 2022-10-015 | After an onward-referral offer |
| Return visit, dental, stayed by choice | ¥1,900 | 2022-10-015 | After an onward-referral offer |
The national figures are minimums, and marquee hospitals charge more. The Japanese Red Cross Medical Center lists 11,000 yen for first and return visits (as of 2020-11-01), and Tsukuba Medical Center lists 11,000 yen for a no-letter first visit.98 Tax-included display also differs by hospital, so confirm the exact figure on the specific hospital's page.1011
The return-visit surcharge applies when a stabilized patient keeps returning to the same large hospital by choice after being offered a written referral elsewhere.93 Exemptions cover emergencies, same-visit admission, referral holders, in-hospital department referrals, public-assistance recipients, clinical-trial participants, disaster victims, and work or traffic accident cases.93
Choosing where to go
New residents should default to a nearby clinic or small to medium hospital for anything non-urgent. Large general hospitals are for referred, severe, or emergency cases.72
Resident guidance converges on one practical step: build an ongoing relationship with a local 内科 (naika, "internal medicine") clinic as the primary-care equivalent.32 That doctor learns the history, writes referrals outward, and receives reverse referrals back.
A standard first visit at any insured facility includes a fixed initial-consultation fee of 2,910 yen in total, with a 30-percent-copay patient paying 873 yen, roughly 900 yen after adjustment (as of 2026-06; confirm current figures with the clinic).7 Treatment, tests, and prescriptions sit on top of that base.
Bring the health-insurance credential, cash or a card, current medications or the medication record, and any referral letter.72 Small suburban clinics may accept cash only, so carrying enough cash avoids a second trip.7
Practitioner sources describe the referral letter as a sealed envelope the patient hands over unopened.7 Opening it may force a paid reissue, which wastes both the document fee and a return trip to the clinic.
Emergency care bypasses this entire flow. Call 119 for serious cases, or the 7119 telephone consultation line when unsure whether the situation is urgent.7 Ambulance transport and same-visit admission are exempt from the surcharge.9
Good to know
A referral letter costs a fee and stays sealed
Preparing the referral document costs 2,500 yen in total, with a 30-percent-copay patient paying 750 yen (as of 2026-06; confirm current figures with the issuing clinic).7 Hand the sealed envelope to the hospital reception unopened.
The reissue practice after a broken seal is inconsistently reported across practitioner sources. Treat the envelope as single-use and avoid opening it for a look.
Emergency care bypasses the referral flow
Ambulance transport and same-visit hospital admission are exempt from the surcharge.9 Emergency outpatient routing follows each hospital's emergency rules, not the referral queue.7
The surcharge targets by-choice walk-ins, not urgent care. When in doubt about urgency, the telephone consultation line exists precisely for that judgment call.7
Large-hospital fees above the floor vary by facility
The national figures are minimums, and prominent hospitals set higher ones: 11,000 yen at the Red Cross and Tsukuba examples (as of 2020-11-01 and 2023-10).98 Other hospitals display tax-included figures such as 7,700 yen for a medical first visit (as of 2024-10-01).3
Check the specific hospital's fee page before a no-referral first visit.1011 A two-minute check can save an 11,000 yen surprise at reception.
A stabilized patient who keeps returning pays again
After a hospital offers a written onward referral and the patient stays by choice, each return visit draws the revisit surcharge.93 Continued attendance under the hospital doctor's own treatment instruction does not draw it.3
The distinction turns on whose decision keeps the patient there. Doctor-directed follow-up is ordinary care, while patient-choice retention after a reverse-referral offer is the surcharged case.3
A new department inside the same hospital counts as a first visit
Being treated at a large hospital and adding another department without an in-hospital referral is treated as a first visit.10 That visit draws the first-visit surcharge even though the patient already attends the hospital.10
Ask the attending doctor for an in-hospital referral, or bring the clinic's letter for the new department. Either path satisfies the referral requirement.10
See also
- Maina-Hokensho: Health Insurance Card Going Digital
- How Japan's Universal-Coverage System Works
- The Freedom-of-Access Norm: Seeing Any Doctor in Japan Without a Referral
- What Insurance Doesn't Cover
- The High-Cost-Catch (Kogaku Ryoyohi) System