Indeed. And people always suggest there is a tipping requirement at high end ryokans.

Though, as I understand it these days, the "gift" for hospital procedures is much less common these days. Not sure if the law has changed or just hospitals clamping down on it. The doctors I know say they haven't got these sorts of "gifts" from patients for years (but then they would say that). Might be different outside the big University hospitals/national centers. Plenty of other opportunities for "gifts" in the medical profession still.