Article 4Responsibilities of the National Government, Prefectures and Municipalities
第四条（国、都道府県及び市町村の責務）
The national government is to take various necessary measures so that national health insurance services are administered soundly and, in order to contribute to the achievement of the purpose prescribed in Article 1, is to actively promote measures concerning health, medical care and welfare and other related measures.
国は、国民健康保険事業の運営が健全に行われるよう必要な各般の措置を講ずるとともに、第一条に規定する目的の達成に資するため、保健、医療及び福祉に関する施策その他の関連施策を積極的に推進するものとする。
A prefecture is to play a central role in stable financial management, ensuring the efficient implementation of national health insurance services by Municipalities, and otherwise in the sound administration of the national health insurance services of the prefecture and of the Municipalities within that prefecture.
都道府県は、安定的な財政運営、市町村の国民健康保険事業の効率的な実施の確保その他の都道府県及び当該都道府県内の市町村の国民健康保険事業の健全な運営について中心的な役割を果たすものとする。
A Municipality is to appropriately implement national health insurance services, including matters concerning the acquisition and loss of eligibility as an insured person, the collection of national health insurance premiums (including national health insurance tax under the Local Tax Act (Act No. 226 of 1950); the same applies in Article 11, paragraph (2), Article 54-3, paragraphs (1), (2) and (4), Article 63-2, Article 81-2, paragraph (1), each item, and paragraph (10), items (ii) and (iii), and Article 82-2, paragraph (2), items (ii) and (iii), and paragraph (6)), and the implementation of health services.
市町村は、被保険者の資格の取得及び喪失に関する事項、国民健康保険の保険料（地方税法（昭和二十五年法律第二百二十六号）の規定による国民健康保険税を含む。第十一条第二項、第五十四条の三第一項、第二項及び第四項、第六十三条の二、第八十一条の二第一項各号並びに第十項第二号及び第三号並びに第八十二条の二第二項第二号及び第三号並びに第六項において同じ。）の徴収、保健事業の実施その他の国民健康保険事業を適切に実施するものとする。
In order to fulfill the responsibilities under the preceding two paragraphs, prefectures and Municipalities are to seek organic coordination with measures concerning health and medical services and welfare services and other related measures.
都道府県及び市町村は、前二項の責務を果たすため、保健医療サービス及び福祉サービスに関する施策その他の関連施策との有機的な連携を図るものとする。
In addition to what is prescribed in paragraph (2) and the preceding paragraph, a prefecture is to provide necessary guidance and advice to National Health Insurance Societies and other persons involved, so that the administration of national health insurance services is carried out appropriately and smoothly.