The health ministry in Japan is planning to expand the range of hospitals that can impose additional fees on patients with no referral from their regular doctors as early as fiscal 2018.

Currently, extra fees of ¥5,000 or more are charged on initial visits to large hospitals with 500 beds or more. There are 262 such hospitals nationwide, mainly those affiliated with universities.

The ministry’s new plan will include hospitals with at least 400 beds, which will add some 150 hospitals.

The additional fees, which started in fiscal 2016, are additional to the patients’ out-of-pocket payments, which amount to 10 to 30 percent in principle of the total medical expenses under public health insurance programs.

The extra fee rule also requires the patients without referrals to pay ¥2,500 or more on their second and later visits.

By broadening the scope of hospitals that can impose the additional fees, the ministry aims to draw a clearer line between larger hospitals and smaller ones and clinics.

Big hospitals should focus on specialized medical services for severely ill patients, while smaller facilities can take care of less serious cases.