This chapter provides a commentary on the present state and challenges regarding the acceptance of international patients in Japan. Despite some heightened expectations that medical tourism could be an engine of growth for Japan, various challenges have emerged to stymie such aspirations. However, it is necessary to open up Japanese medical institutions so that people are more willing to visit Japan and undergo examination and treatment in environments that are accredited as secure and safe. In addition to Japan’s advanced medical devices and technology, international patients also have high expectations of ordinary medical services available to everyone under Japan’s universal health insurance system. Treating international patients within Japan’s medical institutions will also pave the way for objective evaluations of healthcare in Japan according to global criteria. Appropriate development of medical tourism is expected to help strengthen Japan’s global presence in the field of medical services and at the same time to improve the quality of medical services offered domestically, thereby gaining greater support and understanding of the Japanese people and those in the medical profession for such an outward-looking initiative.