This Act comes into effect on January 1, 1992; provided, however, that the provisions set forth in the following items come into effect on the dates specified in those items:

①In the application of the provisions of Article 28-2 of the Act on Health and Medical Services for the Elderly as amended by Article 1 (hereinafter referred to as the "New Elderly Health Act"), in the case where there is a risk that the amount of the co-payment will become an excessive burden in consideration of the ability of the elderly to bear it, etc., the way in which the amount of the co-payment is to be revised is to be reviewed comprehensively, and necessary measures are to be taken based on the results.

②In addition to what is prescribed in the preceding paragraph, with regard to the system of health and medical services for the elderly under the Act on Health and Medical Services for the Elderly, the way in which benefits and the bearing of expenses should be arranged is to be reviewed in light of the purpose of that system, taking into consideration the status of implementation of the system after the enforcement of this Act, trends in medical expenses for the elderly, changes in socioeconomic conditions, etc.

The government is to strive to research methods of evaluating the quality of medical care and other services that the elderly receive at medical institutions providing services covered by health insurance, etc. prescribed in Article 25, paragraph (3) of the Act on Health and Medical Services for the Elderly and at health care facilities for the elderly prescribed in Article 6, paragraph (4) of that Act, so that appropriate medical care suited to the physical and mental characteristics of the elderly is provided, and is to review the way in which the amount of expenses is calculated, such as the comprehensive calculation of the amount of expenses required for medical care provided pursuant to the provisions of Article 25 of that Act, and take required measures based on the results.

The government is to strive to promote necessary measures concerning attendant nursing care and other nursing care provided at hospitals or clinics so that the elderly can appropriately receive such nursing care and other medical care under integrated management in accordance with their physical and mental characteristics.

From the date of enforcement of this Act (hereinafter referred to as the "Effective Date") to March 31, 1993, in Article 28, paragraph (1), item (i) of the New Elderly Health Act, the phrase "1,000 yen (when the amount of the relevant co-payment has been revised pursuant to the provisions of paragraph (1) of the following Article, the amount of the relevant co-payment after the most recent revision pursuant to that paragraph)" is deemed to be replaced with "900 yen", and in item (ii) of that paragraph, the phrase "700 yen (when the amount of the relevant co-payment has been revised pursuant to the provisions of paragraph (2) of the following Article, the amount of the relevant co-payment after the most recent revision pursuant to that paragraph)" is deemed to be replaced with "600 yen".

①With regard to the amount of medical expenses under the provisions of the Act on Health and Medical Services for the Elderly as it stood before the amendment by Article 1 (hereinafter referred to as the "Former Elderly Health Act") pertaining to medical care, provision of drugs, or medical treatment provided before the Effective Date, the provisions then in force continue to govern.

②With regard to the amount of medical expenses under the provisions of the New Elderly Health Act pertaining to medical care, provision of drugs, or medical treatment provided during the period from the Effective Date to March 31, 1993, in Article 32, paragraph (2) of the New Elderly Health Act, the phrase "Article 28" is deemed to be replaced with "Article 28 as replaced pursuant to the provisions of Article 5 of the Supplementary Provisions of the Act Partially Amending the Act on Health and Medical Services for the Elderly, etc. (Act No. 89 of 1991)", and the phrase "paragraph (1), item (ii) of that Article" in paragraph (4) of that Article and the phrase "Article 28, paragraph (1), item (ii)" in paragraph (5) of that Article are deemed to be replaced with "Article 28, paragraph (1), item (ii) as replaced pursuant to the provisions of Article 5 of the Supplementary Provisions of the Act Partially Amending the Act on Health and Medical Services for the Elderly, etc.".

The provisions of Articles 47 through 50 of the New Elderly Health Act apply to the expenses required for medical care (including payment of medical expenses) under the provisions of the New Elderly Health Act, payment of specified medical expenses (including payment of medical expenses), and payment of medical expenses for health care facilities for the elderly that are provided on or after the Effective Date (in the case of the dementia-related part of the Article 48 amendment, April 1, 1992; the same applies hereinafter in this Article), and to the expenses required for the execution of affairs concerning those services, and the provisions then in force continue to govern the expenses required for medical care (including payment of medical expenses) under the provisions of the Former Elderly Health Act, payment of specified medical expenses (including payment of medical expenses), and payment of medical expenses for health care facilities for the elderly that were provided before the Effective Date, and the expenses required for the execution of affairs concerning those services.

With regard to estimated medical expense contributions and fixed medical expense contributions for fiscal years up to and including fiscal year 1990, the provisions then in force continue to govern.