Health Care Policy Making Process

Although a significant part of Japanese health policy is dictated by revisions made to the fee schedule, bills passed through the legislative process form the structural base of policy, which includes government budget. The Japanese fiscal year starts in April and ends in March. The legislative process follows this timeline with budget bills prioritized to meet the start of the next fiscal year every April. Health legislation and other bills are submitted to the Diet by either the Cabinet or by a member of the Diet. In fact, 70% of proposed bills originate in the Cabinet. In addition, 80% of bills that originate in the Cabinet will pass as opposed to 20% of those submitted by a Diet member leading to a significant number of successful Cabinet-driven legislation.¹

Bills reach the Diet after a lengthy process that typically includes the following steps:^2,3

• Problem definition and information gathering
  Cabinet members survey stakeholder interests and gauge media reports. To inform discussions, cabinet members often consult healthcare practitioners and interview various stakeholders and experts.
• Cabinet council discussions^4,5
  Inside the Japanese cabinet there are more than a few hundred councils on topics ranging from space policy to suicide prevention. Councils that hear health policy related discussions include standing councils, such as the Social Security Council and the Committee on Health Insurance, and ad-hoc councils, which are convened to address matters that require a particular level of expertise or to gather a broad range of opinions. These council meetings are usually open to observers or media.
• Evaluation of policy draft by Cabinet Legislation Bureau
  Cabinet members work to gain support for the bill amongst ministries and interested parties since the bill needs to be submitted unanimously.
• Evaluation of proposed bill by ruling party
  The Evaluation Committee of the ruling party, which has mostly been the Liberal Democratic Party, conducts an evaluation of the bill. Without support from the ruling party, the bill dies at this stage. If the ruling party backs the bill, it is returned to the cabinet.
• Prior to submission to the Diet, a cabinet decision on the bill is made.
  Factors used in cabinet decisions include the urgency of the bill and how the bill will fit alongside existing laws. Once the Cabinet decides to proceed with the bill, the bill is submitted to the Diet in February or March by the Prime Minister.

Other bills are submitted by a member of the House of Representatives or a member of the House of Councillors. The member who is officially proposing the bill signs the bill alongside the signatures of members who support the bill. The bill is then given to the Presiding Officer of the proposing member’s House.

Once a bill enters the Diet, deliberations take place in both the House of Representatives and the House of Councillors. Deliberation usually includes discussions in a Standing Committee, an explanation of the bill by a minister or Diet member, a public hearing and debate. Bills pass at this stage in one of the following three ways:

• When at least half of all members in both the House of Representatives and the House of Councillors pass the bill, the bill passes.
• When one house approves the bill but the other house rejects it, a Conference Committee of both houses can be called to develop a proposal on which both Houses can agree.
• A bill that fails to pass both Houses can be passed by the House of Representatives with a majority of at least two-thirds of members present. Known as the “superiority of the House of Representatives (syuugiin no yuuetsu⁶),” this special privilege exists because the House of Representatives is viewed as more reflective of national opinion given that terms are shorter and dissolution of the House of Representatives is always an option.

Once a bill is approved, it is implemented into law between March to June and within 30 days after the bill’s approval by the Diet.

The 2006 Health Care Structural Reform Bill is one example of the legislative policy making process. This bill was drafted by the Ministry of Health, Labour and Welfare and submitted through the Cabinet to the Diet on February 10, 2006. Because the Diet was consumed with budget bill reviews, the Minister of Health, Labour and Welfare did not have a chance to explain the bill in the House of Representatives until April 6. The Subcommittee of Health, Labour and Welfare reviewed the bill and the House of Representatives passed it without revision on May 18. The House of Councillors then received the bill and subsequently passed it on June 14. The bill became law and began being implemented in April 2008.⁷

Another important process that shapes health policy takes place in Japan once every two years is the fee schedule revision. For information about this process, please see Cost Control.

1 The House of Representatives. The National Diet of Japan.http://www.shugiin.go.jp/internet/itdb_english.nsf/html/statics/english/kokkaiannai_e27.pdf/$File/kokkaiannai_e27.pdf(accessed on 16 July, 2015)

2 Iwabuchi, Y. (2013). 日本の医療政策 成り立ちと仕組みを学ぶ. 中央法規出版. pp.32-41

3 Cabinet Legislation Bureau. The Law-making Process. http://www.clb.go.jp/english/process.html (accessed on 4 August, 2015)

4 Cabinet Secretariat. List of councils. http://www.cas.go.jp/jp/gaiyou/jimu/jinjikyoku/satei_01_04_03.html (accessed on 4 August, 2015)

5 Cabinet Office. List of cabinet councils. http://www.cao.go.jp/council.html (accessed on 4 August, 2015)

6 The House of Representatives, Disagreement between the two Houses, Retrieved fromhttp://www.shugiin.go.jp/internet/itdb_english.nsf/html/statics/guide/disagree.htm (accessed on 09-07-2015)

7 Tatara K, Okamoto E, Allin S. Health systems in transition. Copenhagen: World Health Organization, European Observatory on Health Systems and Policies, 2009. P.8