Medical Care Act

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 (xii) 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 (ix), (b):

particulars concerning outpatient medical care particularly needed in the community (referred to as "regional outpatient medical care" in the following Article);

particulars concerning the state of the medical care delivery system for outpatient medical care;

particulars concerning the core hospitals or clinics that provide outpatient medical care specified by Order of the Ministry of Health, Labour and Welfare as set forth in Article 30-18-2, paragraph (1), item (i), based on the reports under the provisions of Article 30-18-2, paragraph (1) and Article 30-18-3, paragraph (1);

in addition to what is listed in the preceding item, particulars concerning the promotion of functional differentiation and coordination of hospitals and clinics;

particulars necessary for securing the functions prescribed in paragraph (1), items (i) and (ii) of the preceding Article in the target area, based on the reports under the provisions of paragraphs (1) and (3) of that Article (including as applied mutatis mutandis pursuant to paragraph (5) of that Article);

particulars concerning the promotion of medical treatment provided by multiple physicians in cooperation;

particulars concerning the efficient utilization of all or part of buildings, equipment, instruments and appliances of medical institutions; and

other particulars necessary for securing the medical care delivery system for outpatient medical care.

When related parties are requested by the prefecture to participate in a consultation conducted by the prefecture pursuant to the provisions of the preceding paragraph, they 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.

When a prefecture consults on the particulars listed in item (iv) of paragraph (1) (limited to particulars specified by Order of the Ministry of Health, Labour and Welfare as concerning long-term care and other services closely related to medical care) pursuant to the provisions of that paragraph, it is to request the participation of the municipalities concerned and take into consideration the contents of the municipal plan prescribed in Article 5, paragraph (1) of the Act on Promotion of Comprehensive Securing of Medical and Long-Term Care in Communities, the Municipal Insured Long-Term Care Service Plan prescribed in Article 117, paragraph (1) of the Long-Term Care Insurance Act, and other plans concerning services closely related to medical care, that the municipalities have prepared.

When a prefecture consults on the particulars listed in item (iv) of paragraph (1) pursuant to the provisions of that paragraph, it is to pay attention to the status of implementation of measures for promoting the maintenance of the health of residents in the target area, the status of implementation of health projects for elderly people (meaning the health projects for elderly people prescribed in Article 125, paragraph (1) of the Act on Assurance of Medical Care for Elderly People) and other projects carried out integrally with them, and the status of efforts toward constructing the community-based integrated care system (meaning 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; the same applies in Article 70, paragraph (1), item (ii) and Article 70-7).

When the target area coincides with the vision area, etc., the prefecture, in lieu of the consultation set forth in paragraph (1) in the relevant target area, may hold consultations on the particulars listed in the items of the same paragraph at the place of consultation in the relevant vision area, etc.

Related 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 that place of consultation.

Where, among the areas prescribed in Article 30-4, paragraph (2), item (xii), 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.

When a prefectural governor has made the designation under the preceding paragraph, the governor must give public notice to that effect, as provided by Order of the Ministry of Health, Labour and Welfare.

A person who intends to establish a clinic (limited to a place where medical practice is conducted and which does not have facilities for admitting patients) in an area designated under paragraph (1) must, except in cases specified by Order of the Ministry of Health, Labour and Welfare as unavoidable, notify the prefectural governor, no later than six months before the date on which the clinic is to be established, as provided by Order of the Ministry of Health, Labour and Welfare, of their intention regarding the provision of regional outpatient medical care in that area and other matters specified by Order of the Ministry of Health, Labour and Welfare.

When, in an area designated under paragraph (1), a person who has given the notification under the preceding paragraph or another person specified by Order of the Ministry of Health, Labour and Welfare (hereinafter referred to as a "notifying person, etc." in this Article) has indicated an intention not to provide regional outpatient medical care in that area, the prefectural governor may request the notifying person, etc. to participate in the consultation at the place of consultation prescribed in paragraph (1) of the preceding Article and to explain the reasons for not providing it and other matters specified by Order of the Ministry of Health, Labour and Welfare (hereinafter referred to as "reasons, etc." in this Article).

A notifying person, etc. who is requested by the prefectural governor pursuant to the provisions of the preceding paragraph must endeavor to participate in the consultation at that place and explain the reasons, etc.

If, based on the content of the explanation under the preceding paragraph, the reasons, etc. are not found to be unavoidable, the prefectural governor may request the notifying person, etc. to provide regional outpatient medical care in that area by a set deadline.

When the prefectural governor finds that the establisher or administrator of a clinic established by a notifying person, etc. who received a request under the provisions of the preceding paragraph is not providing the regional outpatient medical care to which the request relates, the governor may request the establisher or administrator to attend a meeting of the Prefectural Council on Medical Service Facilities and explain the reasons, etc.

The establisher or administrator of the clinic, when requested by the prefectural governor pursuant to the provisions of the preceding paragraph, must endeavor to attend a meeting of the Prefectural Council on Medical Service Facilities and explain the reasons, etc.

Based on the content of the explanation under the preceding paragraph, if the reasons, etc. are not found to be unavoidable, the prefectural governor may, after hearing the opinions of the Prefectural Council on Medical Service Facilities, recommend that the establisher or administrator of the clinic provide regional outpatient medical care in that area.

When a prefectural governor has made a recommendation under the preceding paragraph and the establisher or administrator of the clinic that received the recommendation has not complied with it, the governor may make public that fact.

When a notifying person, etc. who received a request under the provisions of paragraph (6) has not complied with it, when the prefectural governor has made a recommendation under the provisions of paragraph (9), or when the establisher or administrator of the clinic that received the recommendation has not complied with it, the prefectural governor is to notify the Minister of Health, Labour and Welfare to that effect.

The administrator of a hospital or clinic must endeavor, in order to efficiently provide high-quality and appropriate medical care, to take measures to improve the efficiency of operations in the relevant hospital or clinic and the working environment of its medical care professionals and other measures that contribute to ensuring the availability of medical care professionals.

The Minister of Health, Labour and Welfare is to establish and publicize particulars that should serve as guidelines for the appropriate and effective implementation of measures to be taken by administrators of hospitals and clinics in accordance with the provisions of the preceding Article.

The prefecture is to endeavor to implement the following particulars in order to promote the improvement of the efficiency of operations in hospitals or clinics and the working environment of their medical care professionals:

providing consultation, necessary information, advice and other assistance concerning the improvement of the efficiency of operations in hospitals or clinics and the working environment of their medical care professionals;

conducting surveys and awareness-raising activities concerning the improvement of the efficiency of operations in hospitals or clinics and the working environment of their medical care professionals; and

beyond what is listed in the preceding two items, providing support necessary for improving the efficiency of operations in hospitals or clinics and the working environment of their medical care professionals.

The prefecture may entrust all or part of the affairs listed in the items of the preceding paragraph to a person specified by an Order of the Ministry of Health, Labour and Welfare.

The prefecture or a person entrusted pursuant to the provisions of the preceding paragraph (limited to entrustment concerning the affairs listed in the items of paragraph (1) that relate to improving the working environment of medical care professionals (hereinafter referred to as "affairs related to improving the work environment")), when implementing the affairs related to improving the work environment or the affairs related to improving the work environment pertaining to the relevant entrustment, is to pay special attention to the following particulars:

importance of improving the working environment in a hospital or clinic in an acute physician shortage area where physicians will be staffed; and

importance of securing the function as a center to promote the improvement of the working environment of medical care professionals.

The prefecture or a person entrusted pursuant to the provisions of paragraph (2) (limited to entrustment concerning affairs related to improving the work environment), when implementing the affairs related to improving the work environment or the affairs related to improving the work environment pertaining to the relevant entrustment, must mutually cooperate with a person who implements the affairs to support regional medical care prescribed in Article 30-25, paragraph (3) or the affairs pertaining to the entrustment set forth in the same paragraph.

A person entrusted pursuant to the provisions of paragraph (2), or an officer or employee thereof, or a person who used to be such a person must not divulge any secret that has come to their knowledge concerning the affairs pertaining to the relevant entrustment without justifiable grounds.