Supplementary Provisions, Article 16
第十六条
The amount of the estimated medical expense contribution for fiscal year 2003 is, notwithstanding Article 55, paragraph (1) of the New Elderly Health Act, to be the sum total of the amounts set forth in the following items.
平成十五年度の概算医療費拠出金の額は、新老健法第五十五条第一項の規定にかかわらず、次の各号に掲げる額の合計額とする。
The amount set forth in (a) or (b), in accordance with the category of Insurer set forth in (a) or (b), respectively;
次のイ又はロに掲げる保険者の区分に応じ、それぞれイ又はロに掲げる額
An insurer exceeding the estimated burden adjustment base amount for the earlier period (meaning, among Insurers for which the estimated participant adjustment rate for the earlier period exceeds one, an Insurer for which the amount obtained by deducting the amount set forth in (1) from the amount equivalent to the estimated medical expense contribution for the earlier period before burden adjustment exceeds the amount set forth in (2); the same applies hereinafter in this Article): the sum total of the amount obtained by deducting the estimated amount subject to burden adjustment for the earlier period (meaning the amount obtained by deducting the sum total of the amount set forth in (1) and the amount set forth in (2) from the amount equivalent to the estimated medical expense contribution for the earlier period before burden adjustment; the same applies in paragraph (4)) from the amount equivalent to the estimated medical expense contribution for the earlier period before burden adjustment, and the estimated burden adjustment amount for the earlier period;
The sum total of the following amounts;
次に掲げる額の合計額
An amount equivalent to 66 percent of the amount obtained by multiplying the estimated elderly medical expenses for the earlier period pertaining to the relevant Insurer (meaning the amount calculated as specified by Order of the Ministry of Health, Labour and Welfare as the estimated amount of the expenses, borne by municipalities in fiscal year 2003, required for medical care, etc. to be provided before October 1, 2003 to participants aged 75 or over, etc. pertaining to one Insurer; the same applies hereinafter in this Article) by the rate obtained by deducting the estimated specified expense rate for the earlier period from one;
当該保険者に係る前期老人医療費見込額（市町村が平成十五年度において支弁する一の保険者に係る七十五歳以上の加入者等に対する平成十五年十月一日前に行われる医療等に要する費用の見込額として厚生労働省令で定めるところにより算定される額をいう。以下この条において同じ。）に、一から前期特定費用概算率を控除して得た率を乗じて得た額の百分の六十六に相当する額
The amount obtained by multiplying the estimated elderly medical expenses for the earlier period pertaining to the relevant Insurer by the estimated specified expense rate for the earlier period.
当該保険者に係る前期老人医療費見込額に前期特定費用概算率を乗じて得た額
The amount obtained by multiplying the sum total of the following amounts by the burden adjustment base rate for the earlier period.
次に掲げる額の合計額に前期負担調整基準率を乗じて得た額
The amount equivalent to the estimated medical expense contribution for the earlier period before burden adjustment;
前期負担調整前概算医療費拠出金相当額
Of the estimated amount for fiscal year 2003 of the expenses required for benefits by the relevant insurer, the amount of the expenses required for medical-related benefits to be provided before October 1, 2003.
当該保険者の給付に要する費用の平成十五年度における見込額のうち平成十五年十月一日前に行われる医療関連給付に要する費用の額
Insurers other than Insurers exceeding the estimated burden adjustment base amount for the earlier period: the sum total of the amount equivalent to the estimated medical expense contribution for the earlier period before burden adjustment and the estimated burden adjustment amount for the earlier period.
前期概算負担調整基準超過保険者以外の保険者 前期負担調整前概算医療費拠出金相当額と前期負担調整見込額との合計額
The amount set forth in (a) or (b), in accordance with the category of Insurer set forth in (a) or (b), respectively.
次のイ又はロに掲げる保険者の区分に応じ、それぞれイ又はロに掲げる額
An insurer exceeding the estimated burden adjustment base amount for the later period (meaning, among Insurers for which the estimated participant adjustment rate for the later period exceeds one, an Insurer for which the amount obtained by deducting the amount set forth in (1) from the amount equivalent to the estimated medical expense contribution for the later period before burden adjustment exceeds the amount set forth in (2); the same applies hereinafter in this Article): the sum total of the amount obtained by deducting the estimated amount subject to burden adjustment for the later period (meaning the amount obtained by deducting the sum total of the amount set forth in (1) and the amount set forth in (2) from the amount equivalent to the estimated medical expense contribution for the later period before burden adjustment; the same applies in paragraph (9)) from the amount equivalent to the estimated medical expense contribution for the later period before burden adjustment, and the estimated burden adjustment amount for the later period;
The sum total of the following amounts;
次に掲げる額の合計額
An amount equivalent to 62 percent of the amount obtained by multiplying the estimated elderly medical expenses for the later period pertaining to the relevant Insurer (meaning the amount calculated as specified by Order of the Ministry of Health, Labour and Welfare as the estimated amount of the expenses, borne by municipalities in fiscal year 2003, required for medical care, etc. to be provided on or after October 1, 2003 to participants aged 75 or over, etc. pertaining to one Insurer; the same applies hereinafter in this Article) by the rate obtained by deducting the estimated specified expense rate for the later period from one;
当該保険者に係る後期老人医療費見込額（市町村が平成十五年度において支弁する一の保険者に係る七十五歳以上の加入者等に対する平成十五年十月一日以後に行われる医療等に要する費用の見込額として厚生労働省令で定めるところにより算定される額をいう。以下この条において同じ。）に、一から後期特定費用概算率を控除して得た率を乗じて得た額の百分の六十二に相当する額
The amount obtained by multiplying the estimated elderly medical expenses for the later period pertaining to the relevant Insurer by the estimated specified expense rate for the later period.
当該保険者に係る後期老人医療費見込額に後期特定費用概算率を乗じて得た額
The amount obtained by multiplying the sum total of the following amounts by the burden adjustment base rate for the later period.
次に掲げる額の合計額に後期負担調整基準率を乗じて得た額
The amount equivalent to the estimated medical expense contribution for the later period before burden adjustment;
後期負担調整前概算医療費拠出金相当額
Of the estimated amount for fiscal year 2003 of the expenses required for benefits by the relevant insurer, the amount of the expenses required for medical-related benefits to be provided on or after October 1, 2003.
当該保険者の給付に要する費用の平成十五年度における見込額のうち平成十五年十月一日以後に行われる医療関連給付に要する費用の額
Insurers other than Insurers exceeding the estimated burden adjustment base amount for the later period: the sum total of the amount equivalent to the estimated medical expense contribution for the later period before burden adjustment and the estimated burden adjustment amount for the later period.
後期概算負担調整基準超過保険者以外の保険者 後期負担調整前概算医療費拠出金相当額と後期負担調整見込額との合計額
The estimated participant adjustment rate for the earlier period referred to in paragraph (1), item (i), (a) is to be a rate calculated for each Insurer, as specified by Order of the Ministry of Health, Labour and Welfare, on the basis of the rate obtained by dividing the ratio of the estimated total number of participants aged 75 or over, etc. to the estimated total number of participants for all Insurers during the period from April 1, 2003 through September 30 of the same year by the ratio of the estimated number of participants aged 75 or over, etc. to the estimated number of participants for the relevant Insurer during that period (if that ratio is less than the minimum rate for that period, the minimum rate).
第一項第一号イの前期概算加入者調整率は、厚生労働省令で定めるところにより、平成十五年四月一日から同年九月三十日までの期間におけるすべての保険者に係る加入者の見込総数に対する七十五歳以上の加入者等の見込総数の割合を当該期間における当該保険者に係る加入者の見込数に対する七十五歳以上の加入者等の見込数の割合（その割合が当該期間における下限割合に満たないときは、下限割合とする。）で除して得た率を基礎として保険者ごとに算定される率とする。
The amount equivalent to the estimated medical expense contribution for the earlier period before burden adjustment referred to in paragraph (1), item (i), (a) is to be the sum total of the amounts set forth in the following items.
第一項第一号イの前期負担調整前概算医療費拠出金相当額は、次の各号に掲げる額の合計額とする。
An amount equivalent to 66 percent of the amount obtained by multiplying the sum total of the following amounts (referred to as "adjusted estimated elderly medical expenses for the earlier period" in the following item) by the rate obtained by deducting the estimated specified expense rate for the earlier period from one;
次に掲げる額の合計額（次号において「前期調整後老人医療費見込額」という。）に、一から前期特定費用概算率を控除して得た率を乗じて得た額の百分の六十六に相当する額
The amount obtained by multiplying the amount obtained by deducting the estimated medical expenses excluded from adjustment for the earlier period (meaning, where the relevant Insurer is an insurer exceeding the estimated standard for the earlier period (meaning an Insurer for which the rate obtained by dividing the amount calculated as specified by Order of the Ministry of Health, Labour and Welfare as the estimated elderly medical expenses for the earlier period per participant aged 75 or over, etc. pertaining to one Insurer by the amount calculated as specified by Order of the Ministry of Health, Labour and Welfare as the average amount of the estimated elderly medical expenses for the earlier period per participant aged 75 or over, etc. pertaining to all Insurers (referred to as "per-person average of estimated elderly medical expenses" in (a)) exceeds the rate specified by the Cabinet Order referred to in Article 55, paragraph (3), item (i), (a) of the New Elderly Health Act), the amount calculated as specified by Order of the Ministry of Health, Labour and Welfare as the portion of the estimated elderly medical expenses for the earlier period pertaining to the relevant Insurer that exceeds the amount obtained by multiplying the per-person average of estimated elderly medical expenses by the rate specified by that Cabinet Order; the same applies in (b)) from the estimated elderly medical expenses for the earlier period pertaining to the relevant Insurer by the estimated participant adjustment rate for the earlier period;
当該保険者に係る前期老人医療費見込額から前期調整対象外医療費見込額（当該保険者が概算前期基準超過保険者（一の保険者に係る七十五歳以上の加入者等一人当たりの前期老人医療費見込額として厚生労働省令で定めるところにより算定される額をすべての保険者に係る七十五歳以上の加入者等一人当たりの前期老人医療費見込額の平均額として厚生労働省令で定めるところにより算定される額（イにおいて「一人平均老人医療費見込額」という。）で除して得た率が、新老健法第五十五条第三項第一号イの政令で定める率を超える保険者をいう。）である場合における当該保険者に係る前期老人医療費見込額のうち、一人平均老人医療費見込額に当該政令で定める率を乗じて得た額を超える部分として厚生労働省令で定めるところにより算定される額をいう。ロにおいて同じ。）を控除して得た額に、前期概算加入者調整率を乗じて得た額
The amount obtained by multiplying the adjusted estimated elderly medical expenses for the earlier period by the estimated specified expense rate for the earlier period.
前期調整後老人医療費見込額に前期特定費用概算率を乗じて得た額
The estimated burden adjustment amount for the earlier period referred to in paragraph (1), item (i), (a) is the amount obtained by multiplying the amount equivalent to the estimated medical expense contribution for the earlier period before burden adjustment pertaining to the relevant Insurer (for an insurer exceeding the estimated burden adjustment base amount for the earlier period, the amount obtained by deducting the estimated amount subject to burden adjustment for the earlier period from the amount equivalent to the estimated medical expense contribution for the earlier period before burden adjustment) by the estimated burden adjustment addition rate for the earlier period (meaning the rate determined by the Minister of Health, Labour and Welfare on the basis of the rate obtained by dividing the total amount of the estimated amounts subject to burden adjustment for the earlier period pertaining to all Insurers exceeding the estimated burden adjustment base amount for the earlier period by the amount obtained by deducting the total amount of the estimated amounts subject to burden adjustment for the earlier period pertaining to all Insurers exceeding the estimated burden adjustment base amount for the earlier period from the total amount of the amounts equivalent to the estimated medical expense contribution for the earlier period before burden adjustment pertaining to all Insurers).
第一項第一号イの前期負担調整見込額は、当該保険者に係る前期負担調整前概算医療費拠出金相当額（前期概算負担調整基準超過保険者にあっては、前期負担調整前概算医療費拠出金相当額から前期負担調整対象見込額を控除して得た額）に前期概算負担調整加算率（すべての前期概算負担調整基準超過保険者に係る前期負担調整対象見込額の総額を、すべての保険者に係る前期負担調整前概算医療費拠出金相当額の総額からすべての前期概算負担調整基準超過保険者に係る前期負担調整対象見込額の総額を控除して得た額で除して得た率を基礎として厚生労働大臣が定める率をいう。）を乗じて得た額とする。
The estimated specified expense rate for the earlier period referred to in paragraph (1), item (i), (a), (1), (i) is to be the rate obtained by dividing the estimated specified expenses for the earlier period pertaining to each Insurer (meaning the amount calculated as specified by Order of the Ministry of Health, Labour and Welfare as the estimated amount of the expenses, borne by municipalities in fiscal year 2003, required for medical care, etc. to be provided before October 1, 2003 to persons pertaining to one Insurer who fall under the case set forth in Article 28, paragraph (1), item (ii) of the New Elderly Health Act) by the estimated elderly medical expenses for the earlier period pertaining to each Insurer.
第一項第一号イ（１）（ｉ）の前期特定費用概算率は、各保険者に係る前期特定費用見込額（市町村が平成十五年度において支弁する一の保険者に係る新老健法第二十八条第一項第二号に掲げる場合に該当する者に対する平成十五年十月一日前に行われる医療等に要する費用の見込額として厚生労働省令で定めるところにより算定される額をいう。）を各保険者に係る前期老人医療費見込額で除して得た率とする。
The burden adjustment base rate for the earlier period referred to in paragraph (1), item (i), (a), (2) is to be a rate of 25 percent or more specified by Cabinet Order, taking into account trends in medical expenses for the elderly per person, the status of increase in participants aged 75 or over, etc., trends in the expenses required for benefits by insurers, and trends in the number of Insurers exceeding the estimated burden adjustment base amount for the earlier period.
第一項第一号イ（２）の前期負担調整基準率は、一人当たりの老人医療費の動向、七十五歳以上の加入者等の増加の状況、保険者の給付に要する費用の動向及び前期概算負担調整基準超過保険者の数の動向を勘案し、百分の二十五以上において政令で定める率とする。
The estimated participant adjustment rate for the later period referred to in paragraph (1), item (ii), (a) is to be a rate calculated for each Insurer, as specified by Order of the Ministry of Health, Labour and Welfare, on the basis of the rate obtained by dividing the ratio of the estimated total number of participants aged 75 or over, etc. to the estimated total number of participants for all Insurers during the period from October 1, 2003 through March 31, 2004 by the ratio of the estimated number of participants aged 75 or over, etc. to the estimated number of participants for the relevant Insurer during that period (if that ratio is less than the minimum rate for that period, the minimum rate).
第一項第二号イの後期概算加入者調整率は、厚生労働省令で定めるところにより、平成十五年十月一日から平成十六年三月三十一日までの期間におけるすべての保険者に係る加入者の見込総数に対する七十五歳以上の加入者等の見込総数の割合を当該期間における当該保険者に係る加入者の見込数に対する七十五歳以上の加入者等の見込数の割合（その割合が当該期間における下限割合に満たないときは、下限割合とする。）で除して得た率を基礎として保険者ごとに算定される率とする。
The amount equivalent to the estimated medical expense contribution for the later period before burden adjustment referred to in paragraph (1), item (ii), (a) is to be the sum total of the amounts set forth in the following items.
第一項第二号イの後期負担調整前概算医療費拠出金相当額は、次の各号に掲げる額の合計額とする。
An amount equivalent to 62 percent of the amount obtained by multiplying the sum total of the following amounts (referred to as "adjusted estimated elderly medical expenses for the later period" in the following item) by the rate obtained by deducting the estimated specified expense rate for the later period from one;
次に掲げる額の合計額（次号において「後期調整後老人医療費見込額」という。）に、一から後期特定費用概算率を控除して得た率を乗じて得た額の百分の六十二に相当する額
The amount obtained by multiplying the amount obtained by deducting the estimated medical expenses excluded from adjustment for the later period (meaning, where the relevant Insurer is an insurer exceeding the estimated standard for the later period (meaning an Insurer for which the rate obtained by dividing the amount calculated as specified by Order of the Ministry of Health, Labour and Welfare as the estimated elderly medical expenses for the later period per participant aged 75 or over, etc. pertaining to one Insurer by the amount calculated as specified by Order of the Ministry of Health, Labour and Welfare as the average amount of the estimated elderly medical expenses for the later period per participant aged 75 or over, etc. pertaining to all Insurers (referred to as "per-person average of estimated elderly medical expenses" in (a)) exceeds the rate specified by the Cabinet Order referred to in Article 55, paragraph (3), item (i), (a) of the New Elderly Health Act), the amount calculated as specified by Order of the Ministry of Health, Labour and Welfare as the portion of the estimated elderly medical expenses for the later period pertaining to the relevant Insurer that exceeds the amount obtained by multiplying the per-person average of estimated elderly medical expenses by the rate specified by that Cabinet Order; the same applies in (b)) from the estimated elderly medical expenses for the later period pertaining to the relevant Insurer by the estimated participant adjustment rate for the later period;
当該保険者に係る後期老人医療費見込額から後期調整対象外医療費見込額（当該保険者が概算後期基準超過保険者（一の保険者に係る七十五歳以上の加入者等一人当たりの後期老人医療費見込額として厚生労働省令で定めるところにより算定される額をすべての保険者に係る七十五歳以上の加入者等一人当たりの後期老人医療費見込額の平均額として厚生労働省令で定めるところにより算定される額（イにおいて「一人平均老人医療費見込額」という。）で除して得た率が、新老健法第五十五条第三項第一号イの政令で定める率を超える保険者をいう。）である場合における当該保険者に係る後期老人医療費見込額のうち、一人平均老人医療費見込額に当該政令で定める率を乗じて得た額を超える部分として厚生労働省令で定めるところにより算定される額をいう。ロにおいて同じ。）を控除して得た額に、後期概算加入者調整率を乗じて得た額
The amount obtained by multiplying the adjusted estimated elderly medical expenses for the later period by the estimated specified expense rate for the later period.
後期調整後老人医療費見込額に後期特定費用概算率を乗じて得た額
The estimated burden adjustment amount for the later period referred to in paragraph (1), item (ii), (a) is the amount obtained by multiplying the amount equivalent to the estimated medical expense contribution for the later period before burden adjustment pertaining to the relevant Insurer (for an insurer exceeding the estimated burden adjustment base amount for the later period, the amount obtained by deducting the estimated amount subject to burden adjustment for the later period from the amount equivalent to the estimated medical expense contribution for the later period before burden adjustment) by the estimated burden adjustment addition rate for the later period (meaning the rate determined by the Minister of Health, Labour and Welfare on the basis of the rate obtained by dividing the total amount of the estimated amounts subject to burden adjustment for the later period pertaining to all Insurers exceeding the estimated burden adjustment base amount for the later period by the amount obtained by deducting the total amount of the estimated amounts subject to burden adjustment for the later period pertaining to all Insurers exceeding the estimated burden adjustment base amount for the later period from the total amount of the amounts equivalent to the estimated medical expense contribution for the later period before burden adjustment pertaining to all Insurers).
第一項第二号イの後期負担調整見込額は、当該保険者に係る後期負担調整前概算医療費拠出金相当額（後期概算負担調整基準超過保険者にあっては、後期負担調整前概算医療費拠出金相当額から後期負担調整対象見込額を控除して得た額）に後期概算負担調整加算率（すべての後期概算負担調整基準超過保険者に係る後期負担調整対象見込額の総額を、すべての保険者に係る後期負担調整前概算医療費拠出金相当額の総額からすべての後期概算負担調整基準超過保険者に係る後期負担調整対象見込額の総額を控除して得た額で除して得た率を基礎として厚生労働大臣が定める率をいう。）を乗じて得た額とする。
The estimated specified expense rate for the later period referred to in paragraph (1), item (ii), (a), (1), (i) is to be the rate obtained by dividing the estimated specified expenses for the later period pertaining to each Insurer (meaning the amount calculated as specified by Order of the Ministry of Health, Labour and Welfare as the estimated amount of the expenses, borne by municipalities in fiscal year 2003, required for medical care, etc. to be provided on or after October 1, 2003 to persons pertaining to one Insurer who fall under the case set forth in Article 28, paragraph (1), item (ii) of the New Elderly Health Act) by the estimated elderly medical expenses for the later period pertaining to each Insurer.
第一項第二号イ（１）（ｉ）の後期特定費用概算率は、各保険者に係る後期特定費用見込額（市町村が平成十五年度において支弁する一の保険者に係る新老健法第二十八条第一項第二号に掲げる場合に該当する者に対する平成十五年十月一日以後に行われる医療等に要する費用の見込額として厚生労働省令で定めるところにより算定される額をいう。）を各保険者に係る後期老人医療費見込額で除して得た率とする。
The burden adjustment base rate for the later period referred to in paragraph (1), item (ii), (a), (2) is to be a rate of 25 percent or more specified by Cabinet Order, taking into account trends in medical expenses for the elderly per person, the status of increase in participants aged 75 or over, etc., trends in the expenses required for benefits by insurers, and trends in the number of Insurers exceeding the estimated burden adjustment base amount for the later period.
第一項第二号イ（２）の後期負担調整基準率は、一人当たりの老人医療費の動向、七十五歳以上の加入者等の増加の状況、保険者の給付に要する費用の動向及び後期概算負担調整基準超過保険者の数の動向を勘案し、百分の二十五以上において政令で定める率とする。