Many participants understood that health insurance reduces medical costs, and ninety-four percent thought insurance was necessary. Yet forty point three percent reported having no insurance—and the gap was especially stark among people with unspecified visa status. Undocumented and uninsured foreigners living in Japan have faced barriers when trying to obtain appropriate healthcare services, and those barriers have occasionally led to issues with unpaid medical bills to medical institutions.

Relevant information on health and socioeconomic status has been unavailable because this population is difficult to contact. This study used a cross-sectional questionnaire survey of Thai nationals living in Tokyo and the surrounding prefectures, with data collected mainly at public religious events from September twenty twenty-two to December twenty twenty-two.

The questionnaires came from eighty-four participants, but sixty-seven remained in the final analysis after missing variables were excluded. The final sample included participants with unspecified visa status and uninsured status, while most participants expressed positive attitudes toward health insurance.

Economic constraints and the search for better opportunities have often led people to relocate across countries, especially from developing and underdeveloped countries to developed countries. Although relocation can bring better opportunities and income, immigrants may still face poor living environments, language barriers, and difficulty receiving proper healthcare services.

Japan has accepted more immigrants under government policies designed to promote economic growth, and the number of foreign residents has increased significantly over the last twenty years. Foreign residents include documented immigrants with permanent residency or work and study visas, as well as undocumented immigrants residing in Japan illegally.

The Sustainable Development Goals aim to leave no one behind, including immigrants who may face higher risks of poor health problems. Immigrants are vulnerable in accessing adequate healthcare because of language barriers, socioeconomic status, and migration status.

For undocumented migrants, laws and policies can limit the opportunity to achieve better health status and exclude them from the right to health. Fear of deportation can also discourage healthcare use, causing immigrants to wait until illness becomes more serious and expensive to treat.

In Japan, foreign residents are obligated to enroll in public medical insurance: National Health Insurance applies to unemployed people, people working less than thirty hours per week, and students, while Social Insurance applies to people employed full-time. Private insurance is also used by people with long-term illnesses and by travelers, but some clinics and hospitals may not easily accept international healthcare plans.

Undocumented immigrants, uninsured travelers, and some private-insurance holders can therefore fall into a gap in healthcare access. Uninsured patients must cover all medical costs after treatment, increasing the risk of unpaid medical bills and making hospital support complicated because of financial and language barriers.

Since twenty twenty-two, nearly two point five million immigrants have lived in Japan, and that number is rising, while little is known about healthcare accessibility among immigrants there. More than fifty thousand registered Thai nationals live in Japan, while the Immigration Services Bureau reported more than seven thousand Thai nationals living there illegally in twenty twenty-two.

The proportion of undocumented to documented Thai immigrants rose to fifteen percent in twenty twenty-two, the second highest in the world after Malaysia. The study aimed to describe socioeconomic and health information for vulnerable Thai foreigners and assess factors associated with health-insurance knowledge, attitude, and practice.

The questionnaires covered Thai nationals aged twenty or older who lived in Tokyo and surrounding prefectures. Data collection took place mainly at public religious events from September twenty twenty-two through December twenty twenty-two. The survey sites were Ibaraki Prefecture, Chiba Prefecture, and Tokyo in Japan’s Kanto area.

Each event expected more than two hundred participants and offered a high opportunity for vulnerable Thai nationals, including uninsured people, to participate. Figure One maps the survey locations in Japan’s Kanto area, with the enlarged view identifying Tokyo, Ibaraki, Chiba, and nearby prefectures.

The authors collected questionnaires from Thai nationals aged twenty or older at public religious events in Tokyo and surrounding prefectures between September and December twenty twenty-two. This geographic context matters because it defines the population and setting used to examine catastrophic health expenditure and health-insurance knowledge, attitudes, and practices.

The study measured catastrophic health expenditure, or CHE, along with health-insurance knowledge, attitude, and practice. CHE was calculated from annual household out-of-pocket spending and annual household income. CHE was defined as annual household out-of-pocket spending exceeding forty percent of annual household income.

Participants answered yes or no, with yes indicating past CHE without a specific time frame. The analysis used SPSS version twenty-nine point zero and described demographic characteristics, socioeconomic status, CHE incidence, health profiles, health-information access, and health-insurance knowledge, attitude, and practice using frequencies and percentages.

Chi-square analysis examined associations between CHE, health-insurance knowledge, attitude, and practice and sociodemographic or socioeconomic status. Multivariate regression used CHE and insurance knowledge, attitude, and practice as dependent variables, with educational level, duration of stay, and visa type as independent variables.

The significance threshold was p less than zero point zero five, and adjusted odds ratios with ninety-five percent confidence intervals were calculated. The survey collected eighty-four participants in total. After participants with missing data were excluded, sixty-seven participants, or seventy-nine point eight percent, entered the final analysis.

Table one summarizes demographic characteristics for sixty-seven participants, with a separate breakdown of the twenty-two participants whose visa status was unspecified. It reports gender, age, education, hometown, duration of stay, Japanese proficiency using JLPT levels, and visa type; for example, the unspecified-status group includes thirteen participants aged twenty to twenty-nine and twelve at level N5.

This context helps readers interpret who is represented in the study and assess how the subgroup is composed. Table two summarizes socioeconomic status for the total population of sixty-seven participants and the twenty-two with unspecified visa status.

It reports employment, household income, out-of-pocket healthcare spending, and catastrophic healthcare expenditure: seventy-three point one percent were employed full-time, while sixty-four point two percent had annual out-of-pocket costs below four hundred thousand Japanese yen.

Among unspecified visa-status participants, ninety-five point five percent were employed full-time, and ninety point nine percent reported no catastrophic healthcare expenditure, highlighting the economic context surrounding healthcare access. Twenty-five participants, or thirty-seven point three percent, were enrolled in National Health Insurance, and thirteen, or nineteen point four percent, were enrolled in Social Insurance.

Interestingly, forty point three percent reported having no insurance. Forty-one point eight percent were diagnosed with diseases. Seventy-nine point one percent needed to communicate with healthcare providers in Japanese when receiving healthcare services. Healthcare information mostly came from friends and family, at forty point three percent, and from non-governmental social network services sources, at thirty-five point eight percent.

Table three compares sixty-seven participants overall with twenty-two whose visa status was unspecified across insurance, health, information access, knowledge, attitudes, and barriers. In the overall population, twenty-five, or thirty-seven point three percent, had National Health Insurance, while twenty-seven, or forty point three percent, had no insurance; among those with unspecified visa status, twenty, or ninety point nine percent, had none.

The table also reports that sixty-three participants, or ninety-four percent, considered insurance necessary, while language was a reported barrier for twelve participants, or fifty-four point five percent, in the unspecified-visa group. Eighty-two point one percent knew that health insurance was provided in Japan and could reduce medication costs.

Ninety-four percent thought that having insurance was necessary. Despite this positive attitude, reported barriers to having insurance included language at twenty-nine point nine percent, financial barriers at twenty-three point nine percent, complicated procedures at seven point five percent, and time constraints at one point five percent.

The study used bivariate chi-square analysis and multivariate multivariable regression to assess associations between sociodemographic variables and CHE or health-insurance knowledge, attitude, and practice. Unspecified visa status was not associated with CHE incidence: the adjusted odds ratio was one point twenty-four, with a ninety-five percent confidence interval from zero point thirteen to eleven point fifty-two.

Education beyond high school was associated with higher health-insurance knowledge, with an adjusted odds ratio of eleven point eighty-five. A stay longer than five years was also associated with higher health-insurance knowledge, with an adjusted odds ratio of sixteen point eighty-five, while the unspecified-visa group had lower insurance practice, with an adjusted odds ratio of zero point zero two.

Table four reports adjusted odds ratios linking education, duration of stay, and visa status with catastrophic health expenditure and health-insurance knowledge, attitude, and practice. The authors report significantly higher health-insurance knowledge for high-school education or higher, with an aOR of eleven point eighty-five and a ninety-five percent confidence interval from one point eighty-seven to seventy-five point twenty-three.

Duration of stay is also associated with knowledge and practice, while unspecified visa status shows no association with catastrophic health expenditure. Despite the relatively small population size, the study is among the few to reveal demographic characteristics, socioeconomic status, and health profiles of Thai nationals in Japan, especially those without legal residency status.

Around one-third of participants were unspecified visa holders, meaning they had no visa or were overstayed immigrants. The proportion of catastrophic health expenditure was fortunately low, but this should be interpreted cautiously because most people in the unspecified-visa group were young adults without underlying diseases.

Undocumented immigrants may be young and healthy yet exposed to hazardous working conditions, and lacking health insurance can limit healthcare access and increase future health risks. Thai immigrants in Japan tended to have high knowledge and positive attitudes toward having health insurance, but almost half reported holding no health insurance.

The high proportion without health insurance could conceivably be explained by financial and language barriers. Difficulty contacting people without residency status may have affected the sample size because immigrants without a visa may disguise themselves for fear of being caught and deported.

The researchers could approach only some people who participated in gatherings of the Thai community in Japan, so the results might not represent the entire population of Thai immigrants in Japan. Convenience sampling made it difficult to recruit a very specific subgroup, including people experiencing catastrophic health expenditure or having low health profiles who might not have attended the survey events.

The study defined catastrophic health expenditure as healthcare spending exceeding forty percent of household income, and lower thresholds of ten or twenty-five percent could increase the observed incidence. The authors also note that estimating CHE could be affected by the relatively small sample size and that comparing Thai immigrants in Japan with the Japanese population would clarify differences in healthcare access.

The study finds a mismatch between health-insurance knowledge and actual coverage among Thai immigrants in Japan, especially those without legal residency status. The authors argue that immigrant-inclusive healthcare systems are needed.