National Health Insurance Act

Pursuant to Cabinet Order provisions, the national government shall bear the costs incurred by Societies in executing their affairs for national health insurance programs (including affairs concerning the payment of the young-old payments, etc. under the provisions of the Act on Assurance of Medical Care for Elderly People (hereinafter referred to as "young-old payments, etc."), the old-old aid, the contribution for administrative expenses related to the old-old and the contribution for administrative expenses related to childbirth and childcare under the provisions of that Act (hereinafter referred to as "old-old aid, etc."), the payment under the provisions of the Long-Term Care Insurance Act (hereinafter referred to as "long-term care payment"), the contribution for securing medical care in the early phase of an epidemic under the provisions of the Act on the Prevention of Infectious Diseases and Medical Care for Patients with Infectious Diseases (Act No. 114 of 1998) (hereinafter referred to as "contribution for securing medical care in the early phase of an epidemic"), and the children and child-rearing support levy under the provisions of the Act on Support for Children and Child-rearing (Act No. 65 of 2012) (hereinafter referred to as "children and child-rearing support levy")).

In order to stabilize the finances of the national health insurance program provided by prefectures, etc., the national government shall, pursuant to Cabinet Order provisions, bear thirty-two hundredths of the total sum of the amounts listed in the following items for prefectures, with respect to the costs incurred by the Municipalities within each prefecture in providing benefits for medical treatment and paying expenses for Dietary Treatment for inpatients, expenses for Living Support for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, special medical expenses, transport expenses, high-cost medical expenses and expenses for high-cost medical treatment combined with long-term care (in Article 73, paragraph (1), Article 75-2, paragraph (1), Article 76, paragraph (2) and Article 104 referred to as "cost incurred in providing benefits for medical treatment, etc.") and the costs incurred by the prefecture in paying the young-old payment under the provisions of the Act on Assurance of Medical Care for Elderly People (hereinafter referred to as "young-old payment"), the old-old aid under the provisions of that Act (hereinafter referred to as "old-old aid"), the long-term care payment, the contribution for securing medical care in the early phase of an epidemic and the children and child-rearing support levy:

the amount calculated by deducting the amount equal to one half of the total sum of the amount to be transferred pursuant to the provisions of Article 72-3, paragraph (1) and the amount to be transferred pursuant to the provisions of Article 72-4, paragraph (1) from the total sum of: (a) the amount calculated by deducting, from the amount of expenses incurred in providing benefits for medical treatment for insured persons, the amount equivalent to the co-payment relating to such benefits; and (b) the amount of expenses incurred in paying expenses for Dietary Treatment for inpatients, expenses for Living Support for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, special medical expenses, transport expenses, high-cost medical expenses and expenses for high-cost medical treatment combined with long-term care;

the amount of expenses incurred in paying the young-old payment, the old-old aid, the long-term care payment, the contribution for securing medical care in the early phase of an epidemic and the children and child-rearing support levy (or, where there is a young-old subsidy under the provisions of the Act on Assurance of Medical Care for Elderly People (hereinafter referred to as "young-old subsidy"), the amount calculated by deducting such young-old subsidy from such amount of expenses).

With regard to the application of the provisions of the preceding paragraph to a prefecture to which belongs a Municipality that has reduced the ratio of co-payment pursuant to the provisions of Article 43, paragraph (1), or a Municipality for which a prefecture or a Municipality has chosen to bear all or part of the amount equivalent to the co-payment for all or some of the insured persons, the amount listed in item (i) of that paragraph shall be the amount equivalent to the amount listed in that item calculated pursuant to Cabinet Order provisions as if the relevant measures to reduce the ratio of co-payment or to bear all or part of the amount equivalent to the co-payment were not taken.

In addition to what is provided for in paragraph (1), the national government shall, as provided by Cabinet Order, bear for prefectures an amount equal to one-fourth of the total amount of expenses incurred for benefits relating to medical services of an amount or more calculated, as provided by Cabinet Order, as benefits relating to medical services that have a significant impact on national health insurance finances, taking into consideration the ratio of expenses incurred for high-cost benefits relating to medical services to expenses incurred for all benefits relating to medical services for insured persons, etc. (referred to as the "amount of high-cost medical expenses subject to sharing" in Article 72-2, paragraph (2)).

In cases where a prefecture or a Municipality within that prefecture unjustly fails to secure the income that it should have secured, the national government may, as provided by Cabinet Order, reduce the amount that it is to bear for the prefecture pursuant to the provisions of the preceding Article.

The amount of reduction permitted pursuant to the preceding paragraph may not exceed the amount of income which unjustly failed to be secured.

With respect to the national health insurance program provided by prefectures, etc., the national government shall, as provided by Cabinet Order, provide adjusting subsidies to prefectures in order to adjust finances in accordance with the financial conditions and other circumstances of the prefecture and the Municipalities within that prefecture.

The total amount of adjusting subsidies to be provided pursuant to the provisions of the preceding paragraph shall be the total sum of the amounts listed in the following items:

the amount equal to nine hundredths of the total estimated sum of the amount listed in Article 70, paragraph (1), item (i) (or, where the provisions of paragraph (2) of the same Article apply, the amount calculated by applying the provisions of the same paragraph) and the amount listed in item (ii) of paragraph (1) of the same Article (in paragraph (1) of the following Article referred to as the "amount for calculation");

the amount equal to one-fourth of the total amount of the combined sum of the amount to be transferred pursuant to the provisions of Article 72-3, paragraph (1) and the amount to be transferred pursuant to the provisions of Article 72-4, paragraph (1).

In addition to what is provided for in paragraph (1), the national government shall, as provided by Cabinet Order, provide grants to prefectures, within the limits of the budget, in order to support the efforts of prefectures and the Municipalities within those prefectures concerning the maintenance and promotion of the health of insured persons, the promotion of efficient provision of medical care and other optimization of expenses required for medical care (hereinafter referred to as "optimization of medical expenses"), etc.

A prefecture must, as provided by Cabinet Order, transfer from its general account to its special account for national health insurance an amount equal to nine hundredths of the amount for calculation, in order to stabilize the finances of the national health insurance program provided by prefectures, etc. and to adjust finances in accordance with the financial conditions and other circumstances of the Municipalities within the prefecture.

In addition to what is provided for in the preceding paragraph, a prefecture must, as provided by Cabinet Order, transfer from its general account to its special account for national health insurance an amount equal to one-fourth of the amount of high-cost medical expenses subject to sharing.

Each Municipality shall, pursuant to Cabinet Order provisions, transfer from its general fund to the special account of that Municipality for its national health insurance program, an amount calculated, pursuant to Cabinet Order provisions, based on the total amount of insurance premiums relating to insured persons or the national health insurance tax under the provisions of the Local Tax Act, in each case after reductions have been made through reduced assessments of insurance premiums with respect to persons with small income pursuant to a Municipal Ordinance or through any reduction of national health insurance tax as set forth in Article 703-5, paragraph (1) of the same Act and by taking into consideration the financial condition of the national health insurance program and other circumstances.

Each prefecture shall, pursuant to Cabinet Order provisions, bear an amount equal to three-fourths of the amount to be transferred pursuant to the provisions of the preceding paragraph.

Each Municipality must, pursuant to Cabinet Order provisions, transfer from its general fund to the special account of that Municipality for its national health insurance program, an amount calculated, pursuant to Cabinet Order provisions, based on the total amount of insurance premiums relating to insured persons or the national health insurance tax under the provisions of the Local Tax Act, in each case after reductions have been made through reduced assessments of insurance premiums with respect to insured persons who have not yet passed the first March 31 on or after the day they reach the age of 18 pursuant to a Municipal Ordinance or through any reduction of national health insurance tax as set forth in Article 703-5, paragraph (2) of the same Act and by taking into consideration the financial condition of the national health insurance program and other circumstances.

The national government shall, pursuant to Cabinet Order provisions, bear an amount equal to one-half of the amount to be transferred pursuant to the provisions of the preceding paragraph.

Each prefecture shall, pursuant to Cabinet Order provisions, bear an amount equal to one-fourth of the amount to be transferred pursuant to the provisions of paragraph (1).

Each Municipality must, pursuant to Cabinet Order provisions, transfer from its general fund to the special account of that Municipality for its national health insurance program, an amount calculated, pursuant to Cabinet Order provisions, based on the total amount of insurance premiums relating to insured persons or the national health insurance tax under the provisions of the Local Tax Act, in each case after reductions have been made through reduced assessments of insurance premiums with respect to insured persons who are scheduled to give birth or who have given birth pursuant to a Municipal Ordinance or through any reduction of national health insurance tax as set forth in Article 703-5, paragraph (3) of the same Act and by taking into consideration the financial condition of the national health insurance program and other circumstances.

The national government shall, pursuant to Cabinet Order provisions, bear an amount equal to one-half of the amount to be transferred pursuant to the provisions of the preceding paragraph.

Each prefecture shall, pursuant to Cabinet Order provisions, bear an amount equal to one-fourth of the amount to be transferred pursuant to the provisions of paragraph (1).

In addition to the amounts to be transferred pursuant to the provisions of Article 72-3, paragraph (1), Article 72-3-2, paragraph (1) and paragraph (1) of the preceding Article, each Municipality must, pursuant to Cabinet Order provisions, transfer from its general fund to the special account of that Municipality for its national health insurance program an amount calculated, pursuant to Cabinet Order provisions, in accordance with the number of persons with small income and by taking into consideration the financial condition of the national health insurance program and other circumstances.

The national government shall, pursuant to Cabinet Order provisions, bear an amount equal to one-half of the amount to be transferred pursuant to the provisions of the preceding paragraph.

Each prefecture shall, pursuant to Cabinet Order provisions, bear an amount equal to one-fourth of the amount to be transferred pursuant to the provisions of paragraph (1).

The national government shall, pursuant to Cabinet Order provisions, bear, for each prefecture, an amount equal to one-third of the costs specified by Cabinet Order out of the costs required for the specified health checkups pursuant to the provisions of Article 20 of the Act on Assurance of Medical Care for Elderly People (referred to simply as "specified health checkup" in Article 82, paragraph (2)) and the specified health guidance pursuant to the provisions of Article 24 of that Act (referred to as "specified health checkup, etc." in Article 82, paragraph (1) and Article 86) conducted by the Municipalities within that prefecture (referred to as the "amount of costs of specified health checkups, etc." in the following paragraph).

Each prefecture must, pursuant to Cabinet Order provisions, transfer from its general fund to the special account of that prefecture for its national health insurance program an amount equal to one-third of the amount of costs of specified health checkups, etc.