Shin Koike LLM, student fellow, Center for Law and the Biosciences

Introduction

Medical tourism—traveling to another country to receive medical care—has multiple layers, making it both complex and fascinating. Some governments view its promotion as an economic strategy to boost national growth and a means of contributing to global health care. Others, however, see it as a risk to individuals and, ultimately, to public health, particularly when it involves travel to countries with weak healthcare infrastructure or limited regulatory oversight. From the perspective of the private sector, medical tourism would be a growing business opportunity. In 2024, the global market was valued at USD 41.75 billion and is expected to grow even further in the coming years.[1]

With the COVID-19 pandemic now largely under control, countries around the world are once again developing unique policies to attract international patients, and Japan is no exception. In the “Basic Policy on Economic and Fiscal Management and Reform 2024,” issued in June 2024, the Japanese government announced its intention to further expand inbound medical tourism.[2] This policy will be promoted through cooperation among the Ministry of Health, Labour and Welfare (“MHLW”), the Ministry of Economy, Trade and Industry (“METI”), and the Japan Tourism Agency. With this strong governmental push, medical tourism into Japan is expected to grow significantly.

In this blog post, I will first provide a brief overview of what medical tourism is and its main purposes. Then, I will explore the current state of medical tourism into Japan and examine the key ethical and policy issues that need to be addressed. Given these concerns, I argue that the Japanese government should reexamine the ethical concerns associated with medical tourism into Japan, particularly in areas such as infertility and transplant treatment, and consider legally regulating ethically problematic medical practices, rather than leaving such matters solely to professional self-regulation.

What Medical Tourism Is and Why People Choose It

In general, medical tourism refers to traveling to another country to receive medical treatment, usually with a focus on curing, managing, or diagnosing illnesses. This category of tourism often includes fields such as oncology tourism, reproductive tourism, transplant tourism, and others.[3] While there is no universally accepted definition, medical tourism is typically distinguished from “health tourism” or “wellness tourism.”[4] The latter usually involves healthy individuals who travel to promote their overall well-being.

People who engage in medical tourism often do so for reasons such as lower costs, shorter waiting times, or access to treatments that are unavailable or not approved in their home country.[5] In contrast, those who engage in health or wellness tourism are generally motivated not only by the desire to improve their health or well-being, but also by the opportunity to enjoy unique experiences offered by the destination country.

Medical Tourism into Japan: Policy Push and Market Momentum

While there is no specific national policy promoting medical tourism in the United States, several Asian countries, including Japan, are actively encouraging medical tourism into their own countries. In Japan, in addition to offering visas that can be used for medical tourism,[6] the MHLW supports hospitals in accommodating a wide range of languages, which addresses one of the most common challenges in accepting international patients.[7] The MHLW also publishes a list of hospitals that can provide services in foreign languages to assist patients in making informed decisions.[8] Furthermore, the METI is exploring strategies to promote Japan’s medical tourism policies to international travelers more effectively.[9]

The Japanese government also supports the medical travel business. Companies that aim to operate in the medical tourism field can apply to become Accredited Medical Travel Assistance Companies, or AMTACs.[10] These are companies accredited by Medical Excellence JAPAN, an organization that provides international patients with a variety of support services.

In response to these government initiatives, major companies in Japan have begun to enter the field. For example, Mitsubishi Corporation and Resorttrust Group recently announced a joint study exploring opportunities in the medical tourism sector.[11] They are considering the establishment of a joint venture to facilitate medical travel to Japan and to promote Japan’s advanced medical screening technologies and healthcare services globally.

With strong support from both the public and private sectors, medical tourism into Japan is steadily gaining momentum. Given these trends, medical tourism into Japan is expected to grow dramatically in the near future.

Catching the Wave While Guarding Ethical Boundaries

While Japan’s efforts to promote medical tourism are gaining traction through public and private initiatives, the rapid growth of this sector also brings with it a number of complex challenges. To ensure that this growth is sustainable and ethically sound, it is essential to consider the broader implications and risks associated with medical tourism.

Generally, medical tourism presents challenges across three dimensions: (1) issues for patients—such as quality of care, language barriers, and lack of continuity in follow-up care; (2) issues for departure countries—such as capital outflow and inequities in domestic healthcare systems; and (3) issues for destination countries—including shortages of healthcare professionals and the risk of “brain drain,” where higher wages and advanced technologies at medical tourism facilities attract healthcare providers away from public or rural hospitals.[12–14]

Among these concerns, what I find particularly troubling in the context of medical tourism into Japan is the gradual erosion of ethical boundaries, especially in sensitive areas such as infertility and transplant treatment, under pressure from market dynamics.[15]

In Japan, medical tourists are not covered by the national health insurance system, which allows hospitals and clinics to set their own treatment fees. Therefore, as the medical tourism market grows, providing care to medical tourists could become more lucrative than treating domestic patients under the national health insurance system. This growing profitability creates a strong incentive to meet the demands of medical tourists, which could, in turn, lead to the risk of prioritizing profit over ethical standards. For instance, financially struggling hospitals or clinics may be tempted to offer ethically questionable medical practices to medical tourists.

Moreover, in Japan, medical practices with potential ethical implications are often not explicitly prohibited by law, but instead are regulated only through professional guidelines. For instance, living organ transplants from non-relatives are discouraged by guidelines,[16] but are not legally prohibited. Similarly, surrogacy and the use of preimplantation genetic testing (PGT) for sex selection are prohibited through professional self-regulation,[17–18] but not legally banned. While promoting medical tourism could serve Japan’s economic interests and global health contributions, relying solely on self-regulation may be insufficient to prevent ethically problematic practices.

To strike a balance between promoting medical tourism and safeguarding ethical standards, it would be crucial that the Japanese government reexamine these ethical concerns and consider the legal regulation of ethically problematic medical practices, rather than leaving such matters solely to professional self-regulation.

Notes

[1] Medical Tourism Market Size, Share & Trends Analysis Report By Treatment Type (Cardiovascular Treatment, Orthopedic Treatment, Cosmetic Treatment), By Service Provider, By Country, And Segment Forecasts, 2025 – 2030, https://www.grandviewresearch.com/industry-analysis/medical-tourism-market

[2] Basic Policy on Economic and Fiscal Management and Reform 2024, Cabinet Decision issued on June 21, 2024, Provisional Official Translation, https://www5.cao.go.jp/keizai-shimon/kaigi/cabinet/honebuto/2024/2024_basicpolicies_en.pdf

[3] Grace D. Appiah and Michael Christ, Medical Tourism, https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html

[4] Hall, Colin Michael. Medical Tourism : The Ethics, Regulation, and Marketing of Health Mobility / Edited by C. Michael Hall. First edition. Abingdon, Oxon ; Routledge, 2013. Web.

[5] The Centers for Disease Control and Prevention (CDC), Medical Tourism: Travel to Another Country for Medical Care, https://wwwnc.cdc.gov/travel/page/medical-tourism

[6] Ministry of Foreign Affairs of Japan, For those who would like to apply for the “Visa for Medical Stay,” https://www.mofa.go.jp/j_info/visit/visa/medical_stay1.html

[7] Ministry of Health, Labour and Welfare of Japan, Internationalization of Healthcare, https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/iryou/kokusai/index.html

[8] Ministry of Health, Labour and Welfare of Japan, A list compiling information on medical institutions that accept foreign patients, https://www.mhlw.go.jp/stf/newpage_05774.html

[9] Ministry of Economy, Trade and Industry, Existing Government Initiatives, https://www.meti.go.jp/shingikai/mono_info_service/medical_inbound/pdf/001_04_00.pdf

[10] Medical Excellence JAPAN, Accredited Medical Travel Assistance Company (AMTAC), https://medicalexcellencejapan.org/en/business/certification/amtac/

[11] Resorttrust, Inc. and Mitsubishi Corporation, Resorttrust Group and Mitsubishi Corporation Launch Joint Study in Medical Tourism, https://www.mitsubishicorp.com/jp/en/news/release/2024/20241114001.html

[12] The Centers for Disease Control and Prevention (CDC), Medical Tourism: Travel to Another Country for Medical Care, https://wwwnc.cdc.gov/travel/page/medical-tourism

[13] Amini, A., Shahpoori Arani, H., Milani Fard, M. (2022). ‘Medical Tourism Industry: A Systematic Review on Its Principles, Sequels, and Ethical Issues’, Eurasian Journal of Science and Technology, 2(2), pp. 143-155. doi: 10.22034/EJST.2022.2.3

[14] Johnston, R., Crooks, V.A., Snyder, J. et al. What is known about the effects of medical tourism in destination and departure countries? A scoping review. Int J Equity Health 9, 24 (2010). https://doi.org/10.1186/1475-9276-9-24

[15] Amini, A., Shahpoori Arani, H., Milani Fard, M. (2022). ‘Medical Tourism Industry: A Systematic Review on Its Principles, Sequels, and Ethical Issues’, Eurasian Journal of Science and Technology, 2(2), pp. 143-155. doi: 10.22034/EJST.2022.2.3

[16] Japanese Society for Clinical Renal Transplantation, Guidelines for Living Kidney Donors, https://www.jscrt.jp/wp-content/themes/jscrt/pdf/guideline/guideline3.pdf. To ensure that living organ transplants are based on the donor’s free will, the guidelines discourage transplants from non-relatives.

[17] Japan Society of Obstetrics and Gynecology, Statement on Gestational Surrogacy, p.813, https://fa.kyorin.co.jp/jsog/readPDF.php?file=76/8/076080771.pdf#page=43. Surrogacy is prohibited under the guidelines due to the physical risks and psychological burdens it places on the surrogate mother, as well as the potential to unnecessarily complicate legal family relationships.

[18] Japan Society of Obstetrics and Gynecology, Statement on Preimplantation Genetic Testing (PGT) for Infertility and Recurrent Pregnancy Loss, p.796, https://fa.kyorin.co.jp/jsog/readPDF.php?file=76/8/076080771.pdf#page=26. Preimplantation genetic testing (PGT) is permitted only to the extent that it constitutes a medical practice aimed at treating infertility or recurrent pregnancy loss. PGT for sex selection falls outside this scope and raises ethical concerns, and is therefore not permitted under the guideline.