Overview of Major Legislation

YearPolicyDetails
1922Health Insurance Law・First introduction of national health insurance
・Provided health insurance to laborers and employees of small firms
1938National Health Insurance Law・Established National Health Insurance (NHI), a residence-based insurance program for farmers, self-employed , retired, and non-employed administered by municipalities on a voluntary basis
1948Medical Care Act・Legislated the establishment and management of hospitals, clinics, and other facilities; mandated medical care provision
1958Amendment to the National Health Insurance Law・Mandated that all municipalities establish and administer residence-based NHI programs
1961Universal Health Care achieved・Landmark achievement in Japanese health policy history made possible through the expansion of NHI after all municipalities were mandated to administer a NHI program in 1959
1972Free health care for those 70 and over・Created a new structure for those 70 and over and made care free for nearly all those 70 and over
・Reduced copayments within NHI for other enrollees
1982Health Care for the Aged Law・Retracted free care for those 70 and over by imposing a small co-payment
・Cross-subsidized the NHI program by transferring revenue from employment-based health insurance
1985The first revision to the 1948 Medical Care Act・Introduced regional planning for controlling hospital beds
1993The second revision to the 1948 Medical Care Act・Specified “advanced care hospitals” and created a new structure for “health facilities for long-term recuperation”
1997Long Term Care Insurance Law・Launched a mandatory social insurance program that covers care for older persons with health issues, partially relieves caregiver burden, and addresses the needs of the ageing population
1997The third revision to the 1948 Medical Care Act・Launched the regional medical care support hospital system
・Set general regulations for informed consent
2000The fourth revision to the 1948 Medical Care Act・Introduced a bed classification system that required hospitals to report hospital bed use as “general” or “treatment”
・Implemented 2-years mandatory clinical training to become a licensed doctors
・Made compliance with Health Safety Standards mandatory
2006Health Care Reform Act・Promoted public information about health care facilities at prefecture level
・Established the Medical Safety Support Center
2006The fifth revision to the 1948 Medical Care Act・Promoted public information about health care facilities at prefecture level
・Established the Medical Safety Support Center
2012Amendment to the National Health Insurance Law・Promoted of integrate care and analysis of hospital bed figures through the creation of the Bed Classification System and Integrated Community-based Care Plan
・Introduced measures to address physician and nurse shortages
・Introduced classification renewal system for hospitals recognized as “advanced treatment hospitals”
・Introduced measures to improve health care worker work environment
・Promoted home health care
・Promoted clinical trial system improvement
・Introduced a system to investigate medical accidents
・Transferred the financial administration of NHI programs from the municipal level to the prefectural level to strengthen its financial basis
2014The sixth revision to the 1948 Medical Care Act・Revised system for “healthcare corporations”
2015Health Care System Reform Law of 2015・ Transferred oversight of NHI from the municipal level to the prefectural level in an effort to achieve increased fiscal management
・ Increased the cost of health insurance for those employed by large firms and the government
・ Provided for “mixed-billing,” care that combines services and products that are covered by health insurance with services and products that are not covered by insurance