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This text is not in force yetIt by 11 December 2028, on a day set by — at the latest in 2 years
Read the text in force →高齢者の医療の確保に関する法律
Chapter III Coordination of Sharing of Expenses between Insurers Pertaining to Young-Old Persons (Articles 39 to 40)
The law as Act Partially Amending the Medical Care Act, etc. (Act No. 87 of 2025) leaves it, with the words it changes marked.
The main text is read a page at a time: a chapter to a page, and a long chapter in runs of articles. The whole main text, and the supplementary provisions and appended tables this amendment changes. Those it leaves untouched are on the page for the text in force.
The amount of the final and binding young-old payments referred to in Article 37, paragraph (1) is the amount specified in the following items in accordance with the category of the insurer set forth in each of those items:
第三十七条第一項の確定前期高齢者納付金の額は、次の各号に掲げる保険者の区分に応じ、当該各号に定める額とする。
an insurer exceeding the fixed burden adjustment standard (meaning, among Insurers for which the amount equivalent to the fixed young-old payment before burden adjustment for the fiscal year before the previous fiscal year exceeds zero, an Insurer for which the sum total set forth in (a) exceeds the amount set forth in (b) (excluding an insurer exceeding the special fixed burden adjustment standard in the following item); the same applies hereinafter in this Article): the sum total of the amount obtained by deducting the amount subject to burden adjustment (meaning the amount obtained by deducting the amount set forth in (b) from the sum total set forth in (a) (if that amount exceeds the amount equivalent to the fixed young-old payment before burden adjustment, the amount equivalent to the fixed young-old payment before burden adjustment); the same applies in paragraph (3)) from the amount equivalent to the fixed young-old payment before burden adjustment, and the burden adjustment amount;
確定負担調整基準超過保険者（前々年度における負担調整前確定前期高齢者納付金相当額が零を超える保険者のうち、イに掲げる合計額がロに掲げる額を超える者（次号の特別確定負担調整基準超過保険者を除く。）をいう。以下この条において同じ。） 負担調整前確定前期高齢者納付金相当額から負担調整対象額（イに掲げる合計額からロに掲げる額を控除して得た額（当該額が負担調整前確定前期高齢者納付金相当額を上回るときは、負担調整前確定前期高齢者納付金相当額とする。）をいう。第三項において同じ。）を控除して得た額と負担調整額との合計額
the sum total of the following amounts:
次に掲げる額の合計額
the amount equivalent to the fixed young-old payment before burden adjustment for the fiscal year before the previous fiscal year;
前々年度における負担調整前確定前期高齢者納付金相当額
the amount obtained by dividing the fixed amount of aid for the old-old under Article 119, paragraph (1) pertaining to the relevant Insurer in the fiscal year before the previous fiscal year by the fixed old-old aid adjustment rate set forth in the items of Article 121, paragraph (1) pertaining to the relevant Insurer in the same fiscal year;
前々年度における当該保険者に係る第百十九条第一項の確定後期高齢者支援金の額を同年度における当該保険者に係る第百二十一条第一項各号の確定後期高齢者支援金調整率で除して得た額
the amount arrived at when the sum total of the following amounts is multiplied by the base rate for burden adjustment referred to in paragraph (1), item (i), (b) of the preceding Article for the fiscal year before the previous fiscal year;
次に掲げる額の合計額に前々年度の前条第一項第一号ロの負担調整基準率を乗じて得た額
the sum total set forth in (a);
イに掲げる合計額
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;
前々年度における当該保険者の給付に要する費用等の額、医師手当拠出金の額及び流行初期医療確保拠出金の額
an insurer exceeding the special fixed burden adjustment standard (meaning, among Insurers for which the amount equivalent to the fixed young-old payment before burden adjustment for the fiscal year before the previous fiscal year exceeds zero, an Insurer for which the sum total set forth in (a) exceeds the amount set forth in (b) and for which the financial capacity in the same fiscal year, calculated as specified by Cabinet Order, falls short of the standard specified by Cabinet Order; the same applies hereinafter in this Article): the sum total of the amount obtained by deducting the amount subject to special burden adjustment (meaning the amount obtained by deducting the amount set forth in (b) from the sum total set forth in (a) (if that amount exceeds the amount equivalent to the fixed young-old payment before burden adjustment, the amount equivalent to the fixed young-old payment before burden adjustment); the same applies in paragraph (3)) from the amount equivalent to the fixed young-old payment before burden adjustment, and the burden adjustment amount;
特別確定負担調整基準超過保険者（前々年度における負担調整前確定前期高齢者納付金相当額が零を超える保険者のうち、イに掲げる合計額がロに掲げる額を超える者であつて、政令で定めるところにより算定した同年度における当該保険者の財政力が政令で定める基準に満たないものをいう。以下この条において同じ。） 負担調整前確定前期高齢者納付金相当額から特別負担調整対象額（イに掲げる合計額からロに掲げる額を控除して得た額（当該額が負担調整前確定前期高齢者納付金相当額を上回るときは、負担調整前確定前期高齢者納付金相当額とする。）をいう。第三項において同じ。）を控除して得た額と負担調整額との合計額
the sum total of the following amounts:
次に掲げる額の合計額
the amount equivalent to the fixed young-old payment before burden adjustment for the fiscal year before the previous fiscal year;
前々年度における負担調整前確定前期高齢者納付金相当額
the amount obtained by dividing the fixed amount of aid for the old-old under Article 119, paragraph (1) pertaining to the relevant Insurer in the fiscal year before the previous fiscal year by the fixed old-old aid adjustment rate set forth in the items of Article 121, paragraph (1) pertaining to the relevant Insurer in the same fiscal year;
前々年度における当該保険者に係る第百十九条第一項の確定後期高齢者支援金の額を同年度における当該保険者に係る第百二十一条第一項各号の確定後期高齢者支援金調整率で除して得た額
the amount arrived at when the sum total of the following amounts is multiplied by the base rate for special burden adjustment referred to in paragraph (1), item (ii), (b) of the preceding Article for the fiscal year before the previous fiscal year:
次に掲げる額の合計額に前々年度の前条第一項第二号ロの特別負担調整基準率を乗じて得た額
the sum total set forth in (a);
イに掲げる合計額
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.
前々年度における当該保険者の給付に要する費用等の額、医師手当拠出金の額及び流行初期医療確保拠出金の額
an insurer other than an insurer in excess of the fixed burden adjustment standard and a special insurer in excess of the fixed burden adjustment standard:the sum of the amount equivalent to the determined young-old payments before burden adjustment and the burden adjustment amount.
確定負担調整基準超過保険者及び特別確定負担調整基準超過保険者以外の保険者 負担調整前確定前期高齢者納付金相当額と負担調整額との合計額
The amount equivalent to the confirmed young-old payments before burden adjustment referred to in the items of the preceding paragraph is the amount specified in the following items in accordance with the category of insurer set forth in each of those items.
前項各号の負担調整前確定前期高齢者納付金相当額は、次の各号に掲げる保険者の区分に応じ、当該各号に定める額とする。
insurers of employee insurance, etc.: the sum of the amounts listed in (a) and (b):
被用者保険等保険者 イ及びロに掲げる額の合計額
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;
第三十五条第一項各号の確定調整対象基準額から、当該保険者に係る同項各号の調整対象給付費額、前期高齢者に係る後期高齢者支援金の確定額、前期高齢者に係る医師手当拠出金の確定額及び前期高齢者に係る流行初期医療確保拠出金の額の合計額を控除して得た額（当該額が零を下回る場合には、零とする。）の三分の二に相当する額
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);
第三十五条第一項第一号ロの確定報酬調整後調整対象基準額から、当該保険者に係る同項各号の調整対象給付費額、前期高齢者に係る後期高齢者支援金の確定額、前期高齢者に係る医師手当拠出金の確定額及び前期高齢者に係る流行初期医療確保拠出金の額の合計額を控除して得た額（当該額が零を下回る場合には、零とする。）の三分の一に相当する額
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).
被用者保険等保険者以外の保険者 第三十五条第一項各号の確定調整対象基準額から、当該保険者に係る同項各号の調整対象給付費額、前期高齢者に係る後期高齢者支援金の確定額、前期高齢者に係る医師手当拠出金の確定額及び前期高齢者に係る流行初期医療確保拠出金の額の合計額を控除して得た額（当該額が零を下回る場合には、零とする。）
The burden adjustment amount set forth in the items of paragraph (1) is the amount obtained by multiplying the amount obtained by first dividing the amount calculated as specified by Order of the Ministry of Health, Labour and Welfare on the basis of the sum of the amounts set forth in the following items for the fiscal year before the previous fiscal year by the total number of participants for all Insurers in the same fiscal year calculated as specified by Order of the Ministry of Health, Labour and Welfare, and then multiplying the product by the number of participants for the relevant Insurers in the same fiscal year calculated as specified by Order of the Ministry of Health, Labour and Welfare, and then multiplying the product by the fixed burden adjustment amount adjustment rate:
第一項各号の負担調整額は、前々年度における次の各号に掲げる額の合計額を基礎として厚生労働省令で定めるところにより算定した額を、厚生労働省令で定めるところにより算定した同年度における全ての保険者に係る加入者の総数で除して得た額に、厚生労働省令で定めるところにより算定した同年度における当該保険者に係る加入者の数を乗じて得た額に確定負担調整額調整率を乗じて得た額とする。
the total amount subject to burden adjustment pertaining to all insurers in excess of the fixed burden adjustment standards;
全ての確定負担調整基準超過保険者に係る負担調整対象額の総額
the total amount subject to burden adjustment pertaining to all insurers in excess of the special standards for burden adjustment;
全ての特別確定負担調整基準超過保険者に係る負担調整対象額の総額
one third of the total amount (referred to as the "total amount of special burden adjustment, etc." in Article 93, paragraph (3)) arrived at when the amount subject to burden adjustment is deducted from the amount subject to special burden adjustment pertaining to all insurers in excess of the special established standard for burden adjustment.
全ての特別確定負担調整基準超過保険者に係る特別負担調整対象額から負担調整対象額を控除した額の総額（第九十三条第三項において「特別負担調整額の総額等」という。）の三分の一
The adjustment rate for the amount of settled burden adjustment referred to in the preceding paragraph is calculated pursuant to the provisions of Cabinet Order within the range of 90 percent to 110 percent, taking into consideration the amount of young-old benefit expenses per participant who is a young-old.
前項の確定負担調整額調整率は、前期高齢者である加入者一人当たりの前期高齢者給付費額を勘案し、百分の九十から百分の百十の範囲内で政令で定めるところにより算定する。
The amount of contributions for administrative expenses related to the young-old to be collected from each Insurer pursuant to the provisions of Article 36, paragraph (1) is, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, the amount calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, based on the estimated amount of expenses required for the handling of affairs concerning the services of the Organization set forth in Article 139, paragraph (1), item (i) in the relevant fiscal year, in accordance with the estimated number of participants pertaining to each Insurer.
第三十六条第一項の規定により各保険者から徴収する前期高齢者関係事務費拠出金の額は、厚生労働省令で定めるところにより、当該年度における第百三十九条第一項第一号に掲げる機構の業務に関する事務の処理に要する費用の見込額を基礎として、各保険者に係る加入者の見込数に応じ、厚生労働省令で定めるところにより算定した額とする。