Research Methodology

Lost Without Translation

 National Study of Foreigners' Experience of Health Care in Japan
Study Methods



This study will report on the foreign patient experience of accessing and receiving health care in Japan. By means of an online survey, foreign residents and visitors in Japan will address their experience of accessing care, interactions with health care providers and staff, and any cultural or linguistic barriers to effective communication.


The number of foreign residents in Japan has been steadily increasing since 2000, with more than 2.1 million foreigners currently residing in Japan. Chinese residents make up a rapidly growing segment (656,000 in 2008), followed by North and South Koreans, Brazilians, Filipinos, and Americans. In 2012, there were more than 137,000 foreign students (predominantly from China, followed by Korea, Taiwan, Vietnam and Nepal), and the current government aims to double these numbers by 2020.  Low-skilled workers, trainees and interns, and irregular workers, are an often unseen but important part of the economy. Finally, the government is seeking to expand Japan’s capacity for medical tourism, increasing to 30 million by 2030 the number of visitors coming to Japan for medical treatment.

It is well-documented across the globe that foreign residents, migrants, and short-term visitors may experience difficulty in accessing and effectively utilizing health care services due to language and cultural differences. Unaddressed, these barriers can affect patient-provider communication and trust-building, accurate diagnosis, treatment adherence, patient safety and quality of care, clinical outcomes, and patient satisfaction. In the worst-case scenario, miscommunication due to language and cultural barriers can lead to increased risk of patient morbidity and mortality and health care provider liability.

It is critical to understand the health care experience of foreign patients in Japan. Changing demographics, fueled by globalization-oriented policy initiatives, may create an unfortunate collision with a health care system that is unprepared to deal adequately with linguistic and cultural diversity. Having a better understanding of the foreign patient experience can help policymakers and key stakeholders address potentially harmful barriers, ease health care provider interaction with foreigners, and improve overall quality of care.

Purpose/Research Objectives:

1.  To identify and analyze the experience of foreign residents and visitors in Japan with respect to:
•    their experience accessing health care
•    interactions with health care providers and staff
•    any cultural or linguistic barriers to effective communication and delivery of health care services.

2.  To identify for policymakers and health care professionals the opportunities and challenges to improving the health care experience of foreigners in Japan.

Process/Research Targets and Methodology

Research targets:

To identify, by means of an online survey and through focus groups and key stakeholder interviews, the experience of foreign residents and visitors in Japan with respect to receiving health services.

Specific targets for data collection:

Regarding the personal experience of care:  foreign-born residents; expatriate (short-term) professionals and their families; short-term/migrant workers; international students; medical tourists.  The initial target audience will be English speakers; additional groups will be included according to the availability of translation for survey questions and responses.

Regarding the context of health care delivery to foreigners:  representative stakeholders who interact with or develop policies and programs for the delivery of health care to foreigners, e.g. Japanese doctors and other clinical or administrative staff who interact with foreigners; health benefits managers for companies that employee foreigners; individuals involved in the medical tourism industry; professional medical interpreters; health policymakers and policy observers.


Phase 1

1.    Background research on related studies (multicultural patient experience, patient experience in Japan) and patient experience of care survey tools*.

2.    Development of draft survey tool

3.    Pilot test of survey tool (English speaking foreign patients in Kobe) and focus group.

4.    Analysis of pilot responses and refinement of survey tool

5.    Implementation of final survey (online)

6.    Analysis of survey responses

7.    Determination of feasibility of in-depth interviews with select, self-identified survey respondents.

8.    Interviews with a small sample of representative stakeholders

9.    Write-up of results:  journal article, with possible addition of an issue brief or white paper.

10.   Dissemination of results to key stakeholders (policymakers, academia, medical associations and professionals, media, interpreters, foreign community representatives and service providers)

Phase 2 (surveys of other linguistic groups) will proceed according to the availability of support for translated surveys and analysis in other languages.

* CAHPS Cultural Competency Item Set (CAHPS-CC)
   AMA Communication Climate Assessment Toolkit (C-CAT)

For more information, please contact:

Julia Puebla Fortier
Director, DiversityRx: Resources for Cross Cultural Health Care

Find Resources