Have you ever been asked to bring a letter of reference when you go to see a doctor at a university hospital? Many people worry if they are turned away seeing a doctor without a letter of reference by a hospital.

I think there is no medical institutions that says “you can see a doctor by no means” but
hospital’s functional differentiation that makes you choose which hospital to go by your symptom and medical treatment content has made progress these days. So we tend to have an increased need for a letter of reference to see a doctor.

Even though your illness is light, you might want to see a doctor at a university hospital but Japanese medical society has a system that a hospital in charge of advanced acute medical care only accepts a patient whom medical professional judge who needs to receive a medical this medical treatment.

If there are a lot of people who don’t bring a ltter of referrence with them, hospital’s revenue will reduce

Even while patients increase due to rapid aging population, the problems of limited medical funds and regulations towards the number of beds set in a room avoid increasing big hospital in the background that such a “a letter of reference” system spread around in Japan.

In addition, the number of medical workers including doctors is not really sufficient. If patients with light illness concentrate to big hospital, it becomes out of control.

The reason why a hospital requires you persistently to submit a letter of reference from a small regional clinic is because it has something to do with economic induction by medical fees. Check items regarding introduction rate is set to increase patients bringing a letter of reference for the doctor to a big hospital on medical fees system.

Introduction rate is the one of how many people bring a letter of reference to see a doctor.
For example, by the medical fee revision, advanced treatment hospitals and regional medical support hospitals that has 500 beds can only demand low insurance points to the government about patient’s first visit charge outpatient service charge if introduction rate is less than 50%.

Medical service fees is 10 yen for 1 point. So low introduction rate hospital’s revenue will reduce inevitably

In the first place, regional medical support hospital is a flagship hospital and it is involved greatly with introduction rate and reverse introduction rate ( introduction rate of making a patient return back to a clinic he/she originally went to if patient’s symptom get better). If a hospital is designated as a regional medical support hospital, it can add additional charge on basic hospitalization rates (hospital’s revenue increases), which is one of induction. As a result, a big hospital installs incentive(induction) to increase new patients who bring a letter of reference in such a background.

A letter of reference is called officially “medical information report”. If a patient has a doctor written a letter of reference, “medical information report fee” is incurred (patient’s expenses). On the other hand, if you go to see a doctor to a hospital that has 200 beds without a letter of reference, your expenses are subject to System for healthcare services provided combining insurance-covered and non-covered services and extra charge will be incurred. This extra charge amount is left to hospital’s discretion so the range of its price is pretty wide from a couple hundred yen to a couple thousands yen.


  System for healthcare services provided combining insurance-covered and non-covered services, which is not generally permittable, is a system that accept treatment partially covered by insurance only for medical items designated by the Japanese government. Extra bed charge corresponds to this.

Extra charge of a hospital that has more than 200 beds is not only incurred to the first visit charge. Even if a patient keep seeing a doctor in a hospital that has more than 200 beds although a doctor suggests a patient a reverse introduction to return back to a small regional clinic after a certain medical treatment has already done, this hospital can keep charging. But if being charged, it is much cheaper than that for first visit.

You may think it inconvenient to see a doctor to a big hospital directly but, apart from pros and cons, you may have to know the reason why you need to submit a letter of reference to a big hospital to see a doctor in Japan.

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