Governments of all types across Japan have begun campaigns to encourage foreign tourists to purchase travel insurance, with a recent surge in people leaving unpaid medical bills putting pressure on Japanese hospital budgets.

If uninsured travelers are injured or fall ill during their stay in Japan, they have to foot the bill for all medical expenses, and nearly 30 percent of travelers arrive having taken out no overseas travel insurance policy at all, according to a government survey.

Government agencies are using various ways to nudge foreign travelers toward buying insurance, including placing flyers at tourist information centers in airports and hotels, as well as distributing cards listing the price of the most expensive hospital treatments.

“Have you remembered to book your peace of mind?” reads a flyer printed in English and placed at a tourist information center at Narita airport in Chiba Prefecture, one of the most common landing spots in Japan and somewhere that has seen an increase in the number of tourists seeking travel insurance advice.

The flyer, also available in Chinese, Korean, and Thai, was created by the Japan Tourism Agency and distributed to airports nationwide to inform tourists that they can quickly and easily buy insurance using their smartphones or other devices, even after arriving in Japan.

The issue is impacting Japan’s health system.

According to a survey by the Health, Labor and Welfare Ministry, roughly 20 percent of hospitals which have treated foreign tourists have seen the patient’s medical bills go unpaid, including one hospital where the total amount exceeded 10 million yen ($92,000).

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A survey conducted by the tourism agency in fiscal 2018 showed 27 percent of foreign travelers arrived uninsured, while 48 percent said they bought insurance from travel agencies or insurance companies and 23 percent enrolled in travel insurance plans through credit cards. Five percent fell ill or suffered injuries while in Japan.

According to the survey, the top reason for foreign tourists not taking out travel insurance was they believed it unnecessary, while others said they did not consider it at all or were simply unaware of it.

Japan’s tourism agency has undertaken various trial campaigns to find effective ways of getting foreign tourists to purchase travel insurance in Japan, but without much success.

Sompo Japan Nipponkoa Insurance Inc. developed an insurance policy in cooperation with the tourism agency and started selling the product in 2016 as the country saw an increase in the number of foreign tourists.

The company succeeded in keeping the price of the policy relatively low by cutting the coverage offered for loss or damage of personal items and focusing instead on delivering medical coverage.

Since launching the service, the company has seen an increase in the number of people taking out policies each year, it said.

Southern Japan’s Okinawa Prefecture, popular with foreign tourists for its beaches and warm weather, has been distributing cards and sticking plasters, among other items, promoting travel insurance.

The cards list examples of fees uninsured travelers can incur for medical services, such as “700,000 yen for heatstroke” and “3 million yen for a broken bone.”

“We’ve heard concerns from medical institutions about possibly vast amounts of unpaid medical bills,” said an official of the island prefecture. “We will continue our efforts to increase the number of people who buy insurance policies after they arrive in Okinawa.”