Act on Assurance of Medical Care for Elderly People
高齢者の医療の確保に関する法律
Contents
Read it chapter by chapter; the first chapter follows below. Or read the whole law on one page.
- Chapter I General Provisions第一章 総則Articles 1–7 · 7
- Chapter II Promotion of Appropriate Medical Expenses第二章 医療費適正化の推進Articles 8–31 · 33
- Chapter III Coordination of Sharing of Expenses between Insurers Pertaining to Young-Old Persons第三章 前期高齢者に係る保険者間の費用負担の調整Articles 32–46 · 15
- Chapter IV Late-Stage Elderly Medical Care System第四章 後期高齢者医療制度Articles 47–138 · 104
- Chapter V Operations of the Medical Information Infrastructure and Medical Fee Examination and Payment Organization Related to the Medical Care System for the Elderly第五章 医療情報基盤・診療報酬審査支払機構の高齢者医療制度関係業務Articles 139–154 · 16
- Chapter VI Medical Services for the Elderly by the National Health Insurance Federation第六章 国民健康保険団体連合会の高齢者医療関係業務Articles 155–157 · 3
- Chapter VII Miscellaneous Provisions第七章 雑則Articles 157-2–166 · 15
- Chapter VIII Penal Provisions第八章 罰則Articles 167–171 · 9
Chapter I General Provisions
第一章 総則
第一条（目的）
The purpose of this Act is to formulate a plan for promoting the optimization of medical expenses and to take measures for the implementation of health checkups, etc. by insurers in order to ensure appropriate medical care for the citizens in their old age, and with regard to medical care for the elderly, to establish a system necessary for adjusting the sharing of expenses between insurers pertaining to the young-old and for providing appropriate medical care benefits, etc. for the old-old, based on the principle of joint and several action by citizens, thereby improving the health of the citizens and promoting the welfare of the elderly.
この法律は、国民の高齢期における適切な医療の確保を図るため、医療費の適正化を推進するための計画の作成及び保険者による健康診査等の実施に関する措置を講ずるとともに、高齢者の医療について、国民の共同連帯の理念等に基づき、前期高齢者に係る保険者間の費用負担の調整、後期高齢者に対する適切な医療の給付等を行うために必要な制度を設け、もつて国民保健の向上及び高齢者の福祉の増進を図ることを目的とする。
第二条（基本的理念）
Citizens, based on the spirit of self-help and solidarity, are to endeavor at all times to maintain and improve their health, being conscious of the mental and physical changes that occur as a result of aging, and to bear the expenses required for medical care for elderly persons in a fair manner.
国民は、自助と連帯の精神に基づき、自ら加齢に伴つて生ずる心身の変化を自覚して常に健康の保持増進に努めるとともに、高齢者の医療に要する費用を公平に負担するものとする。
Citizens are to be given the opportunity to receive appropriate health services to help maintain their health in old age, in accordance with their age, mental and physical condition, etc., at work, in the community, or at home.
国民は、年齢、心身の状況等に応じ、職域若しくは地域又は家庭において、高齢期における健康の保持を図るための適切な保健サービスを受ける機会を与えられるものとする。
The national government must take all necessary measures to ensure the smooth implementation of efforts to ensure the appropriateness of the expenses required for medical care by citizens in old age and the sound operation of the medical insurance system for the elderly (meaning the adjustment of the sharing of expenses among insurers pertaining to the young-old provided for in Chapter III and the medical insurance system for the old-old provided for in Chapter IV; the same applies hereinafter), and actively promote medical care, public health, social welfare, and other related measures in order to contribute to the achievement of the purpose provided for in Article 1.
Article 4Responsibilities of Local Governments
第四条（地方公共団体の責務）
A local government must respect the purport of this Act and implement the necessary measures to ensure that efforts are made to ensure the appropriateness of the expenses required for medical care by residents in old age and the management of the medical care system for the elderly is carried out appropriately and smoothly.
地方公共団体は、この法律の趣旨を尊重し、住民の高齢期における医療に要する費用の適正化を図るための取組及び高齢者医療制度の運営が適切かつ円滑に行われるよう所要の施策を実施しなければならない。
In efforts to ensure the optimization of expenses required for medical care by residents in old age as prescribed in the preceding paragraph, the prefecture is to play a central part in obtaining the cooperation of Insurers, the Association of Medical Care Systems for the Elderly Aged 75 and older prescribed in Article 48 (referred to as the "Association of Medical Care Systems for the Elderly Aged 75 and older" in Articles 8 through 16 and Article 27), medical personnel, and other relevant persons, in light of its responsibility to ensure the medical care delivery system (meaning the medical care delivery system prescribed in Article 30-3, paragraph (1) of the Medical Care Act (Act No. 205 of 1948)) in the prefecture and the sound operation of national health insurance services by the prefecture and municipalities (including special wards; the same applies hereinafter) within the prefecture.
前項に規定する住民の高齢期における医療に要する費用の適正化を図るための取組においては、都道府県は、当該都道府県における医療提供体制（医療法（昭和二十三年法律第二百五号）第三十条の三第一項に規定する医療提供体制をいう。）の確保並びに当該都道府県及び当該都道府県内の市町村（特別区を含む。以下同じ。）の国民健康保険事業の健全な運営を担う責務を有することに鑑み、保険者、第四十八条に規定する後期高齢者医療広域連合（第八条から第十六条まで及び第二十七条において「後期高齢者医療広域連合」という。）、医療関係者その他の関係者の協力を得つつ、中心的な役割を果たすものとする。
Article 5Responsibilities of Insurers
第五条（保険者の責務）
An insurer must endeavor to actively promote the services necessary for maintaining the health of its members in old age, and must cooperate so that the operation of the medical care system for the elderly is implemented in a sound and smooth manner.
Article 6Responsibilities of Medical Care Professionals
第六条（医療の担い手等の責務）
Physicians, dentists, pharmacists, nurses, and other medical care professionals, as well as the establishers and administrators of medical institutions prescribed in Article 1-2, paragraph (2) of the Medical Care Act, must cooperate with the various measures, policies, and undertakings prescribed in the preceding three Articles.
医師、歯科医師、薬剤師、看護師その他の医療の担い手並びに医療法第一条の二第二項に規定する医療提供施設の開設者及び管理者は、前三条に規定する各般の措置、施策及び事業に協力しなければならない。
第七条（定義）
The term "Medical Insurance Acts" as used in this Act means the following acts:
この法律において「医療保険各法」とは、次に掲げる法律をいう。
the Mariners Insurance Act (Act No. 73 of 1939);
船員保険法（昭和十四年法律第七十三号）
National Public Officers Mutual Aid Association Act (Act No. 128 of 1958);
国家公務員共済組合法（昭和三十三年法律第百二十八号）
Local Public Officers, etc. Mutual Aid Association Act (Act No. 152 of 1962).
地方公務員等共済組合法（昭和三十七年法律第百五十二号）
the Private School Teachers Mutual Aid Act (Act No. 245 of 1953).
私立学校教職員共済法（昭和二十八年法律第二百四十五号）
The term "Insurers" as used in this Act means Japan Health Insurance Association, health insurance societies, prefectures and municipalities, national health insurance societies, mutual aid association, or the Promotion and Mutual Aid Corporation for Private Schools of Japan, which provide medical care benefits pursuant to the provisions of the Medical Insurance Acts.
この法律において「保険者」とは、医療保険各法の規定により医療に関する給付を行う全国健康保険協会、健康保険組合、都道府県及び市町村、国民健康保険組合、共済組合又は日本私立学校振興・共済事業団をいう。
The term "insurers of employee insurance, etc." as used in this Act means insurers (excluding Japan Health Insurance Association, prefectural and municipal governments, and national health insurance societies as insurers under the provisions of Article 123, paragraph (1) of the Health Insurance Act) or national health insurance societies whose members are persons who do not become insured under the same Act with the approval under the provisions of Article 3, paragraph (1), item (viii) of the Health Insurance Act, as specified by the Minister of Health, Labour and Welfare.
この法律において「被用者保険等保険者」とは、保険者（健康保険法第百二十三条第一項の規定による保険者としての全国健康保険協会、都道府県及び市町村並びに国民健康保険組合を除く。）又は健康保険法第三条第一項第八号の規定による承認を受けて同法の被保険者とならない者を組合員とする国民健康保険組合であつて厚生労働大臣が定めるものをいう。
The term "participant" as used in this Act means the following persons:
この法律において「加入者」とは、次に掲げる者をいう。
an insured pursuant to the provisions of the Health Insurance Act; provided, however, that this does not apply to a specially-permitted insured for day laborers pursuant to the provisions of Article 3, paragraph (2) of the same Act;
an insured under the provisions of the Mariners Insurance Act;
船員保険法の規定による被保険者
an insured pursuant to the provisions of the National Health Insurance Act;
国民健康保険法の規定による被保険者
a member of a mutual aid association based on the National Public Officers mutual aid association Act or the local public employee, etc. mutual aid association Act;
国家公務員共済組合法又は地方公務員等共済組合法に基づく共済組合の組合員
a member of the Private School Teachers mutual aid system under the provisions of the Private School Teachers Mutual Aid Act;
私立学校教職員共済法の規定による私立学校教職員共済制度の加入者
a dependent pursuant to the provisions of the Health Insurance Act, the Mariners Insurance Act, the National Public Officers mutual aid association Act (including as applied mutatis mutandis pursuant to other Acts), or the local public employee, etc. mutual aid association Act; provided, however, that this does not apply to a dependent pursuant to the provisions of the Health Insurance Act of a specially-insured day laborer insured pursuant to the provisions of Article 3, paragraph (2) of the same Act;
健康保険法、船員保険法、国家公務員共済組合法（他の法律において準用する場合を含む。）又は地方公務員等共済組合法の規定による被扶養者。ただし、健康保険法第三条第二項の規定による日雇特例被保険者の同法の規定による被扶養者を除く。
a person whose specially-insured day laborer certificate book received pursuant to the provisions of Article 126 of the Health Insurance Act has not run out of blank space to affix additional health insurance stamps, or such person's dependent pursuant to the provisions of the same Act; provided, however, that this shall not apply to any person for whom a period during which said person shall not be eligible as a specially-insured day laborer pursuant to the provisions of Article 3, paragraph (2) of the same Act is running upon the approval obtained pursuant to the provisions of the proviso of the same paragraph or who has returned such specially-insured day laborer certificate book pursuant to the provisions of Article 126, paragraph (3) of the same Act or such person's dependent pursuant to the provisions of the same Act.
健康保険法第百二十六条の規定により日雇特例被保険者手帳の交付を受け、その手帳に健康保険印紙をはり付けるべき余白がなくなるに至るまでの間にある者及び同法の規定によるその者の被扶養者。ただし、同法第三条第二項ただし書の規定による承認を受けて同項の規定による日雇特例被保険者とならない期間内にある者及び同法第百二十六条第三項の規定により当該日雇特例被保険者手帳を返納した者並びに同法の規定によるその者の被扶養者を除く。