Act on Assurance of Medical Care for Elderly People

The Minister of Health, Labour and Welfare may, in order to contribute to the improvement of nationalthe health of the people, use anonymized medical data (meaning medical insurance-related information processed in accordance with the standards specified by Order of the Ministry of Health, Labour and Welfare so as to make it impossible to identify a specific insured or other person specified by Order of the Ministry of Health, Labour and Welfare pertaining to the medical insurance-related information (referred to as "the person themselves" in the following Article and Article 16-7, paragraph (1)) and to restore the medical insurance-related information used to prepare it; the same applies hereinafter), or may provide it, as specified by Order of the Ministry of Health, Labour and Welfare, to a person listed in the following items who conducts the business specified respectively in those items as business found to have considerable public interest in being conducted upon receiving the provision of anonymized medical data.

The Minister of Health, Labour and Welfare may, in order to contribute to improving the health of the people, use pseudonymized medical insurance-related information (meaning medical insurance-related information processed in accordance with the standards specified by Order of the Ministry of Health, Labour and Welfare so that the person themselves pertaining to the medical insurance-related information cannot be identified unless collated with other information; the same applies hereinafter).

The Minister of Health, Labour and Welfare may, in order to contribute to improving the health of the people, when finding it necessary for a person listed in the following items who conducts the services specified in the relevant item as services found to have considerable public interest by receiving provision of pseudonymized medical insurance-related information to use the pseudonymized medical insurance-related information in order to conduct those services, provide the pseudonymized medical insurance-related information to that person, as specified by Order of the Ministry of Health, Labour and Welfare:

other national administrative organs and local governments:surveys concerning the planning and drafting of policies that contribute to the provision of appropriate health and medical services;

universities and other research institutes:research on the causes of diseases and methods of prevention, diagnosis, and treatment of diseases, and other research on the improvement and promotion of public health;

private business operators and other persons specified by Order of the Ministry of Health, Labour and Welfare:analyses that contribute to research and development in the medical field and other services specified by Order of the Ministry of Health, Labour and Welfare (excluding those carried out for the purpose of using them in the advertisement or promotion of specific goods or services).

In the case of making use or provision pursuant to the provisions of the preceding two paragraphs, the Minister of Health, Labour and Welfare may use the relevant pseudonymized medical insurance-related information in combination with the pseudonymized medical care-related information prescribed in Article 150-7, paragraph (1) of the Health Insurance Act, the pseudonymized long-term care insurance-related information prescribed in Article 118-8, paragraph (1) of the Long-Term Care Insurance Act, and other information specified by Order of the Ministry of Health, Labour and Welfare, or provide it in a state in which it can be used in combination with them.

If the Minister of Health, Labour and Welfare intends to provide pseudonymized medical insurance-related information pursuant to the provisions of paragraph (2), the Minister must hear the opinion of the Social Security Council in advance.

When providing pseudonymized medical insurance-related information pursuant to the provisions of paragraph (2) of the preceding Article, if the Minister of Health, Labour and Welfare finds it necessary, the Minister is to impose restrictions on the purpose or method of use of the pseudonymized medical insurance-related information provided, and other necessary restrictions, on a person who receives and uses pseudonymized medical insurance-related information pursuant to the provisions of that paragraph (hereinafter referred to as a "user of pseudonymized medical data").

The provisions of Article 68 and Articles 76 through 107 of the Act on the Protection of Personal Information (Act No. 57 of 2003) do not apply to cases where the Minister of Health, Labour and Welfare uses or provides pseudonymized medical insurance-related information pursuant to the provisions of paragraph (1) or (2) of the preceding Article.

The provisions of Articles 16-3 through 16-6 apply mutatis mutandis to the handling of pseudonymized medical insurance-related information by a user of pseudonymized medical data.

To the extent necessary for the enforcement of the provisions of this Section, the Minister of Health, Labour and Welfare may order users of anonymized medical data and users of pseudonymized medical data (excluding other administrative organs of the national government; hereinafter the same applies referred to as "users of anonymized or pseudonymized medical data" in this paragraph and the following Article) to make a report or submit or present books and documents, or have the relevant officials question the relevant persons or enter the offices or other places of business of the users of anonymized or pseudonymized medical data to inspect the books, documents, and any other articles of the users of anonymized or pseudonymized medical data.

When the Minister of Health, Labour and Welfare finds that a user of anonymized or pseudonymized medical data is in violation of any of the provisions of Articles 16-3 through 16-6 (including cases where these provisions apply mutatis mutandis pursuant to Article 16-9) or the restrictions imposed pursuant to the provisions of Article 16-8, paragraph (1) (including cases where those provisions apply mutatis mutandis pursuant to paragraph (2) of the following Article), the Minister of Health, Labour and Welfare may order the person to take necessary measures to rectify the violation.

The Minister of Health, Labour and Welfare may entrust the investigation and analysis prescribed in Article 16, paragraph (1) and the affairs pertaining to the use orand provision under Article 16-2, paragraph (1) and Article 16-7, paragraphs (1) and (2), in whole or in part, to the Medical Information Infrastructure and Medical Fee Examination and Payment Organization under the Medical Information Infrastructure and Medical Fee Examination and Payment Organization Act (Act No. 129 of 1948) (hereinafter referred to as the "Organization"), the Federation of National Health Insurance Associations prescribed in Article 45, paragraph (5) of the National Health Insurance Act (hereinafter referred to as the "NHI federation"), or other persons specified by Order of the Ministry of Health, Labour and Welfare (referred to as the "Organization, etc." in the following Article).

The provisions of Article 16-8, paragraph (1) apply mutatis mutandis to cases where a person entrusted pursuant to the provisions of the preceding paragraph provides pseudonymized medical insurance-related information based on that entrustment.

The provisions of Article 68 and Articles 76 through 107 of the Act on the Protection of Personal Information do not apply to cases where a person entrusted pursuant to the provisions of paragraph (1) uses or provides pseudonymized medical insurance-related information based on that entrustment.

Users of anonymized medical data must pay a fee in the amount specified by Cabinet Order in consideration of the actual costs to the national government (when the Organization, etc. conducts all of the affairs related to the provision of anonymized medical data under Article 16-2, paragraph (1) upon entrustment from the Minister of Health, Labour and Welfare pursuant to the provisions of paragraph (1) of the preceding Article, the Organization, etc.).

The provisions of the preceding three paragraphs apply mutatis mutandis to the fee in the case where a user of pseudonymized medical data is provided with pseudonymized medical insurance-related information pursuant to the provisions of Article 16-7, paragraph (2).

the amount equivalent to two-thirds of the amount obtained by subtracting the amount set forth in 34. from the sum of the amounts set forth in 1. and 2through 3. (if the amount is less than zero, it is deemed to be zero):

the estimated base amount calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, based on the amount subject of the physician allowance contribution under the provisions of the Act on Promotion of Comprehensive Securing of Medical and Long-Term Care in Communities pertaining to adjustment the relevant Insurer in the relevant fiscal year. (hereinafter referred to as "physician allowance contribution"), in accordance with the ratio of the prospective amount of young-old benefit expenses prescribed in item (i) of the following paragraph to the estimated amount of the expenses required for benefits by insurers prescribed in that item (hereinafter referred to in this Article and Article 38, paragraph (2) as the "estimated amount of physician allowance contribution pertaining to the young-old");

the estimated base amount subject to adjustment in the relevant fiscal year.

the amount equivalent to one third of the amount obtained by deducting the estimated base amount for subject to adjustment after adjustment of remunerationsremuneration adjustment in the relevant fiscal year from the sum of the estimated amount of benefit expenses subject to adjustment pertaining to the insurer andInsurer, the estimated amount of Medical Care Assistanceaid for the Elderly Aged 75 old-old pertaining to the young-old and overthe estimated amount of physician allowance contribution pertaining to the young-old in the relevant fiscal year (if the amount is less than zero, it is deemed to be zero);

insurersInsurers other than insurers covered byInsurers of employee insurance, etc.:the amount obtained by deducting the estimated base amount for subject to adjustment in the relevant fiscal year from the sum of the estimated amount of benefit expenses subject to adjustment pertaining to the relevant insurers andInsurers, the estimated amount of Medical Care Assistanceaid for the Elderly Aged 75 old-old pertaining to the young-old and overthe estimated amount of physician allowance contribution pertaining to the young-old in the relevant fiscal year (if the amount is less than zero, it is deemed to be zero).

The estimated base amount subject to adjustment set forth in the items of paragraph (1) is the amount obtained by multiplying the sum of the estimated amount of benefit expenses subject to adjustment set forth in the items of the same paragraph pertaining to the relevant insurer andInsurer, the estimated amount of Medical Care Assistanceaid for the Elderly Aged 75 and overold-old pertaining to the young-old (in the case of an insurer of employee insurance, etc., the amount obtained by multiplying the relevant amount by the estimated amount adjustmentcorrection rate) and the estimated amount of physician allowance contribution pertaining to the young-old by the estimated participant adjustment rate.

The estimated base amount subject to adjustment after remuneration adjustment set forth in paragraph (1), item (i), (b) is the amount obtained by multiplying by the estimated participant adjustment rate the sum total of the amount obtained by multiplying the sum total of the estimated amount of benefit expenses subject to adjustment set forth in the items of that paragraph pertaining to the relevant Insurer and the estimated amount of physician allowance contribution pertaining to the young-old by the rate obtained by dividing the amount set forth in item (i) for the relevant fiscal year by the amount set forth in item (ii) (referred to as the "estimated remuneration adjustment rate" in paragraph (6), item (i)) and the correction rate for estimated benefit expense correction rateexpenses, etc., and the amount obtained by multiplying the estimated amount of aid for the old-old pertaining to the young-old by the estimated amount correction rate.

the amount obtained by dividing the amount calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare as the prospective amount of theestimated total amount of standardized remunerationsstandard remuneration pertaining to the insurerInsurer (referred to as the "prospective amount of theestimated total amount of standardized remunerationsstandard remuneration" in the following item and Article 120, paragraph (1), item (i), (ac) and (bd)) by the prospectiveestimated number of subscribersparticipants pertaining to the insurerInsurer calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare;

The correction rate for estimated benefit expense adjustment rateexpenses, etc. referred to in paragraph (4) is the rate calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare so that the total of the amounts set forth in item (i) pertaining to each of the Insurers of employee insurance, etc. is equal to the total of the amounts set forth in item (ii):

the amount arrived at when the estimated amountsum total of the covered estimated amount of benefit expenses subject to adjustment referred to in the items of paragraph (1) and the estimated amount of physician allowance contribution pertaining to the young-old is multiplied by the estimated remuneration adjustment rate and the estimated participant adjustment rate;

the amount arrived at when the estimated amountsum total of the covered estimated amount of benefit expenses subject to adjustment referred to in the items of paragraph (1) and the estimated amount of physician allowance contribution pertaining to the young-old is multiplied by the estimated participant adjustment rate.

the amount equivalent to two-thirds of the amount obtained by subtracting the amount set forth in 45. from the sum of the amounts set forth in 1. through 34. (if the amount is less than zero, it is deemed to be zero):

the portion of the amount of the contribution for securing medical care incalculated pursuant to the early phaseprovisions of an epidemic under the Act onOrder of the PreventionMinistry of Infectious DiseasesHealth, Labour and Medical Care for Patients with Infectious Diseases (Act No. 114 of 1998) (hereinafter referred to asWelfare, based on the "contribution for securing medical care inamount of the early phase of an epidemic")physician allowance contribution pertaining to the relevant Insurer in the fiscal year before the previous fiscal year that is calculated, as pertaining to participants who are, in accordance with the ratio of the amount of young-old adults, as specified by Order benefit expenses prescribed in item (i) of the Ministry following paragraph to the amount of Health, Labour and Welfare expenses required for benefits by the relevant Insurer (hereinafter referred to as the "amount of contribution for securing medical care inin this Article and Article 39, paragraph (2) as the early phase"fixed amount of an epidemicphysician allowance contribution pertaining to the young-old");

the fixed base amount calculated, as specified by Order of the Ministry of Health, Labour and Welfare, based on the amount subject of the contribution for securing medical care in the early phase of an epidemic under the Act on the Prevention of Infectious Diseases and Medical Care for Patients with Infectious Diseases (Act No. 114 of 1998) (hereinafter referred to adjustment as the "contribution for securing medical care in the early phase of an epidemic") pertaining to the relevant Insurer in the fiscal year before the previous fiscal year., in accordance with the ratio of the amount of young-old benefit expenses prescribed in item (i) of the following paragraph to the amount of expenses required for benefits by the relevant Insurer (hereinafter referred to as the "amount of contribution for securing medical care in the early phase of an epidemic pertaining to the young-old");

the fixed base amount subject to adjustment in the fiscal year before the previous fiscal year.

the amount equivalent to one third of the amount obtained by subtracting the fixed base amount subject to adjustment after theremuneration adjustment of fixed remunerations in the fiscal year before the previous fiscal year from the sum of the amount of benefit expenses subject to adjustment pertaining to the insurerInsurer, the fixed amount of Medical Care Assistance for aid for the old-old pertaining to the Elderly Aged 75 and over young-old, the fixed amount of physician allowance contribution pertaining to the young-old, and the amount of contributionscontribution for securing medical care in the early stagephase of an epidemic pertaining to the young-old in the same fiscal year (if the amount is less than zero, it is deemed to be zero);

insurersInsurers other than insurersInsurers of employee insurance, etc.:the amount obtained by subtracting the finalfixed base amount for subject to adjustment in the fiscal year before the previous fiscal year from the sum of the amount of benefit expenses subject to adjustment pertaining to the relevant insurersInsurers, the finalfixed amount of Medical Care Assistance for aid for the old-old pertaining to the Elderly Aged 75 and over young-old, the fixed amount of physician allowance contribution pertaining to the young-old, and the amount of contributionscontribution for securing medical care in the early stagephase of an epidemic pertaining to the young-old in the same fiscal year (if the amount is less than zero, it is deemed to be zero).

The finalfixed base amount for subject to adjustment set forth in the items of paragraph (1) is the amount obtained by multiplying the total of the amount of benefit expenses subject to adjustment set forth in the items of the same paragraph pertaining to the insurerInsurer, the finalfixed amount of Medical Care Assistanceaid for the Elderly Aged 75 and overold-old pertaining to the young-old (in the case of Insurers of employee insurance, etc., the amount obtained by multiplying the amount by the finalfixed amount adjustmentcorrection rate), the fixed amount of physician allowance contribution pertaining to the young-old, and the amount of contributions to ensurecontribution for securing medical care in the early stagephase of an epidemic pertaining to the young-old, by the finalfixed participant adjustment rate.

The fixed base amount subject to adjustment after remuneration adjustment set forth in paragraph (1), item (i), (b) is the amount obtained by multiplying by the fixed participant adjustment rate the sum total of the amount obtained by multiplying the sum total of the amount of benefit expenses subject to adjustment set forth in the items of that paragraph pertaining to the relevant Insurer, the fixed amount of physician allowance contribution pertaining to the young-old and the amount of contribution for securing medical care in the early phase of an epidemic pertaining to the young-old by the rate obtained by dividing the amount set forth in item (i) by the amount set forth in item (ii) for the fiscal year before the previous fiscal year (referred to as the "fixed remuneration adjustment rate" in paragraph (6), item (i)) and the correction rate for fixed benefit expenses, etc., and the amount obtained by multiplying the fixed amount of aid for the old-old pertaining to the young-old by the fixed amount correction rate.

the amount obtained by multiplying the sum of the amount of paymentbenefit expenses subject to adjustment set forth in the items of paragraph (1), the fixed amount of physician allowance contribution pertaining to the young-old and the amount of contributionscontribution for ensuringsecuring medical care in the early stagephase of an epidemic pertaining to young-old persons set forth in the items of paragraph (1)young-old by the fixed remuneration adjustment rate and the fixed participant adjustment rate;

the amount obtained by multiplying the sum of the amount of paymentbenefit expenses subject to adjustment set forth in the items of paragraph (1) , the fixed amount of physician allowance contribution pertaining to the young-old, and the amount of contributions to ensurecontribution for securing medical care in the early stagephase of an epidemic pertaining to the young-old by the fixed participant adjustment rate.

the amount calculated as specified by Order of the Ministry of Health, Labour and Welfare as the estimated amount of the expenses required for benefits by insurers in the relevant fiscal year (including the expenses required for the payment of the day laborer contribution prescribed in Article 173, paragraph (2) of the Health Insurance Act; referred to as "expenses required for benefits by insurers, etc." in the following item, (b), (2) and Article 39, paragraph (1), item (i), (b), (2) and item (ii), (b), (2)), and the amount of physician allowance contribution;

the amount calculated as specified by Order of the Ministry of Health, Labour and Welfare as the estimated amount of the expenses required for benefits by insurers, etc. in the relevant fiscal year, and the amount of physician allowance contribution.

the amount equivalent to two-thirds of the amount obtained by deducting the sum total of the estimated amount of benefit expenses subject to adjustment set forth in the items of Article 34, paragraph (1) pertaining to the relevant Insurer and, the estimated amount of aid for the old-old pertaining to the young-old and the estimated amount of physician allowance contribution pertaining to the young-old from the estimated base amount subject to adjustment set forth in the items of Article 34, paragraph (1) (if the amount is less than zero, it is deemed to be zero);

the amount equivalent to one third of the amount obtained by deducting the sum total of the estimated amount of benefit expenses subject to adjustment set forth in the items of Article 34, paragraph (1) pertaining to the relevant Insurer and, the estimated amount of aid for the old-old pertaining to the young-old and the estimated amount of physician allowance contribution pertaining to the young-old from the estimated base amount subject to adjustment after remuneration adjustment set forth in Article 34, paragraph (1), item (i), (b) (if the amount is less than zero, it is deemed to be zero).

insurersInsurers other than insurers covered byInsurers of employee insurance, etc.:the amount obtained by deducting the sum of the estimated amount of benefit expenses subject to adjustment set forth in the items of Article 34, paragraph (1) pertaining to the relevant insurers andInsurers, the estimated amount of Medical Care Assistanceaid for the Elderly Aged 75 old-old pertaining to the young-old, and overthe estimated amount of physician allowance contribution pertaining to the young-old (if the relevant amount is less than zero, it is deemed to be zero) from the estimated base amount subject to adjustment set forth in the items of the same paragraph.

the amount of the expenses required for benefits by insurers, etc. of the relevant Insurer, the amount of the physician allowance contribution and the amount of the contribution for securing medical care in the early phase of an epidemic, in the fiscal year before the previous fiscal year;

the amount of the expenses required for benefits by insurers, etc. of the relevant Insurer, the amount of the physician allowance contribution and the amount of the contribution for securing medical care in the early phase of an epidemic, in the fiscal year before the previous fiscal year.

the amount equivalent to two-thirds of the amount obtained by subtracting the sum of the amount of benefitsbenefit expenses subject to adjustment set forth in the items of Article 35, paragraph (1) pertaining to the insurerInsurer, the fixed amount of Medical Care Assistance for aid for the old-old pertaining to the Elderly Aged 75 and over young-old, the fixed amount of physician allowance contribution pertaining to the young-old, and the amount of contributions to ensurecontribution for securing medical care in the early stagephase of an epidemic pertaining to the young-old (if the amount is less than zero, it is deemed to be zero) from the fixed base amount subject to adjustment set forth in the items of the same paragraph;

the amount equivalent to one third of the amount obtained by deducting, from the fixed base amount for adjustment aftersubject to adjustment of fixed compensationafter remuneration adjustment set forth in Article 35, paragraph (1), item (i), (b), the sum of the amount of benefit expenses subject to adjustment set forth in the items of the same paragraph pertaining to the insurerInsurer, the fixed amount of Medical Care Assistance for aid for the old-old pertaining to the Elderly Aged 75 and over young-old, the fixed amount of physician allowance contribution pertaining to the young-old, and the amount of contributions to ensurecontribution for securing medical care in the early stagephase of an epidemic pertaining to the young-old (if the amount is less than zero, it is deemed to be zero);

insurersInsurers other than insurersInsurers of employee insurance, etc.:the amount obtained by subtracting the sum of the amount of benefit expenses subject to adjustment set forth in the items of Article 35, paragraph (1) pertaining to the relevant insurersInsurers, the fixed amount of Medical Care Assistance for aid for the old-old pertaining to the Elderly Aged 75 and over young-old, the fixed amount of physician allowance contribution pertaining to the young-old, and the amount of contributions to ensurecontribution for securing medical care in the early stagephase of an epidemic pertaining to the young-old from the fixed base amount subject to adjustment set forth in the items of the same paragraph (if the amount is less than zero, it is deemed to be zero).

The provisions of Article 16-716-10, paragraph (2) apply mutatis mutandis to questions pursuant to the provisions of the preceding two paragraphs, and the provisions of paragraph (3) of the same Article apply mutatis mutandis to the authority granted pursuant to the provisions of the preceding two paragraphs.

The provisions of Article 16-716-10, paragraph (2) and Article 66, paragraph (2) apply mutatis mutandis to questions and inspections pursuant to the provisions of the preceding paragraph, and the provisions of Article 16-716-10, paragraph (3) apply mutatis mutandis to the authority granted pursuant to the provisions of the preceding paragraph.

The provisions of Article 16-716-10, paragraph (2) apply mutatis mutandis to questions and inspections pursuant to the provisions of the preceding paragraph, and the provisions of paragraph (3) of the same Article apply mutatis mutandis to the authority granted pursuant to the provisions of the preceding paragraph.

The national government, pursuant to the provisions of Cabinet Order, bears, with respect to the for an Association of Medical Care Systems for the Elderly Aged 75 and older, an amount equivalent to 3/12 of the sum total (hereinafter referred to as the "total Amount Subject to Sharing") of the amount obtained by deducting the amount of expenses incurred in providing benefits for medical treatment, etc. pertaining to persons falling under the case listed in Article 67, paragraph (1), item (iii)following amounts (hereinafter referred to as the "amount of specified expenses") from the sum total (hereinafter referred to as the "amount of expenses incurred in providing benefits for medical treatment, etc.") of the amount obtained by deducting the amount equivalent to the co-payment for the benefits from the amount of expenses required for the benefits for medical treatment pertaining to insured and the amount of expenses required for payment of dietary treatment expenses for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, special medical expenses, transport expenses, high-cost medical expenses and sizable medical and nursing expenses (referred to as the "Amount Subject to Sharing" in item (i) of the following paragraph and Article 100, paragraph (1)), and the amount obtained by deducting, from the amount of the contribution for securing medical care in the early phase of an epidemic, the amount obtained by multiplying that amount by the ratio of the amount of specified expenses to the amount of expenses incurred in providing benefits for medical treatment, etc. (referred to as the "amount of specified contribution for securing medical care in the early phase of an epidemic" in Article 100, paragraph (1)) (referred to as the "contribution Amount Subjectsubject to Sharing" in Article 100, paragraph (1)).sharing"):

the amount (referred to as the "Amount Subject to Sharing" in item (i) of the following paragraph and Article 100, paragraph (1), item (i)) obtained by deducting, from the sum total of the amount obtained by deducting the amount equivalent to the co-payment pertaining to benefits for medical treatment from the amount of expenses required for benefits for medical treatment pertaining to the insured, and the amount of expenses required for payment of dietary treatment expenses for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, special medical expenses, transport expenses, high-cost medical expenses, and sizable medical and nursing expenses (hereinafter referred to as the "amount of expenses incurred in providing benefits for medical treatment, etc."), the amount of expenses incurred in providing benefits for medical treatment, etc. pertaining to persons who fall under the cases set forth in Article 67, paragraph (1), item (iii) (hereinafter referred to in this paragraph, Article 100, paragraph (1), item (i), and paragraph (2), item (i) as the "amount of specified expenses");

the amount (referred to as the "physician allowance contribution amount subject to sharing" in Article 100, paragraph (1), item (ii) and Article 120, paragraph (1), item (i), (b)) obtained by deducting, from the amount of expenses required for payment of physician allowance contribution, the amount (referred to as the "amount of specified physician allowance contribution" in Article 100, paragraph (1), item (ii) and Article 120, paragraph (1), item (i), (b)) obtained by multiplying the amount of expenses required for payment of that physician allowance contribution by the ratio of the amount of specified expenses to the amount of expenses incurred in providing benefits for medical treatment, etc.;

the amount (referred to as the "contribution amount subject to sharing" in Article 100, paragraph (1), item (iii)) obtained by deducting, from the amount of expenses required for payment of contribution for securing medical care in the early phase of an epidemic, the amount (referred to as the "amount of specified contribution for securing medical care in the early phase of an epidemic" in that item) obtained by multiplying the amount of expenses required for payment of that contribution for securing medical care in the early phase of an epidemic by the ratio of the amount of specified expenses to the amount of expenses incurred in providing benefits for medical treatment, etc.

The national government, beyond in addition to what is listedprovided for in the preceding paragraph, pursuant to the provisions of Cabinet Order, in order to achieve the financial stability of old-old medical care, bears, with respect to the Association of Medical Care Systems for the Elderly Aged 75 and older, an amount equivalent to 1/4 of the amount obtained by multiplying the sum total of the expenses required for benefits related to extremely expensive medical care that are not less than the amount calculated as specified by Cabinet Order as having a significant impact on the finances of old-old medical care due to the occurrence of benefits related to extremely expensive medical care, taking into consideration the ratio of benefits related to extremely expensive medical care to the amount of expenses required for all benefits related to medical care pertaining to insured and other factors, by the sum of the following rates (referred to as the "amount of high-cost medical expenses subject to sharing" in Article 96, paragraph (2)).

the contribution rate for the old-old in Article 100, paragraph (12).

Among the expenses borne in the special account for old-old medical care of the Association of Medical Care Systems for the Elderly Aged 75 and older, the amount obtained by adding, to the sum total of the amount obtained by multiplying the Amount Subject to Sharing by the rate obtained by deducting the contribution rate for the old-old and 50 percent from one and the amount obtained by multiplying the amount of specified expenses by the rate obtained by deducting the contribution rate for the old-old from one (hereinafter referred to as the "amount subject to insurance payment" in this Section), the sum total of the amount obtained by multiplying the contribution Amount Subject to Sharing by the rate obtained by deducting the contribution rate for the old-old and 50 percent from one and the amount obtained by multiplying the amount of specified contribution for securing medical care in the early phase of an epidemic by the rate obtained by deducting the contribution rate for the old-old from onefollowing amounts (referred to as the "total amount subject to insurance payment" in Article 121, paragraph (1)) is to be covered by the Old-Old Subsidy granted by the Organization to the Association of Medical Care Systems for the Elderly Aged 75 and older, pursuant to the provisions of Cabinet Order.

the sum total of the amount obtained by multiplying the Amount Subject to Sharing by the rate obtained by deducting the contribution rate for the old-old and 50 percent from 1, and the amount obtained by multiplying the amount of specified expenses by the rate obtained by deducting the contribution rate for the old-old from 1 (hereinafter referred to in this Section as the "amount subject to insurance payment");

the sum total of the amount obtained by multiplying the physician allowance contribution amount subject to sharing by the rate obtained by deducting the contribution rate for the old-old and 50 percent from 1, and the amount obtained by multiplying the amount of specified physician allowance contribution by the rate obtained by deducting the contribution rate for the old-old from 1;

the sum total of the amount obtained by multiplying the contribution amount subject to sharing by the rate obtained by deducting the contribution rate for the old-old and 50 percent from 1, and the amount obtained by multiplying the amount of specified contribution for securing medical care in the early phase of an epidemic by the rate obtained by deducting the contribution rate for the old-old from 1.

The contribution rate for the old-old set forth in the items of the preceding paragraph is specified by Cabinet Order every two years based on the rate obtained by multiplying the number set forth in item (i) by the rate set forth in item (ii) and then dividing the product by the number set forth in item (iii):

A municipality must collect insurance premiums to cover the expenses required for old-old medical care (including expenses required for payment of the Fiscal Stability Fund contributions, the contributions and childbirth support payments pursuant to the provisions of Article 117, paragraph (2), the physician allowance contributions, etc. pursuant to the provisions of the Act on Promotion of Comprehensive Securing of Medical and Long-Term Care in Communities (hereinafter referred to as the "physician allowance contributions, etc."), the contribution for securing medical care in the early phase of an epidemic, etc. pursuant to the provisions of the Act on the Prevention of Infectious Diseases and Medical Care for Patients with Infectious Diseases (referred to as the "contribution for securing medical care in the early phase of an epidemic, etc." in paragraph (3) and Article 116, paragraph (2)), and the children and child-rearing support levy).

The insurance premiums rate referred to in the preceding paragraph must be able to maintain a balanced budget in general throughout two years in light of the estimated amount of expenses incurred in providing benefits for medical treatment, etc., the estimated amount of expenses required for payment of the Fiscal Stability Fund contributions, the contributions and childbirth support payments pursuant to the provisions of Article 117, paragraph (2), the physician allowance contributions, etc., the contribution for securing medical care in the early phase of an epidemic, etc., and the children and child-rearing support levy, the estimated amount of expenses required for redemption of borrowings from the prefecture pursuant to the provisions of Article 116, paragraph (1), item (ii), the estimated amount of expenses required for health services for the elderly provided for in Article 125, paragraph (1) and for the services provided for in paragraph (5) of the same Article, the status of distribution of income of insured and its prospects, the national treasury burden, and the amount of the Old-Old Subsidy, etc. in Article 100, paragraph (1).

the estimated amount of insurance premiums received: the amount calculated pursuant to the provisions of Cabinet Order as the amount to be allocated to the amount of expenses incurred in providing benefits for medical treatment, etc., the amount of expenses required for payment of the Fiscal Stability Fund contributions, the contributions and childbirth support payments pursuant to the provisions of paragraph (2) of the following Article, the physician allowance contributions, etc., the contribution for securing medical care in the early phase of an epidemic, etc., and the children and child-rearing support levy, and the amount of expenses required for redemption of borrowings from the prefecture pursuant to the provisions of item (ii) of the preceding paragraph (hereinafter referred to as "Borrowings for Fund Project" in this paragraph), out of the total amount of insurance premiums that are expected to be received, during the specified period (meaning every two-fiscal-year period from fiscal year 2008, which is the first year; the same applies hereinafter in this paragraph), by the municipalities that organize the Association of Medical Care Systems for the Elderly Aged 75 and older in that Association;

the actual amount of insurance premiums received: the amount calculated pursuant to the provisions of Cabinet Order as the amount to be allocated to the sum total of the amount obtained by deducting the amount equivalent to the co-payment for the benefits from the amount of expenses spent on benefits for medical treatment and the amount of expenses spent on payment of dietary treatment expenses for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, special medical expenses, transport expenses, high-cost medical expenses and sizable medical and nursing expenses (hereinafter referred to as the "amount of costs spent on benefits for medical treatment, etc." in this paragraph), the amount of expenses spent on payment of the Fiscal Stability Fund contributions, the contributions and childbirth support payments pursuant to the provisions of paragraph (2) of the following Article, the physician allowance contributions, etc., the contribution for securing medical care in the early phase of an epidemic, etc., and the children and child-rearing support levy, and the amount of expenses spent on redemption of Borrowings for Fund Project, out of the total amount of insurance premiums received during the specified period by the municipalities that organize the Association of Medical Care Systems for the Elderly Aged 75 and older;

the amount of revenue subject to fund projects: the amount calculated pursuant to the provisions of Cabinet Order as the amount to be allocated to the amount of costs spent on benefits for medical treatment, etc., the amount of expenses spent on payment of the Fiscal Stability Fund contributions, the contributions and childbirth support payments pursuant to the provisions of paragraph (2) of the following Article, the physician allowance contributions, etc., the contribution for securing medical care in the early phase of an epidemic, etc., and the children and child-rearing support levy, and the amount of expenses spent on redemption of Borrowings for Fund Project, out of the total of the amounts received during the specified period in the special account for old-old medical care of the Association of Medical Care Systems for the Elderly Aged 75 and older (excluding the amount of grants for fund business set forth in item (v) and the amount of Borrowings for Fund Project);

the amount of expenses subject to fund projects: the amount calculated pursuant to the provisions of Cabinet Order as the sum total of the amount of costs spent on benefits for medical treatment, etc., the amount of expenses spent on payment of the Fiscal Stability Fund contributions, the contributions and childbirth support payments pursuant to the provisions of paragraph (2) of the following Article, the physician allowance contributions, etc., the contribution for securing medical care in the early phase of an epidemic, etc., and the children and child-rearing support levy, and the amount of expenses spent on redemption of Borrowings for Fund Project, during the specified period at the Association of Medical Care Systems for the Elderly Aged 75 and older;

Insurers of employee insurance, etc.: the amount obtained by multiplying the amount obtained by multiplying the amount obtained by dividing the total of the estimated amountssum totals of the amounts subject to insurance payment set forth in (a) and (b) of all Associations of Medical Care Systems for the Elderly Aged 75 and older in the relevant fiscal year by the estimated total number of participants pertaining to all Insurers in the same fiscal year, calculated as specified by Order of the Ministry of Health, Labour and Welfare, by the estimated number of participants pertaining to all Insurers of employee insurance, etc. in the same fiscal year, calculated as specified by Order of the Ministry of Health, Labour and Welfare, by the rate obtained by dividing the amount set forth in (ac) by the amount set forth in (bd) for the same fiscal year and the estimated old-old aid adjustment rate;

the estimated amount of the Total Amount of Standard Fees pertainingamount subject to the Insurer of employee insurance, etc. payment;

the sum estimated amount of the estimated amountssum total of the total amount of standardized remunerations pertaining obtained by multiplying the physician allowance contribution amount subject to all Insurers of employee insurance, etc.sharing by the rate obtained by deducting the contribution rate for the old-old set forth in Article 100, paragraph (2) and 50 percent from 1, and the amount obtained by multiplying the amount of specified physician allowance contribution by the rate obtained by deducting the contribution rate for the old-old set forth in that paragraph from 1;

the estimated total standard remuneration pertaining to the relevant insurer of employee insurance, etc.;

the sum total of the estimated total standard remuneration pertaining to all Insurers of employee insurance, etc.;

Insurers other than Insurers of employee insurance, etc.: the amount obtained by multiplying the amount obtained by multiplying the amount obtained by dividing the total of the estimated amountssum totals of the amounts subject to insurance paymentset forth in (a) and (b) of the preceding item of all Associations of Medical Care Systems for the Elderly Aged 75 and older in the relevant fiscal year by the estimated total number of participants pertaining to all Insurers in the same fiscal year, calculated as specified by Order of the Ministry of Health, Labour and Welfare, by the estimated number of participants pertaining to the relevant Insurer in the same fiscal year, calculated as specified by Order of the Ministry of Health, Labour and Welfare, by the estimated old-old aid adjustment rate.

The provisions of Article 16-716-10, paragraph (2) apply mutatis mutandis to the inspection pursuant to the provisions of the preceding two paragraphs, and the provisions of paragraph (3) of the same Article apply mutatis mutandis to the authority pursuant to the provisions of the preceding two paragraphs.

The provisions of Article 16-716-10, paragraph (2) apply mutatis mutandis to questions pursuant to the provisions of the preceding two paragraphs, and the provisions of paragraph (3) of the same Article apply mutatis mutandis to the authority granted pursuant to the provisions of the preceding two paragraphs.

The provisions of Article 16-716-10, paragraph (2) apply mutatis mutandis to the inspection under the provisions of the preceding paragraph, and the provisions of paragraph (3) of the same Article apply mutatis mutandis to the authority under the provisions of the preceding paragraph.

The provisions of Article 16-716-10, paragraph (2) apply mutatis mutandis to questions and inspections pursuant to the provisions of the preceding paragraph, and the provisions of paragraph (3) of the same Article apply mutatis mutandis to the authority granted pursuant to the provisions of the preceding paragraph.

A person who falls underIn the case where any of the following items applies, the person who committed the violation is punished by imprisonment for not more than one year or by a fine of not more than 500,000 yen, or both:

a if the person whohas, in violation of the provisions of Article 16-6, has disclosed the content of anonymized medical data related to medical insurance, etc. acquired in relation to the use of the anonymized medical data related to medical insurance, etc. to another person without justifiable grounds, or used the information for an unjust purpose;

a person whoif the person has violated an order issued under, in violation of the provisions of Article 16-8.16-6 as applied mutatis mutandis pursuant to Article 16-9, disclosed the content of pseudonymized medical insurance-related information acquired in relation to the use of the pseudonymized medical insurance-related information to another person without justifiable grounds, or used the information for an unjust purpose;

if the person has violated an order issued under the provisions of Article 16-11.

A person whoIf a person fails to make a report or submit or present books and documents under the provisions of Article 16-716-10, paragraph (1), or makes a false report or submits or presents false books and documents, or fails to answer or gives a false answer to the questions under the provisions of the same paragraph, or refuses, interferes with, or evades the on-site inspection under the provisions of the same paragraph, the person who committed the violation is punished by a fine of not more than 500000 yen.