Section 1 Plans to Optimize Medical Expenses
第一節 医療費適正化計画等
第八条（医療費適正化基本方針及び全国医療費適正化計画）
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.
厚生労働大臣は、国民の高齢期における適切な医療の確保を図る観点から、医療に要する費用の適正化（以下「医療費適正化」という。）を総合的かつ計画的に推進するため、医療費適正化に関する施策についての基本的な方針（以下「医療費適正化基本方針」という。）を定めるとともに、六年ごとに、六年を一期として、医療費適正化を推進するための計画（以下「全国医療費適正化計画」という。）を定めるものとする。
The Basic Policy on Regulating Medical Expenses is to provide for the following matters:
医療費適正化基本方針においては、次に掲げる事項を定めるものとする。
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;
次条第一項に規定する都道府県医療費適正化計画において定めるべき目標に係る参酌すべき標準その他の当該計画の作成に当たつて指針となるべき基本的な事項
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;
次条第一項に規定する都道府県医療費適正化計画の達成状況の評価に関する基本的な事項
basic particulars concerning investigation and analysis of the expenses required for medical services;
医療に要する費用の調査及び分析に関する基本的な事項
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).
医療費適正化基本方針は、医療法第三十条の三第一項に規定する基本方針、介護保険法（平成九年法律第百二十三号）第百十六条第一項に規定する基本指針及び健康増進法（平成十四年法律第百三号）第七条第一項に規定する基本方針と調和が保たれたものでなければならない。
The National Plan for Regulating Medical Expenses is to specify the following matters:
全国医療費適正化計画においては、次に掲げる事項を定めるものとする。
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;
国民の健康の保持の推進に関し、医療費適正化の推進のために国が達成すべき目標に関する事項
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;
医療の効率的な提供の推進に関し、医療費適正化の推進のために国が達成すべき目標に関する事項
matters concerning measures to be taken by the national government in order to achieve the goals set forth in the preceding two items;
前二号の目標を達成するために国が取り組むべき施策に関する事項
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);
第一号及び第二号の目標を達成するための保険者、後期高齢者医療広域連合、医療機関その他の関係者の連携及び協力に関する事項
in light of the implementation of projects based on the medical care plan (meaning the medical care plan prescribed in Article 30-4, paragraph (1) of the Medical Care Act; the same applies hereinafter) of each prefecture, matters concerning the results of the promotion of the differentiation and coordination of the bed functions (meaning the bed functions prescribed in Article 30-3, paragraph (2), item (vi) of the same Act; the same applies hereinafter) expected during the period of the plan;
各都道府県の医療計画（医療法第三十条の四第一項に規定する医療計画をいう。以下同じ。）に基づく事業の実施を踏まえ、計画の期間において見込まれる病床の機能（同法第三十条の三第二項第六号に規定する病床の機能をいう。以下同じ。）の分化及び連携の推進の成果に関する事項
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;
計画の達成状況の評価に関する事項
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 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.
厚生労働大臣は、前項第一号から第三号までに掲げる事項を定めるに当たつては、病床の機能の分化及び連携の推進、医療法第六条の三第一項に規定するかかりつけ医機能（次条第四項において「かかりつけ医機能」という。）の確保並びに地域における医療及び介護の総合的な確保の促進に関する法律（平成元年法律第六十四号）第二条第一項に規定する地域包括ケアシステム（次条第四項において「地域包括ケアシステム」という。）の構築に向けた取組並びに国民の加齢に伴う身体的、精神的及び社会的な特性を踏まえた医療及び介護の効果的かつ効率的な提供の重要性に留意するものとする。
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.
厚生労働大臣は、医療費適正化基本方針及び全国医療費適正化計画を定め、又はこれを変更しようとするときは、あらかじめ、関係行政機関の長に協議するものとする。
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.
厚生労働大臣は、医療費適正化基本方針及び全国医療費適正化計画を定め、又はこれを変更したときは、遅滞なく、これを公表するものとする。
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.
厚生労働大臣は、全国医療費適正化計画の作成及び全国医療費適正化計画に基づく施策の実施に関して必要があると認めるときは、保険者、後期高齢者医療広域連合、医療機関その他の関係者に対して必要な協力を求めることができる。
Article 9Prefectural Plan for Regulating Medical Expenses
第九条（都道府県医療費適正化計画）
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.
都道府県は、医療費適正化基本方針に即して、六年ごとに、六年を一期として、当該都道府県における医療費適正化を推進するための計画（以下「都道府県医療費適正化計画」という。）を定めるものとする。
The Prefectural Plan for Regulating Medical Expenses is to provide for the following matters:
都道府県医療費適正化計画においては、次に掲げる事項を定めるものとする。
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;
住民の健康の保持の推進に関し、当該都道府県における医療費適正化の推進のために達成すべき目標に関する事項
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;
医療の効率的な提供の推進に関し、当該都道府県における医療費適正化の推進のために達成すべき目標に関する事項
particulars concerning the results of the promotion of the differentiation and coordination of the bed functions expected during the period of the plan, based on the implementation of the project under the medical care plan of the relevant prefecture;
当該都道府県の医療計画に基づく事業の実施を踏まえ、計画の期間において見込まれる病床の機能の分化及び連携の推進の成果に関する事項
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:
都道府県医療費適正化計画においては、前項に規定する事項のほか、おおむね都道府県における次に掲げる事項について定めるものとする。
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;
前項第一号及び第二号の目標を達成するための保険者、後期高齢者医療広域連合、医療機関その他の関係者の連携及び協力に関する事項
particulars concerning the investigation and analysis of the expenses required for medical services in the prefecture;
当該都道府県における医療に要する費用の調査及び分析に関する事項
matters concerning the evaluation of the status of the achievement of the plan.
計画の達成状況の評価に関する事項
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 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.
都道府県は、第三項第三号に掲げる事項を定めるに当たつては、当該都道府県以外の都道府県における医療に要する費用その他厚生労働省令で定める事項を踏まえるものとする。
A prefectural plan for regulating medical expenses must be in harmony with the medical care plan, the prefectural insured long-term care services plan as prescribed in Article 118, paragraph (1), Long-Term Care Insurance Act, and the prefectural health promotion plan as prescribed in Article 8, paragraph (1) of the Health Promotion Act.
都道府県医療費適正化計画は、医療計画、介護保険法第百十八条第一項に規定する都道府県介護保険事業支援計画及び健康増進法第八条第一項に規定する都道府県健康増進計画と調和が保たれたものでなければならない。
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)).
都道府県は、都道府県医療費適正化計画を定め、又はこれを変更しようとするときは、あらかじめ、関係市町村及び第百五十七条の二第一項の保険者協議会（第十項及び第十二条第一項において「保険者協議会」という。）に協議しなければならない。
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.
都道府県は、都道府県医療費適正化計画を定め、又はこれを変更したときは、遅滞なく、これを公表するよう努めるとともに、厚生労働大臣に提出するものとする。
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.
都道府県は、都道府県医療費適正化計画の作成及び都道府県医療費適正化計画に基づく施策の実施に関して必要があると認めるときは、保険者、後期高齢者医療広域連合、医療機関その他の関係者に対して必要な協力を求めることができる。
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.
都道府県が、前項の規定により保険者又は後期高齢者医療広域連合に対して必要な協力を求める場合においては、保険者協議会を通じて協力を求めることができる。
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.
厚生労働大臣は、都道府県に対し、都道府県医療費適正化計画の作成の手法その他都道府県医療費適正化計画の作成上重要な技術的事項について必要な助言をすることができる。
Article 11Publication of the Progress of Plans
第十一条（計画の進捗状況の公表等）
A prefecture is to endeavor to publicize the state of progress of the prefectural plan for regulating medical expenses in each fiscal year (meaning the period from April 1 of each year to March 31 of the following year; the same applies hereinafter) (excluding the fiscal year in which the results under the following paragraph were publicized and the evaluation set forth in paragraph (1) of the following Article was conducted) pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.
都道府県は、厚生労働省令で定めるところにより、年度（毎年四月一日から翌年三月三十一日までをいう。以下同じ。）（次項の規定による結果の公表及び次条第一項の評価を行つた年度を除く。）ごとに、都道府県医療費適正化計画の進捗状況を公表するよう努めるものとする。
In order to contribute to the preparation of the Prefectural Plan for Regulating Medical Expenses in the next term, the prefecture is to endeavor to publicize the results of surveys and analyses on the state of progress of the Prefectural Plan for Regulating Medical Expenses during the plan period (hereinafter referred to as the "Plan Period" in this paragraph and paragraph (4)) in the fiscal year that includes the end date of the Prefectural Plan for Regulating Medical Expenses, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.
都道府県は、次期の都道府県医療費適正化計画の作成に資するため、厚生労働省令で定めるところにより、都道府県医療費適正化計画の期間（以下この項及び第四項において「計画期間」という。）の終了の日の属する年度において、当該計画期間における当該都道府県医療費適正化計画の進捗状況に関する調査及び分析の結果を公表するよう努めるものとする。
In order to contribute to the preparation of the Basic Policies for Regulating Medical Expenses, when a prefecture has conducted the investigation and analysis set forth in the preceding paragraph, it is to endeavor to report the results to the Minister of Health, Labour and Welfare pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.
都道府県は、医療費適正化基本方針の作成に資するため、前項の調査及び分析を行つたときは、厚生労働省令で定めるところにより、その結果を厚生労働大臣に報告するよう努めるものとする。
If a prefecture finds that the goals set forth in Article 9, paragraph (2), items (i) and (ii) cannot be achieved during the plan period, or that the expenses required for medical care in the prefecture significantly exceed the target expenses required for medical care by the prefecture, the prefecture is to analyze the causes of this, and endeavor to take necessary measures in cooperation with insurers, Association of Medical Care Systems for the Elderly Aged 75 and older, medical institutions, and other relevant persons to eliminate the causes.
都道府県は、計画期間において、第九条第二項第一号及び第二号の目標を達成できないと認める場合又は当該都道府県における医療に要する費用が都道府県の医療に要する費用の目標を著しく上回ると認める場合には、その要因を分析するとともに、当該要因の解消に向けて、保険者、後期高齢者医療広域連合、医療機関その他の関係者と協力して必要な対策を講ずるよう努めるものとする。
The Minister of Health, Labour and Welfare is to publicize the status of progress of the national plan for regulating medical expenses in each fiscal year (excluding the fiscal year in which the results under the following paragraph were publicized and the evaluation referred to in paragraph (3) of the following Article was conducted) pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.
厚生労働大臣は、厚生労働省令で定めるところにより、年度（次項の規定による結果の公表及び次条第三項の評価を行つた年度を除く。）ごとに、全国医療費適正化計画の進捗状況を公表するものとする。
In order to contribute to the preparation of the national medical expense optimization plan for the next term, the Minister of Health, Labour and Welfare is to publicize the results of the investigation and analysis of the state of progress of the national medical expense optimization plan during the plan period (hereinafter referred to as the "plan period" in this paragraph and the following paragraph) in the fiscal year that includes the end date of the plan period, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.
厚生労働大臣は、次期の全国医療費適正化計画の作成に資するため、厚生労働省令で定めるところにより、全国医療費適正化計画の期間（以下この項及び次項において「計画期間」という。）の終了の日の属する年度において、当該計画期間における当該全国医療費適正化計画の進捗状況に関する調査及び分析の結果を公表するものとする。
If the Minister of Health, Labour and Welfare finds that the goals set forth in Article 8, paragraph (4), items (i) and (ii) cannot be achieved during the plan period, or that the expenses required for medical care by the national government significantly exceed the target expenses required for medical care by the national government, the Minister is to analyze the causes of this, and take necessary measures to resolve the causes in cooperation with insurers, Association of Medical Care Systems for the Elderly Aged 75 and older, medical institutions, and other relevant parties.
厚生労働大臣は、計画期間において、第八条第四項第一号及び第二号の目標を達成できないと認める場合又は国における医療に要する費用が国の医療に要する費用の目標を著しく上回ると認める場合には、その要因を分析するとともに、当該要因の解消に向けて、保険者、後期高齢者医療広域連合、医療機関その他の関係者と協力して必要な対策を講ずるものとする。