Medical Care Act

The prefecture, with regard to basic policy and the regional medical care vision, is to provide a plan (hereinafter referred to as "medical care plan") for ensuring the medical care delivery system in the relevant prefecture, in accordance with the actual conditions in the area.

particulars related to the vision ofensuring the future medical care delivery system including the following particulars (hereinafter referred to as "regionalfor outpatient medical care vision") in the area specified in accordance with the standards set down by an Order of the Ministry of Health, Labour and Welfare as the standards for promoting the differentiation and coordination of bed functions in the region (hereinafter referred to as "vision area");

the future requirements for the number of beds for each functional classification of beds prescribed in Article 30-13, paragraph (1) (hereinafter simply referred to as the "future requirements for the number of beds") in the vision area calculated pursuant to an Order of the Ministry of Health, Labour and Welfare; and

beyond what is listed in (a), particulars specified by an Order of the Ministry of Health, Labour and Welfare as necessary for promoting the differentiation and coordination of the bed functions in the vision area;

particulars related to the promotion of the differentiation and coordination of bed functions to achieveensuring the regional medicalprimary care visionfunction;

the following particulars related to the promotion ofensuring the provisionavailability of information on bed functionsphysicians;

the policy for ensuring the availability of physicians in the following areas (limited, in the case of the area listed in (2), to where its establishment is necessary);

the areas prescribed in items (xii) and (xiii); and

the area established, with reference to the criteria established by the Minister of Health, Labour and Welfare, as an area in which it is necessary to focus on ensuring the availability of physicians;

the target of the number of physicians to be secured in the area prescribed in item (xii) to be determined based on the indicator concerning the number of physicians in the relevant area calculated by the method specified by an Order of the Ministry of Health, Labour and Welfare;

the target number of physicians to be secured in the area prescribed in item (xiii) to be determined based on the indicator concerning the number of physicians in the relevant area calculated by the method specified by an Order of the Ministry of Health, Labour and Welfare; and

the target number of physicians to be secured in the area listed in (a)(2) (limited to where that area has been established); and

measures for ensuring the availability of physicians, such as the dispatch of physicians, toward achieving the targets listed in (b) and (c), and measures for ensuring the availability of physicians, such as the dispatch of physicians, toward achieving the target listed in (d) (limited to where the area listed in (a)(2) has been established);

particulars related to ensuring the medical care delivery system for outpatient medical careavailability of medical care professionals (excluding physicians);

particulars related to ensuring the primary care function;

the following particulars related to ensuring the availability of physicianssafety in medical care;

the policy for ensuring the availability of physicians in the following areas (limited, in the case of the area listed in (2), to where its establishment is necessary);

the areas prescribed in items (xiv) and (xv); and

the area established, with reference to the criteria established by the Minister of Health, Labour and Welfare, as an area in which it is necessary to focus on ensuring the availability of physicians;

the target of the number of physicians to be secured in the area prescribed in item (xiv) to be determined based on the indicator concerning the number of physicians in the relevant area calculated by the method specified by an Order of the Ministry of Health, Labour and Welfare;

the target number of physicians to be secured in the area prescribed in item (xv) to be determined based on the indicator concerning the number of physicians in the relevant area calculated by the method specified by an Order of the Ministry of Health, Labour and Welfare; and

the target number of physicians to be secured in the area listed in (a)(2) (limited to where that area has been established); and

measures for ensuring the availability of physicians, such as the dispatch of physicians, toward achieving the targets listed in (b) and (c), and measures for ensuring the availability of physicians, such as the dispatch of physicians, toward achieving the target listed in (d) (limited to where the area listed in (a)(2) has been established);

particulars related to ensuring the establishment of an area to be classified as a regional unit for the availabilitydevelopment of medical care professionals mainly beds in hospitals (excluding physicians)beds prescribed in the following item, psychiatric hospital beds, infectious disease hospital beds and tuberculosis hospital beds) and beds in clinics;

particulars related to ensuring safety the establishment of an area that combines two or more areas prescribed in the preceding item as a regional unit for the development of mainly long-term care beds in hospitals that provide special medical care or general beds used for special medical care as specified by an Order of the Ministry of Health, Labour and Welfare;

particulars related toin the establishmentevent of an area to be classified as a regional unit for the developmentestablishment of mainly beds in hospitals (excluding bedsareas prescribed in the following item, psychiatric beds, infectious disease beds and tuberculosis beds) and beds in clinics;paragraphs (5) and (6), particulars related to the establishment of the relevant areas; and

particulars related to the establishment of an area that combines two or more areas prescribed intarget number of beds for long-term care beds and general beds, the preceding item as a regional unit for the developmenttarget number of mainly long-term care beds in hospitals that provide special medical care or generalfor psychiatric hospital beds, the target number of beds used for special medical care as specified by an Orderinfectious disease hospital beds, and the target number of the Ministry of Health, Labour and Welfare;beds for tuberculosis hospital beds.

in the event of the establishment of areas prescribed in paragraphs (6) and (7), particulars related to the establishment of the relevant areas; and

particulars related to the target number of beds for long-term care beds and general beds, the target number of beds for psychiatric beds, the target number of beds for infectious disease beds, and the target number of beds for tuberculosis beds.

The prefecture, In stipulating the particulars listed in paragraph (2), item (ix) (limited to those pertaining to the areas listed in stipulating particulars concerning (a)(1) of that item), the regional prefecture, for each type of medical care vision, to be provided that is to take into consideration specified by an Order of the contentsMinistry of reports under Article 30-13, paragraph (1), Health, Labour and Welfare, may establish, in accordance with the prospects for changes in standard specified by an Order of the demographic structure Ministry of Health, Labour and other trends Welfare concerning the indicator prescribed in demand for medical care, paragraph (2) item (ix), (b), the prospects for the arrangement area prescribed in item (xii) of medical care professionals and medical institutions, and other circumstancesthe same paragraph where the number of physicians is recognized to be small.

In stipulating the particulars listed in paragraph (2), item (xiix) (limited to those pertaining to the areas listed in (a)(1) of that item), the prefecture, for each type of medical care to be provided that is specified by an Order of the Ministry of Health, Labour and Welfare, may establish, in accordance with the standard specified by an Order of the Ministry of Health, Labour and Welfare concerning the indicator prescribed in paragraph (2) item (xiix), (b), the area prescribed in item (xivxii) of the same paragraph where the number of physicians is recognized to be smalllarge.

In stipulating Standards related to the particulars listed establishment of areas provided for in paragraph (2), item (xi) (limited to those pertaining to the areas listed items (xii) and (xiii), and the target number of beds provided for in (a)(1item (xv) of that item), the prefecture, same paragraph (for each type of medical care to be provided that is specified by an Order of standards related to the target number of long-term care beds and general beds, standards based on the Ministry of Health, Labour and Welfare, may establish, in accordance with the standard specifiedtotal number calculated according to the respective bed classifications) are to be as prescribed by an Order of the Ministry of Health, Labour and Welfare concerning the indicator prescribed in paragraph (2) item (xi), (b), the area prescribed in item (xiv) of the same paragraph where the number of physicians is recognized to be large.

Standards related The prefecture, where it wishes to stipulate the establishment target number of areasbeds provided for in paragraph (2), items (xiv) and item (xv), and the target number of beds provided forwhen a sudden increase in item (xvii) of the same paragraph (for standards related to the target number of long-term care beds and general beds,population is expected or when there are other circumstances as provided by a Cabinet Order, may disregard the standards based on set forth in the total number calculated accordingpreceding paragraph with regard to each type of bed) are to be as prescribed by an Order ofthe required number of beds provided for in the same item, pursuant to the Ministryprovisions of Health, Labour and Welfarea Cabinet Order.

The prefecture, where it wishes to stipulate the target number of beds provided for in After providing public notice of the medical care plan for the prefecture pursuant to the provisions of paragraph (2) item (xvii)17), the relevant prefecture, when a sudden increase in population is expected , when an announcement concerning the outbreak, etc. of a pandemic influenza or similar infectious disease, etc. prescribed in Article 16, paragraph (2) of the Act on the Prevention of Infectious Diseases and Medical Care for Patients with Infectious Diseases has been made, or when there are other circumstances as provided by a Cabinet Order, may disregardregard the standards set forth innumber calculated pursuant to the preceding paragraph with regard to provisions of a Cabinet Order as the target number of beds provided for in the sameparagraph (2), item, pursuant (xv) for the areas specified by Cabinet Order, and may engage in activities related to the provisions of agranting permission for applications for permission to establish hospitals and granting permission for other applications as prescribed by Cabinet Order.

After providing public notice of the medical care plan for athe prefecture pursuant to the provisions inof paragraph (1817), the relevant prefecture, when a sudden increase in population is expected, whenwhere there has been an announcement concerning the outbreak, etc. ofapplication for permission to establish a pandemic influenza or similar infectious disease, etc.hospital that includes beds as prescribed in Article 16, paragraph (2)by an Order of the Act on the PreventionMinistry of Infectious DiseasesHealth, Labour and Medical Care for Patients with Infectious Diseases has been madeWelfare, or whenwhere there are other circumstances has been another application as providedprescribed by a Cabinet Order, may regard the target number of beds provided for in paragraph (2), item (xviixv) as the number calculated pursuant to the provisions of a Cabinet Order, in areas as provided by Cabinet Order, and may engage in activities related to granting permission for applications for permission to establish hospitals and granting permission for other applications as prescribed by Cabinet Orderthe relevant application.

After providing public notice of the medical care plan for the prefecture pursuant to the provisions of paragraph (1817), the relevant prefecture, where there has been an application for permission to establish a hospital that includes beds as prescribedor any other application specified by an a Cabinet Order of the Ministry of Health, Labour and Welfare, or has been filed by a participating corporation, etc. (meaning a participating corporation, etc. prescribed in Article 70, paragraph (1)) of a regional medical coordination promotion corporation and where there has been another it is found that the relevant application as prescribed by a Cabinet is necessary for promoting the achievement of the regional medical care vision and other requirements specified by an Order, of the Ministry of Health, Labour and Welfare are met, may regard the number obtained by adding the number calculated pursuant to the provisions of a Cabinet Order asto the target number of beds provided for in paragraph (2), item (xviixv) in areas the relevant medical care plan pertaining to the relevant application as provided by Cabinet Orderthe relevant target number of beds, and may engage in activities related to granting permission for the relevant application.

After providing public notice of theIn preparing medical care plan for the prefecture pursuant toplans, prefectures must ensure consistency with the provisions of paragraph (18), the relevant prefecture, where an application for permission to establish a hospital or any other application specified by a Cabinet Order has been filed by a participating corporation, etc. (meaning a participating corporation, etc.prefectural plans prescribed in Article 4, paragraph (1) of the Act on Promotion of Comprehensive Securing of Medical and Long-Term Care in Communities and the prefectural long-term care insurance business support plans prescribed in Article 70118, paragraph (1)) of a regional medical coordination promotion corporationthe Long-Term Care Insurance Act, and where it is found thatwith the relevant application is necessary for promoting the achievementprevention plans prescribed in Article 10, paragraph (1) of the regional medical care vision specified in the relevant medical care plan and other requirements specified by an Order ofAct on the MinistryPrevention of Health, LabourInfectious Diseases and Welfare are met, may regard the number obtained by adding the number calculated pursuant to the provisions of a Cabinet Order toMedical Care for Patients with Infectious Diseases and the target number of beds provided forprefectural action plans prescribed in paragraph (2), item (xvii) in the relevant medical care plan pertaining to the relevant application as the relevant target number Article 7, paragraph (1) of beds, and may engage in activities related to granting permission for the relevant applicationthe Act on Special Measures Against Novel Influenza.

In preparing medical care plans, prefectures must ensure consistency with the prefectural plans prescribed in Article 4, paragraph (1) ofare to endeavor to ensure that harmony is maintained with plans prepared pursuant to the Act on Promotion of Comprehensive Securingprovisions of Medical and Long-Term Care in Communitiesother laws and the prefectural long-term care insurance business support plans prescribed in Article 118, paragraph (1) of the Long-Term Care Insurance Act,regulations and with the prevention plans prescribed in Article 10, paragraph (1) of the Act on the Prevention of Infectious Diseases particulars that concern ensuring medical care, and Medical Care for Patients with Infectious Diseases and the prefectural action plans prescribed in Article 7, paragraph (1) of the Act on Special Measures Against Novel Influenza (Act No. 31 of 2012)must endeavor to seek coordination among public health, pharmacy, social welfare, and other measures which are closely related to medical care.

In preparing medical care plans, prefectures are to endeavor to ensure that harmony is maintained with plans prepared pursuant to undertake liaison and coordination with related prefectures, when it is considered necessary in the provisionslight of other laws and regulationsthe supply and with particulars that concern ensuringdemand of medical care, and must endeavor to seek coordination among public health, pharmacy, social welfare, and other measures which are closely related to medical care in areas near the boundaries of the relevant prefectures.

In preparing medical care plans, prefectures are to undertake liaison and coordinationThe prefecture must hear the opinions of groups of persons with related prefectures, when it is considered necessarythe relevant knowledge and experience in the light of the supply and demand of diagnoses or prescriptions, in order to prepare a draft medical care in areas near the boundaries of the relevant prefecturesplan based on expert scientific opinions on medical care.

The prefecture must hear the opinions of groups of persons with the relevant knowledge the Prefectural Council on Medical Service Facilities, municipalities, and experience in diagnoses or prescriptions, in order to prepare a draft the insurers' council in advance, when stipulating the medical care plan or revising the medical care plan based on expert scientific opinions on medical carepursuant to the provisions of Article 30-6.

The prefecture must hear the opinions of the Prefectural Council on Medical Service Facilities, municipalities (includingWhen a part of the administrative associations and cross-regional federations set forth in Article 284, paragraph (1) of the Local Autonomy Act (Act No. 67 of 1947) that handle first aid services), andprefecture has established a medical care plan or revised a medical care plan pursuant to the Councilprovisions of Insurers set forth in Article 157-2, paragraph (1) of30-6, it must submit the Act on Assurance of Medical Care for Elderly People (Act No. 80relevant plan to the Minister of 1982) in advance, when stipulating the medical care plan or revising the medical care plan pursuant toHealth, Labour and Welfare without delay and provide public notice of the provisions of Article 30-6details thereof.

When a prefecture has established a medical care plan or revised a medical care plan pursuant to the provisions of Article 30-6, it must submit the relevant plan to the Minister of Health, Labour and Welfare without delay and provide public notice of the details thereof.

A prefecture, if it finds it necessary for the preparation of the regional medical care vision or the medical care plan, or for the execution of activities based on the medical care plan, may request the delivery of any necessary information from the municipalities and other public offices, medical insurers provided for in Article 7, paragraph (7) of the Long-Term Care Insurance Act (referred to as "medical insurers" in Article 30-14, paragraph (1) and Article 30-18-5, paragraph (1)), or establishers, administrators or founders of medical institutions, including information concerning the functions of medical institutions within the boundaries of the relevant prefecture.

The prefecture, every three years, must inspect, analyze and evaluate the particulars listed in Article 30-4, paragraph (2), items (vi), (x)-2viii) and (xiix), and, out of the particulars listed in the following items, those relating to the particulars listed in items (vi), (x)-2viii) and (xiix) of that paragraph and other particulars specified by an Order of the Ministry of Health, Labour and Welfare (referred to as "specified particulars" in the following paragraph), and is to revise the medical care plan of the relevant prefecture when it finds it necessary:

particulars listed in each item of Article 30-4, paragraph (2) (excluding items (vi), (x)-2viii) and (xiix)); and

Establishers, administrators and founders of medical institutions are to endeavor to cooperate as necessary in the construction of the medical care coordination system, in order to contribute to the implementation of the regional medical care vision and the medical care plan.

hospitals:To secure necessary medical care in the community by cooperating in the promotion of differentiation and coordination of the medical institution functions and bed functions in the community, according to the medical institution functions and bed functions; and

Administrators of hospitals or clinics are to provide in-home medical care, and are to seek cooperation with welfare services and endeavor to give the necessary support for the provision of in-home medical care, in order to contribute to the implementation of the regional medical care vision and the medical care plan.

Establishers and administrators of hospitals are to endeavor to allow the use of all or parts of the hospital's buildings, equipment, instruments, and tools by physicians, dentists, or pharmacists who do not work at the relevant hospital in their practice, research, or training, provided there is no hindrance to the medical care services of the relevant hospital, in order to contribute to the implementation of the regional medical care vision and the medical care plan.

National government and local governments are to endeavor to undertake any necessary measures, including improving hospitals or clinics in areas with insufficient hospitals or clinics, promoting the differentiation and coordination of the medical institution functions and bed functions in the community and ensuring the availability of physicians, in order to promote the fulfillment of the regional medical care vision and medical care plans.

The prefectural governor, where it is specifically necessary in order to promote the fulfillment of the regional medical care vision and the medical care plan, may hear the opinions of the Prefectural Council on Medical Service Facilities, and recommend that a person who wishes to establish a hospital or clinic, or an establisher or administrator of a hospital or clinic, establish a hospital, increase a hospital's number of beds, or change its bed classifications, or recommend that such a person establish beds in a clinic or increase the number of beds in a clinic.

The provisions of Article 7-2, paragraphs (38) through (510) apply mutatis mutandis to hospitals established by persons other than those listed in each item of paragraph (1) of the same Article (limited to those having long-term care beds or general beds) or clinics (limited to those setting up beds with permission under Article 7, paragraph (3)), when it is especially necessary for promoting the achievement of the medical care plan. In this case, the term "order" in Article 7-2, paragraph (38) is replaced with "request", the term "preceding three paragraphsparagraphs (1) through (3) and the preceding paragraph" in paragraph (49) of the same Article is replaced with "the preceding paragraph", the term "area and the relevant vision area" is replaced with "area", the term "the number of existing beds, and the number of beds to which the relevant application relates" is replaced with "the number of beds", the termsterm "refuse permission as set forth in paragraphsparagraph (1) through paragraph (3) of the preceding Article pursuant to the provisions of paragraph (1) or, paragraph (2), or paragraph (3)7) or if the governor wishes to issue an order pursuant to the provisions of paragraph (8)" in paragraph (510) of the same Article is replaced with "issue an order pursuant to the provisions of paragraph (38)", and the term "wishes to issue an order" is replaced with "wishes to issue a request".

When a prefectural governor finds that the establisher or administrator of a hospital or clinic that has received a request under Article 7-2, paragraph (38) as applied mutatis mutandis by replacing the terms in accordance with the preceding paragraph has not taken measures pertaining to the relevant request without justifiable grounds, the prefectural governor may recommend that the relevant establisher or administrator of the hospital or clinic should take the relevant measures, after hearing the opinions of the Prefectural Council on Medical Service Facilities.

The administrator of a hospital or clinic with long-term care beds or general beds must, in order to promote the differentiation and coordination of medical institution functions (meaning the content of the medical care provided as a medical institution in the community by each hospital or clinic; the same applies hereinafter in this Article) and bed functions in the community, as provided by an Order of the Ministry of Health, Labour and Welfare, report the following particulars to the governor of the prefecture where the hospital or clinic is situatedlocated, in accordance with the classification specified by an Order of the Ministry of Health, Labour and Welfare according to the medical institution functions of the hospital or clinic and the classification specified by an Order of the Ministry of Health, Labour and Welfare according to bed functions (hereinafter referred to as the "functional classification of beds"):

The prefecture is to establish a place of consultation (hereinafter referred to as the "place of consultation" except for paragraphs (4) and (5), Article 30-18-4, paragraph (3), Article 30-18-5, paragraphs (1) and (2), Article 30-18-6, paragraphs (4) and (5), and Article 30-23, paragraph (1)) for consultation with those of the municipalities, organizations of academic experts on medical treatment, other medical experts, medical insurers, and other related parties that are specified by an Order of the Ministry of Health, Labour and Welfare (hereinafter referred to as "related parties" in this Articleparagraph and the following paragraph) in each of the vision areas and other areas that the governor of the relevant prefecture deems appropriate (referred to as the "vision area, etc." in paragraph (4), Article 30-16, paragraph (1) and Article 30-18-5, paragraph (5)), and, in cooperation with related parties, is to hold consultations on measures to achievepromote the future requirements for the number differentiation and coordination of medical institution functions in light of beds the outlook for future medical institution functions specified in the regional medical care planvision, measures to achieve the future requirements for the number of beds, and other particulars necessary to promote the achievement of the regional medical care vision.

In order to promote the achievement of the regional medical care vision specified in the medical care plan, a person who has filed an application prescribed in Article 7, paragraph (5) must endeavor to respond to a request made by the prefectural governor to participate in a consultation at the place of consultation, with regard to the establishment of a hospital or an increase in the number of beds or a change in the type of beds inbed classifications of a hospital, or the establishment of beds in a clinic or an increase in the number of beds or a change in the type of beds inbed classifications of a clinic pertaining to the relevant application.

When the vision area, etc. coincides with the target area prescribed in Article 30-18-5, paragraph (1), the prefecture may, in lieu of the consultation set forth in paragraph (1) in the relevant vision area, etc., hold consultations on the particulars necessary to promote the achievement of the regional medical care vision (limited to those related to ensuring the medical care delivery system for outpatient medical care) at the place of consultation prescribed in paragraph (1) of the same Article in the relevant target area.

Related parties as prescribed in Article 30-18-5, paragraph (1), when requested by the prefecture to participate in a consultation conducted by the prefecture pursuant to the provisions of the preceding paragraph, are to endeavor to cooperate by participating in it, and must also endeavor to cooperate in the implementation of particulars which related parties have agreed upon at the place of such consultation.

In the case where the reference date bed functions and the bed functions after the reference date pertaining to a report under the provisions of Article 30-13, paragraph (1) are different, or in other cases specified by an Order of the Ministry of Health, Labour and Welfare, the prefectural governor, if the number of beds of hospitals, etc. subject to a report on medical institution functions, etc. in the vision area including the location of the hospital, etc. subject to a report on medical institution functions, etc. having filed the relevant report (hereinafter referred to as a "reporting hospital, etc." in this Article), according to the functional classification of beds pertaining to the bed functions after the reference date pertaining to the relevant report, has already reached the future requirements for the number of beds in the relevant vision area as specified in the regional medical care planvision according to the functional classification of beds pertaining to the bed functions after the reference date pertaining to the relevant report, may request the establisher or administrator of a reporting hospital, etc. to submit a document stating the reasons why the reference date bed functions and the bed functions after the reference date pertaining to the relevant report are different, and other particulars specified by an Order of the Ministry of Health, Labour and Welfare (hereinafter referred to as "reasons, etc." in this Article).

The provisions of the preceding paragraph apply mutatis mutandis to a reporting hospital, etc. established by a person other than those listed in the items of Article 7-2, paragraph (1), when it is especially necessary for promoting the achievement of the regional medical care vision specified in the medical care plan. In this case, the term "order" in the preceding paragraph is replaced with "request".

The prefectural governor, when no agreement is reached through consultation at the place of consultation on particulars necessary to promote the achievement of the regional medical care vision specified in the medical care plan, or when otherwise specified by an Order of the Ministry of Health, Labour and Welfare, may instruct the establisher or administrator of a hospital, etc. subject to a report on medical institution functions, etc. (limited to those established by the persons listed in the items of Article 7-2, paragraph (1)) in the vision area, etc. to provide medical care pertaining to those of the functional classifications of beds for which the number of existing beds according to the functional classification of beds in the vision area pertaining to the relevant vision area, etc. has not reached the future requirements for the number of beds in the relevant vision area specified in the regional medical care planvision, and to take other necessary measures, after hearing the opinions of the Prefectural Council on Medical Service Facilities.

The provisions of the preceding paragraph apply mutatis mutandis to a hospital, etc. subject to a report on medical institution functions, etc. established by a person other than those listed in the items of Article 7-2, paragraph (1), when it is especially necessary for promoting the achievement of the regional medical care vision specified in the medical care plan. In this case, the term "instruct" in the preceding paragraph is replaced with "request".

The prefecture is to establish a place of consultation for consultation with organizations of academic experts on medical treatment, other medical experts, medical insurers, and other related parties (hereinafter referred to as "related parties" in this paragraph and the following paragraph) in each of the areas set forth in Article 30-4, paragraph (2), item (xivxii) and other areas that the governor of the relevant prefecture deems appropriate (hereinafter referred to as the "target area" in this Article), and, in cooperation with related parties, is to hold consultations on the following particulars (with regard to the particulars listed in items (iii), (v) and (vi), limited to those related to securing the medical care delivery system for outpatient medical care; the same applies in paragraph (5)), and summarize and publicize the results thereof:

the following particulars, based on information on the number of physicians shown by the indicators prescribed in Article 30-4, paragraph (2), item (xiix), (b):

In the case prescribed in the preceding paragraph, relatedRelated parties as prescribed in Article 30-14, paragraph (1), when requested by the prefecture to participate in a consultation conducted by the prefecture pursuant to the provisions of the preceding paragraph, are to endeavor to cooperate by participating in it, and must also endeavor to cooperate in the implementation of particulars which related parties have agreed upon at thethat place of such consultation.

Where, among the areas prescribed in Article 30-4, paragraph (2), item (xivxii), there is an area in which the rate calculated, as provided by Order of the Ministry of Health, Labour and Welfare, as corresponding to the ratio of the number of physicians providing outpatient medical care to the number of out-patients, or other indicators specified by Order of the Ministry of Health, Labour and Welfare, exceed the standards specified by Order of the Ministry of Health, Labour and Welfare, and the prefectural governor finds that, among such areas, there is an area where it is particularly necessary to secure regional outpatient medical care, the prefectural governor is to designate that area.

The prefectural governor, when holding consultations on the particulars listed in item (ii) of the preceding paragraph, must take into account the information on the number of physicians indicated by the indicator prescribed in Article 30-4, paragraph (2) item (xiix), (b) and give consideration to other particulars specified by an Order of the Ministry of Health, Labour and Welfare, so that the dispatch of physicians will contribute to ensuring the availability of physicians in acute physician shortage areas.

to conduct surveys and analyses concerning: trends in ensuring the availability of physicians in hospitals and clinics located in the areas prescribed in Article 30-4, paragraph (65); factors contributing to ensuring the availability of physicians in hospitals and clinics located in the areas prescribed in Article 30-4, paragraph (76); and other particulars concerning the securing of medical care required in the region;

a medical corporation that establishes hospitals in one prefecture and clinics in the area prescribed in Article 30-4, paragraph (2), item (xivxii) specified in the medical care plan of the prefecture other than the prefecture where the relevant hospitals are located, which is adjacent to the area prescribed in the same item specified in the medical care plan of the prefecture where the relevant hospitals are located, and medical care in the relevant hospitals and the relevant clinics is provided in an integrated manner in conformity with the standards specified by an Order of the Ministry of Health, Labour and Welfare:The prefecture where the relevant hospitals are located;

A medical coordination promotion area is established by taking into consideration the vision area specified in the regional medical care planvision of the prefecture to which the relevant medical coordination promotion area belongs.

In granting approval for medical coordination promotion, the prefectural governor must give consideration to consistency with the regional medical care vision specified in the medical care plan of the prefecture and hear the opinions of the Prefectural Council on Medical Service Facilities in advance.

when they have violated an order or disposition based on the provisions of Article 6-8, paragraph (2), Article 7-2, paragraph (38), Article 23-2, Article 24, Article 28, Article 29, paragraph (1), or Article 30-15, paragraph (6).