Act on Assurance of Medical Care for Elderly People

From the perspective of ensuring appropriate medical care for the people in old age, in order to promote the optimization of expenses required for medical care (hereinafter referred to as "optimization of medical expenses") in a comprehensive and systematic manner, the Minister of Health, Labour and Welfare is to establish basic policies concerning measures for the optimization of medical expenses (hereinafter referred to as the "basic policies for the optimization of medical expenses"), and establish a plan for promoting the optimization of medical expenses every six years (hereinafter referred to as the "national plan for the optimization of medical expenses") with six years as one period.

The Basic Policy on Regulating Medical Expenses is to provide for the following matters:

the standards to be taken into consideration pertaining to the targets to be specified in the Prefectural Plan for Regulating Medical Expenses as prescribed in paragraph (1) of the following Article and other basic matters to be guidelines in preparing the plan;

basic matters concerning the evaluation of the degree of achievement of the prefectural plan for regulating medical expenses prescribed in paragraph (1) of the following Article;

basic particulars concerning investigation and analysis of the expenses required for medical services;

beyond what is set forth in the preceding three items, important matters concerning the promotion of the optimization of medical expenses.

The basic policies for regulating medical expenses must be in harmony with the basic policies prescribed in Article 30-3, paragraph (1) of the Medical Care Act, the basic guidelines prescribed in the Article 116, paragraph (1) of the Long-Term Care Insurance Act (Act No. 123 of 1997), and the basic policies prescribed in Article 7, paragraph (1) of the Health Promotion Act (Act No. 103 of 2002).

The National Plan for Regulating Medical Expenses is to specify the following matters:

the particulars of the goals that the national government must achieve to advance the optimization of medical expenses in connection with the furtherance of the people's commitment to maintaining their health;

with regard to the promotion of the efficient provision of medical care, matters concerning the targets to be achieved by the national government for the promotion of the optimization of medical expenses;

matters concerning measures to be taken by the national government in order to achieve the goals set forth in the preceding two items;

particulars concerning coordination and cooperation among insurers, Association of Medical Care Systems for the Elderly Aged 75 and older, medical institutions, and other relevant persons in order to achieve the goals set forth in items (i) and (ii);

in light of the implementation of projects based on the regional medical care vision of each prefecture (meaning the regional medical care vision prescribed in Article 30-3-3, paragraph (1) of the Medical Care Act; the same applies hereinafter) and the medical care plan (meaning the medical care plan prescribed in Article 30-4, paragraph (1) of the same Act; the same applies hereinafter), matters concerning the results of the promotion of the differentiation and coordination of the medical institution functions (meaning the medical institution functions prescribed in Article 30-3, paragraph (2), item (vi) of the same Act; the same applies hereinafter) and the bed functions (meaning the bed functions prescribed in item (vii) of the same paragraph; the same applies hereinafter) expected during the period of the plan;

matters concerning the prospective expenses required for medical care during the period of the plan calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, based on the matters set forth in the preceding item, the expected effects of the optimization of medical expenses through the promotion of the maintenance of citizens' health and the promotion of the efficient provision of medical care to achieve the goals set forth in items (i) and (ii), and other matters specified by Order of the Ministry of Health, Labour and Welfare (referred to as the "national target of expenses required for medical care" in Article 11, paragraph (7));

matters concerning the evaluation of the status of the achievement of the plan;

beyond what is set forth in the preceding items, matters necessary for promoting the optimization of medical expenses.

In specifying the particulars set forth in items (i) through (iii) of the preceding paragraph, the Minister of Health, Labour and Welfare is to pay attention to the significance of promoting the differentiation and coordination of medical institution functions and bed functions, securing the family doctor function prescribed in Article 6-3, paragraph (1) of the Medical Care Act (referred to as the "family doctor function" in paragraph (4) of the following Article), efforts towards the establishment of the community-based integrated care system prescribed in Article 2, paragraph (1) of the Act on Promotion of Comprehensive Securing of Medical and Long-Term Care in Communities (Act No. 64 of 1989) (referred to as the "community-based integrated care system" in paragraph (4) of the following Article), and the effective and efficient provision of medical care and nursing care in light of the physical, mental and social characteristics of the citizens as they age.

The Minister of Health, Labour and Welfare is to consult with the head of a relevant administrative organ in advance, when intending to establish or change the Basic Policies for Regulating Medical Expenses or the National Plan for Regulating Medical Expenses.

When the Minister of Health, Labour and Welfare has established or revised the Basic Policies for Ensuring Appropriate Medical Expenses and the National Plan for Ensuring Appropriate Medical Expenses, the Minister is to publicize this without delay.

The Minister of Health, Labour and Welfare may request necessary cooperation from insurers, Association of Medical Care Systems for the Elderly Aged 75 and older, medical institutions, and other relevant persons, when the Minister finds it necessary for the preparation of the national plan for regulating medical expenses and the implementation of measures based on the national plan for regulating medical expenses.

A prefecture is to establish a plan to promote the optimization of medical expenses in the prefecture (hereinafter referred to as the "prefectural plan for the optimization of medical expenses") every six years, with six years as one period, in line with the basic policy for the optimization of medical expenses.

The Prefectural Plan for Regulating Medical Expenses is to provide for the following matters:

with regard to the promotion of the maintenance of residents' health, matters concerning targets to be achieved for the promotion of the optimization of medical expenses in the prefecture;

with regard to the promotion of the efficient provision of medical care, matters concerning targets to be achieved for the promotion of the optimization of medical expenses in the relevant prefecture;

particulars concerning the results of the promotion of the differentiation and coordination of the medical institution functions and bed functions expected during the period of the plan, based on the implementation of the projects under the regional medical care vision and medical care plan of the relevant prefecture;

matters concerning the prospective expenses required for medical care during the plan period calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, based on the matters set forth in the preceding item and the effects of the optimization of medical expenses that are expected to be achieved by promoting the maintenance of residents' health and promoting the efficient provision of medical care in order to achieve the goals set forth in item (i) and item (ii) (referred to as the "prefectural target for expenses required for medical care" in Article 11, paragraph (4)).

In addition to the matters prescribed in the preceding paragraph, a prefectural plan for regulating medical expenses is to, in general, provide for the following matters concerning the prefecture:

matters concerning measures to be taken by the prefecture in order to achieve the goals set forth in items (i) and (ii) of the preceding paragraph;

particulars concerning coordination and cooperation among insurers, Association of Medical Care Systems for the Elderly Aged 75 and older, medical institutions, and other relevant persons in order to achieve the goals set forth in items (i) and (ii) of the preceding paragraph;

particulars concerning the investigation and analysis of the expenses required for medical services in the prefecture;

matters concerning the evaluation of the status of the achievement of the plan.

In specifying the particulars set forth in paragraph (2), items (i) and (ii) and item (i) of the preceding paragraph, the prefecture is to pay attention to the importance of promoting the differentiation and coordination of the medical institution functions and bed functions in the region, securing the family doctor function, efforts towards the construction of a community-based integrated care system, and the effective and efficient provision of medical care and nursing care in light of the physical, mental and social characteristics of residents as they age.

A prefecture, in providing for the particulars set forth in paragraph (3), item (iii), is to take into consideration the expenses required for medical services in a prefecture other than the relevant prefecture and other particulars specified by Order of the Ministry of Health, Labour and Welfare.

A prefectural plan for the optimization of medical expenses must be in harmony with the regional medical care vision, the medical care plan, the prefectural insured long-term care services plan as prescribed in Article 118, paragraph (1) of the Long-Term Care Insurance Act, and the prefectural health promotion plan as prescribed in Article 8, paragraph (1) of the Health Promotion Act.

When a prefecture intends to establish or change a prefectural plan for the optimization of medical expenses, it must consult in advance with the relevant municipalities and the Council of Insurers under Article 157-2, paragraph (1) (referred to as the "Council of Insurers" in paragraph (10) and Article 12, paragraph (1)).

When a prefecture has formulated or revised its prefectural plan for regulating medical expenses, it is to endeavor to publicize the plan and submit it to the Minister of Health, Labour and Welfare without delay.

A prefecture may request necessary cooperation from Insurers, Association of Medical Care Systems for the Elderly Aged 75 and older, medical institutions, and other relevant persons when it finds it necessary for the preparation of a Prefectural Plan for Regulating Medical Expenses and the implementation of measures based on the Prefectural Plan for Regulating Medical Expenses.

If a prefecture requests necessary cooperation from insurers or Association of Medical Care Systems for the Elderly Aged 75 and older pursuant to the provisions of the preceding paragraph, the prefecture may request the cooperation through the council of insurers.

The Minister of Health, Labour and Welfare may provide a prefecture with necessary advice on methods for formulating a prefectural plan for optimization of medical expenses and other important technical matters for formulating a prefectural plan for optimization of medical expenses.