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.

The following particulars are to be stipulated in the medical care plan:

particulars related to the activities set forth in item (iv) and item (v) and ensuring in-home medical care that should be achieved in the prefecture;

particulars related to the medical care coordination system (meaning the system to ensure the sharing of functions between medical institutions and the coordination of operations; the same applies hereinafter) pertaining to activities as set forth in item (iv) and item (v) and ensuring in-home medical care;

particulars related to promoting the provision of information on functions of medical institutions under the medical care coordination system;

particulars related to activities connected with treatment or prevention of illnesses prescribed by an Order of the Ministry of Health, Labour and Welfare as lifestyle diseases or other illnesses that are recognized as specifically requiring the provision of extensive and continuous medical care in order to ensure the health of the citizens;

particulars related to activities that are necessary for ensuring the following medical care (hereinafter referred to as "activities to ensure emergency medical care") (limited to where it is necessary to ensure this in the case of medical care listed in (d));

emergency medical care;

medical care in times of disaster;

medical care at times when an infectious disease whose spread is likely to have a serious impact on the lives and health of the citizens is spreading or there is a risk of its spreading;

medical care in remote areas;

perinatal medical care;

pediatric medical care (including pediatric emergency medical care);

beyond what is listed in (a) through (f), medical care that is recognized by the prefectural governor as being specifically necessary in the light of the status of outbreaks of illness, etc. in the relevant prefecture;

particulars related to ensuring in-home medical care;

particulars related to ensuring the medical care delivery system for outpatient medical care;

particulars related to ensuring the primary care function;

the following particulars related to ensuring the availability of physicians;

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 availability of medical care professionals (excluding physicians);

particulars related to ensuring safety in medical care;

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

particulars related to 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;

in the event of the establishment of areas prescribed in paragraphs (5) and (6), 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 hospital beds, the target number of beds for infectious disease hospital beds, and the target number of beds for tuberculosis hospital beds.

Beyond the particulars listed in each item of the preceding paragraph, efforts is to be made so that medical care plans stipulate the following particulars:

particulars related to targets for the development of regional medical care support hospitals and targets for the development of other medical institutions in consideration of the functions of such institutions; and

beyond what is listed in the preceding item, particulars necessary for securing the medical care delivery system.

The prefecture must consider the following particulars when stipulating particulars listed in paragraph (2) item (ii):

specific measures for the establishment of a medical care coordination system are to be specified for each disease prescribed by an Order of the Ministry of Health, Labour and Welfare set forth in item (iv) of paragraph (2) or medical care listed in (a) through (g) of item (v) of the same paragraph or in-home medical care;

the details of the establishment of the medical care coordination system are to ensure that patients can receive appropriate medical care continuously even after being discharged from the hospital;

the details of the establishment of the medical care coordination system are to include the coordination between health and medical services and welfare services provided in medical institutions and in homes; and

the medical care coordination system is to be established through consultation among medical care professionals, long-term care service providers provided for in the Long-Term Care Insurance Act, citizens, and other related parties in the community.

In stipulating the particulars listed in paragraph (2), item (ix) (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 (ix), (b), the area prescribed in item (xii) of the same paragraph where the number of physicians is recognized to be small.

In stipulating the particulars listed in paragraph (2), item (ix) (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 (ix), (b), the area prescribed in item (xii) of the same paragraph where the number of physicians is recognized to be large.

Standards related to the establishment of areas provided for in paragraph (2), items (xii) and (xiii), and the target number of beds provided for in item (xv) of the same paragraph (for standards related to the target number of long-term care beds and general beds, standards based on the total number calculated according to the respective bed classifications) are to be as prescribed by an Order of the Ministry of Health, Labour and Welfare.

The prefecture, where it wishes to stipulate the target number of beds provided for in paragraph (2) item (xv), when a sudden increase in population is expected or when there are other circumstances as provided by a Cabinet Order, may disregard the standards set forth in the preceding paragraph with regard to the required number of beds provided for in the same item, pursuant to the provisions of a Cabinet Order.

After providing public notice of the medical care plan for the prefecture pursuant to the provisions of paragraph (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 regard the number calculated pursuant to the provisions of a Cabinet Order as the target number of beds provided for in paragraph (2), item (xv) for the areas specified 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 Order.

After providing public notice of the medical care plan for the prefecture pursuant to the provisions of paragraph (17), the relevant prefecture, where there has been an application for permission to establish a hospital that includes beds as prescribed by an Order of the Ministry of Health, Labour and Welfare, or where there has been another application as prescribed by a Cabinet Order, may regard the target number of beds provided for in paragraph (2), item (xv) 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 the relevant application.

After providing public notice of the medical care plan for the prefecture pursuant to the provisions of paragraph (17), 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. prescribed in Article 70, paragraph (1)) of a regional medical coordination promotion corporation and where it is found that the relevant application 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 to the target number of beds provided for in paragraph (2), item (xv) in the relevant medical care plan pertaining to the relevant application as the relevant target number of beds, and may engage in activities related to granting permission for the relevant application.

In preparing medical care plans, prefectures must ensure consistency with the 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 118, paragraph (1) of the Long-Term Care Insurance Act, and with the prevention plans prescribed in Article 10, paragraph (1) of the Act on the Prevention of Infectious Diseases 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.

In preparing medical care plans, prefectures are to endeavor to ensure that harmony is maintained with plans prepared pursuant to the provisions of other laws and regulations and with particulars that concern ensuring 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 preparing medical care plans, prefectures are to undertake liaison and coordination with related prefectures, when it is considered necessary in the light of the supply and demand of medical care in areas near the boundaries of the relevant prefectures.

The prefecture must hear the opinions of groups of persons with the relevant knowledge and experience in diagnoses or prescriptions, in order to prepare a draft medical care plan based on expert scientific opinions on medical care.

The prefecture must hear the opinions of the Prefectural Council on Medical Service Facilities, municipalities, and the insurers' council in advance, when stipulating the medical care plan or revising the medical care plan pursuant to the provisions of Article 30-6.

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.