Getting a Family Doctor (Kakaritsuke-i) in Japan: The First Thing Retirees Should Set Up

Why a Clinic Comes Before a Hospital in Japan

Japan has no GP registration system, so newly arrived retirees have to build a "family doctor" relationship themselves, starting with a neighborhood clinic rather than a hospital.

Retirees moving from a country with a registered GP system often assume they need to find a "family doctor" through some formal enrollment. Japan does not work that way. There is no national registry that assigns a doctor to a resident, and no requirement to sign up anywhere before you can be seen. What exists instead is a looser concept called kakaritsuke-i, literally "the doctor you go to." It becomes your family doctor simply because you keep returning to the same clinic, and the clinic keeps a chart on you. For a retiree who has just set up housing, health insurance, and daily life after moving to Japan, choosing that first clinic is one of the few remaining steps, and it is easy to skip because nothing forces you to do it.

The practical reason to do it anyway is structural, not sentimental. Japan's outpatient system is built around a two-tier flow: local clinics handle first contact, and large hospitals handle referred, specialist, or urgent cases. Walking into a large hospital without a referral is allowed, but it is treated as skipping a step in that flow, and the fee structure reflects that. A resident who never picks a clinic ends up defaulting to whichever large hospital is nearest whenever something comes up, paying more for a routine first visit and starting from zero each time because no one has their history.

This article covers the practical side of setting up that relationship: what a kakaritsuke-i actually is, what it costs to skip one, how to hand over your medical history at a first visit, and how the clinic relationship extends later into referrals and home visits. For the separate question of finding a clinic where English is actually spoken, Finding English-Speaking Doctors in Japan for an Elderly Parent covers that search process in detail; this article assumes you have found a candidate clinic and focuses on what to do once you are in the chair.

Documents and History to Bring to a First Appointment

A first clinic visit runs faster and safer when a retiree arrives with insurance proof, a medication list, and a short written summary of their medical history.

Enrolled residents need their health insurance card (kokumin kenko hoken or shakai hoken) at every visit; without it, the clinic bills the full, uninsured rate and reimburses later, which is a bad first impression to leave with a new clinic. If a retiree has recently completed healthcare enrollment in Japan, the card itself may still be in process; some municipalities issue a temporary certificate that clinics will accept, so it is worth asking the ward or city office rather than assuming a visit must wait.

A first appointment at a Japanese clinic rarely includes a long English-language interview about medical history the way a first GP appointment might abroad. The doctor will typically ask a shorter set of questions and rely more on what is written down. Bringing a one-page summary translated into Japanese (or at least a bilingual list) of chronic conditions, past surgeries, allergies, and current medications saves real time and reduces the chance something gets missed in a fast-paced clinic schedule. If prescriptions are still being carried over from a previous country, that history connects directly to how medication continues after a move to Japan, and the clinic doctor is usually the one who converts an overseas prescription into a Japanese one.

Retirees who are not confident navigating this in Japanese should not treat that as a reason to avoid the clinic altogether. A short prepared document, or a family member joining the first visit by phone, generally gets a first appointment through without needing fluent Japanese in the room.

How Kakaritsuke-i Works Without a Registration System

Becoming someone's kakaritsuke-i is informal: a patient chooses a clinic, returns for ordinary care, and over repeat visits the clinic accumulates the history that makes it function like a family doctor.

There is no form that names a clinic as your kakaritsuke-i, no card, and no exclusivity requirement. In practice, a resident registers as a new patient at whichever clinic they choose (usually a short intake form on the first visit), and returns there for anything that does not need a specialist: colds, blood pressure checks, prescription renewals, general symptoms. Over a handful of visits, the doctor accumulates a chart that includes history, medications, and how the patient responds to treatment, which is the substance of the relationship even though nothing formal was signed.

Because the relationship is built through repetition rather than paperwork, the choice of clinic matters more in Japan than in a system where a GP is assigned or easily reassigned. A retiree who bounces between different clinics for convenience never accumulates that chart anywhere, and effectively has no kakaritsuke-i even after years in Japan. The Japan Medical Association describes a kakaritsuke-i as a doctor a patient trusts enough to consult on anything health-related, who understands their living situation, and who brings in a specialist when a problem is outside their own scope; that description is closer to a working definition of the role than any legal one, because Japanese law does not define it precisely.

For a retiree without a strong existing preference, the simplest starting point is a general internal medicine clinic (naika) within walking or short transit distance of home, since most non-emergency, non-specialist care runs through internal medicine first.

The Selective Treatment Fee for Skipping a Clinic

Visiting a large hospital directly, without a referral letter, adds a mandatory extra charge of at least ¥7,000 for a first visit and ¥3,000 for a follow-up, on top of normal insurance costs.

Since an October 2022 revision, hospitals designated as specific function hospitals or as regional medical support hospitals with 200 or more beds are required to collect a minimum "selective treatment" charge (senteiiryouhi) from patients who arrive without a referral letter: at least ¥7,000 for a first outpatient visit and ¥3,000 for a follow-up visit, with dental set lower (2024–2026, MHLW). This is not an insurance co-payment; it is an additional flat charge the hospital must collect on top of the normal bill, and individual hospitals can set the amount higher than the floor. Genuine emergency arrivals, including by ambulance, are generally exempted.

The system exists to push routine, first-contact care toward clinics and reserve large hospitals for referred and specialist cases, which is the same logic behind building a kakaritsuke-i relationship in the first place. A retiree who defaults to the nearest big hospital whenever something feels wrong is not just paying more; they are also being seen by whichever specialist is on duty rather than by a doctor who already has their chart.

The table below lines up the three realistic starting points for a retiree without a doctor yet.

Explaining Your Medical History at the First Visit

Clinics rely on what a patient brings in writing more than on a long verbal history, so a short bilingual summary matters more at a first Japanese visit than it typically would abroad.

A first-visit intake at a Japanese clinic is usually a paper or tablet form covering current symptoms, allergies, and current medications, followed by a short consultation. It is not built around a long narrative interview, so information that is not written down is easy to lose in translation or in time pressure. This is where the one-page summary from Part 1 earns its cost.

If a retiree is coming with several ongoing prescriptions from another country, it is worth stating plainly at the first visit that the goal is to establish an ongoing relationship, not just get a one-time refill. Japanese clinics generally welcome that framing, since it is exactly what kakaritsuke-i means to them, and it changes how much the doctor invests in building the chart from the first appointment onward.

The Kakaritsuke Medical Function Reporting System and What Changes for Patients

A 2025 reform requires almost all Japanese clinics and hospitals to report their kakaritsuke-i capabilities to the prefecture each year, and the published results are meant to help residents compare what a given clinic can actually handle.

Under a revised Medical Care Act, Japan introduced a kakaritsuke medical function reporting system (kakaritsuke iryou kinou houkoku seido) that took effect in April 2025, requiring most medical institutions, aside from specific function hospitals and dental clinics, to report annually via the national G-MIS system whether they have doctors trained in kakaritsuke-i functions, which of roughly 17 clinical areas they cover, and whether they can manage around 40 common chronic conditions such as hypertension. The first reporting window is scheduled for January to March 2026, with prefectures expected to publish the collected results for residents to consult, and municipalities set to use the same data to identify gaps in local kakaritsuke-i coverage (MHLW, 2025).

For a retiree, the practical effect is that choosing a clinic no longer has to be a guess based on proximity alone; once results are published, prefectures are meant to make it possible to check whether a specific clinic reports handling chronic disease management, home visits, or after-hours contact before committing to it as a long-term kakaritsuke-i. This is still new, and availability of English-language versions of the published data varies by prefecture, so it is reasonable to ask a clinic directly what it reported rather than relying only on the public listing.

From Kakaritsuke Clinic to Specialist Referrals

Once a kakaritsuke-i is established, referrals into hospital specialist care generally move faster and avoid the selective treatment fee, because the clinic issues the referral letter directly.

The clearest day-to-day payoff of having a kakaritsuke-i is the referral letter (shoukaijou). When a clinic doctor who already knows a patient's history decides a specialist is needed, they write a referral addressed to a named hospital and department, which both waives the selective treatment fee at that hospital and typically speeds up scheduling, since the receiving specialist already has a clinical summary rather than starting from a blank intake. Retirees managing a chronic condition, such as those continuing prescriptions and chronic care after a move to Japan, tend to need this referral path more than once a year, which is part of why the relationship pays for itself quickly.

Costs that fall outside standard insurance coverage, including some specialist consultations and non-covered tests a referral leads to, are worth budgeting for separately; what national health insurance does not cover for retirees in Japan lays out where those gaps typically appear.

When Clinic Visits Become Hard: The Path to Home Medical Care

A kakaritsuke-i relationship is also the usual route into home medical care later, since a doctor who already has a patient's history is the one best placed to decide when house calls should replace clinic visits.

For a retiree who is currently mobile, this section may feel premature, but it is the reason the relationship is worth building years before it becomes necessary. When getting to a clinic becomes difficult due to age or a change in health, the existing kakaritsuke-i doctor is generally the one who arranges the transition to house-call visits or connects the patient to a home care physician, rather than a family having to start that search from nothing during a crisis. Home medical care in Japan: house-call doctors and visiting nurses covers how that later stage works in more detail, including how it is typically initiated through an existing clinic relationship.

Overseas family members researching what to set up before or shortly after a parent's move can find the broader sequence, including this step, in the guide to moving to Japan with elderly parents.