【2018 Ver.】1.3 Overview of Major Legislation

YearPolicyDetails
1922Establishment of the Health Insurance Act・Provided health insurance to employees with a certain level of income
1938Establishment of the National Health Insurance Act・Established National Health Insurance (NHI), a residence-based insurance program for farmers, the self-employed, the retired, and the non-employed, administered by municipal governments on a voluntary basis
Establishment of the Ministry of Health and Welfare
1939Establishment of Health Insurance for Employees Act・Provided health insurance to employees working at financial companies etc.
1942Health Insurance Act amended・Integrated the Health Insurance Act and Health Insurance For Employees Act
・Introduced a system of partial cost-sharing
1948Establishment of the Medical Care Act・Legislated the establishment and management of hospitals, clinics, and other facilities, as well as their scope and number of personnel
1958National Health Insurance Act amended・Mandated that all municipalities establish and administer residence-based NHI programs
・NHI became compulsory for those not covered by other plans
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
・Out-of-pocket responsibility becomes 0% for insured people with employee insurance, 50% for dependents, and 30% for those enrolled in NHI
・Establishment of high-cost medical expense system
1972Act on Social Welfare for the Elderly amended・Created a new structure for those 70 and over and made care free for nearly all people age 70 and over
・Reduced copayments within NHI for other enrollees
1973Health Insurance Act amended・Establishment of medical expenses for the elderly payment system
・Fixed rate of state aid for Government-Managed Health Insurance
1982Public Aid for the Aged Act・Retracted free care for those aged 70 and over by imposing a small co-payment
・Stipulated coverage of medical expenses for the elderly via fiscal adjustment among insurers. Treated people aged 70 and over separately from the existing health insurance system, subsidizing costs via public funding (national government 2/3, prefectural governments 1/6, municipal governments 1/6) and contributions from insurers in the existing health insurance system.
1985The first revision to the 1948 Medical Care Act・Introduced regional medical planning for the management of hospital beds
1990“Eight Acts” [20] related to welfare amended・Municipalities were obligated to formulate municipal healthcare plans for the elderly
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”
1997Establishment of the Long-Term Care Insurance Act・Launched a mandatory social insurance program that covers care for older people with health issues, partially relieves caregiver burdens, and addresses the needs of the aging population
The third revision to the 1948 Medical Care Act・Launched the regional medical care support hospital system
・Set general regulations for informed consent
2000Partial revision of the Health Insurance Act・High-cost medical expense system amended
・Revised the upper limit for health insurance premium rates
・Abolished out-of-pocket expenditures on medicine related to the elderly
・Revised a portion of expenditures related to the elderly
The fourth revision to the 1948 Medical Care Act・Introduced a bed classification system that required hospitals to report hospital bed use under the categories of “general” or “treatment”
・Implemented 2-year mandatory clinical training period for doctor licensing
・Made medical safety management systems legally mandatory for all medical facilities
2002Partial revision of the Health Insurance Act・Revised out-of-pocket expenditures
・Introduced total compensation system for health insurance premiums
・Increased insurance premium rate for Government-Managed Health Insurance
・Revised calculation method for medical expense contributions for the elderly
・Other measures, including those to strengthening the financial foundation of NHI
2005Long-Term Care Insurance Act amended・Established preventive benefit and regional support projects for the creation of a preventative medicine system
・Following a review of facility benefits, it become no longer possible to use benefits for expenses relate to food and housing at long-term care facilities. A supplementary benefits program for low income users is set up
・Created of community-based services to establish new service systems, enhance residential services, improve the integrated community care system, strengthen support for middle-income households, and coordinate medical care and nursing care / establish a clearer division of roles
・Established insurance fees for primary beneficiaries that reflected, in detail, the ability of that person to pay expenses, following a review of the state of medical expenditures and the management system for such expenditures. Also revised the long-term care licensing system, strengthened insurer functions, and revised cost-sharing schemes and other issues.
2006Health Care Reform Act・Established a new medical care service system targeted at people aged 75 and over
・Establish a public corporation to hand over the administration of Government-Managed Health Insurance for employees of SMEs from the national Government to the prefectural governments
Partial revision of the Health Insurance Act・Formulated a medical cost optimization plan to optimize medical expenses over the medium- to long-term, such as lifestyle disease measures and the correction of long-term hospitalization fees
・Revised the content and scope of insurance benefits
・Abolished medical facilities that only provided long-term care
・Established a new medical care service system for the elderly
The fifth revision to the 1948 Medical Care Act・Promoted public information about healthcare facilities at the prefecture level
2008Long-Term Care Insurance Act and Act on Social Welfare for the Elderly amended・Created a business management system under laws and regulations for nursing care service providers
・Issued advance notification on the suspension or abolition of nursing care service providers
・Made the clarification of services at the time of a nursing care service provider suspension or abolition mandatory.
Cabinet Order to revise part of enforcement ordinance for the Health Insurance Act etc.・Revised the calculation criteria for high-cost medical expenses
・Established requirements for payment related to high cost long-term care and calculation standards related to nursing care
・Established the introduction of a hospital bed function reporting system and a vision for community care
・Called for the strengthening of the roles of prefectures and transitioning of NHI management to prefectures
・Revised the medical corporation system and social welfare corporation system
・Called for collaboration between medical care and nursing care and construction of an integrated community care system
・Called for Financial support to promote the reform of the provision of medical and nursing care services
・Called for a studies on training general practitioners, communicating information to the public, the duties of medical professionals, and the establishment of team medical care. Emphasized that data should be continuously collected and periodically reevaluated.
・Called for the stabilization of the health insurance system, ensuring fairness in cost-sharing related to insurance premiums
・Called for prioritization and efficiency improvements related to medical benefits (a correction of the range of eligible medical treatment etc.)
2009Cabinet Order to revise part of enforcement ordinance for the Health Insurance Act・Revised the Childbirth Lump-Sum Allowance and benefit for the childbirth of a family member (increase of 40,000 yen)
2011Establishment of the Act Revising a Portion of the Long-Term Care Insurance Act to Strengthen the Foundation of Long-Term Care Services・Strengthened collaborations between medical and nursing care providers. Promoted comprehensive support (integrated community care system) for caregivers etc. who cooperate with medical care, nursing care, prevention, housing, and living support services.
・Established Long-Term Care Service Plans based on an understanding of the regional needs and issues in the places where people live, created a 24-hour regular and periodic care services and complex services
・Extended the date for the elimination of hospital beds used only for long-term care
・Promoted the supply of housing with in-home care services for the elderly
2012National Health Insurance Act amended・Transferred the financial administration of NHI programs from the municipal level to the prefectural level to strengthen the financial basis of NHI
2013Partial revision of the Health Insurance Act and other acts・Took measures including the two-year extension of fiscal support for the Japan Health Insurance Association which was previously in place from 2010 to 2012 (These include: 1. government subsidies, and 2. methods by which insurers could handle money owed to support healthcare for those age 75 and over)
・Raised the share of healthcare expenditures incurred by the Japan Health Insurance Association that were covered by Government subsidies from 13% to 16.4% for two years
Establishment of social security reform program・Clarified items to be examined for a reform of the healthcare system and the long-term care insurance system
・Established a system for the reporting of hospital bed functions
・Considered all aspects of the total compensation ratios for supporting people aged 75 and over
・Revised out-of-pocket expenditures among people aged 70 to 74 years old
・Revised the high-cost medical expenditure system
2014Establishment of the Law to the Related Acts for Securing Comprehensive Medical and Long-Term Care in the Community・Set up new funds within prefectures that utilize consumption tax revenue to promote strong collaboration between medical care and nursing care
・Created the requirement that medical institutions report the functions of hospital beds (beds for intensive , acute, recovery, or chronic patients) to prefectural governors in order to ensure the efficient and effective provision of healthcare in each community Also created the requirement that prefectures formulate a regional medical vision for their local healthcare systems based on that
・Enhanced community support projects and shifted funds for preventative medicine benefits to community support projects in order to foster a comprehensive regional care system and ensure fair cost-sharing.
Cabinet Order to revise part of enforcement ordinance for the Health Insurance Act・Revised the Childbirth Lump-Sum Allowance.
・Revised criteria for calculating high-cost medical care benefits and combined medical treatment costs for high-cost long-term care
The sixth revision to the 1948 Medical Care Act・Promoted integrate care and the analysis of hospital bed information through the creation of the Bed Classification System and Integrated Community-based Care Plan
・Introduced measures to address physician and nurse shortages
・Introduced a classification renewal system for hospitals recognized as “advanced treatment hospitals”
・Introduced measures to improve the work environment for healthcare workers
・Promoted home healthcare
・Promoted the improvement of the clinical trial system
・Introduced a system to investigate medical accidents
・Revised the healthcare corporations system
Establishment of Act for Securing Comprehensive Medical and Long-Term Care・Implemented measures aimed at ensuring the efficient and effective provision of medical care at the community level
・Established the integrated community care system and revised cost-sharing to be more fair.
2015Establishment of the Act Revising a Portion of the National Health Insurance Act to Build a Sustainable Health Insurance System ・Transferred responsibility for the fiscal management of NHI from municipal governments to prefectural governments
・Increased insurance premiums for employees of large corporations and civil servants
・Established "patient offer system" that allows users to cover medical expenses through a combination of insurance benefits and out-of-pocket funding
The seventh revision to the 1948 Medical Care Act・Established a system for the creation of corporations to promote regional medical collaborations
・Revised the medical corporation system
2017The eighth revision to the 1948 Medical Care Act・Established regulations on governance reforms at advanced treatment hospitals
・Established restrictions on what medical institution websites, publications, and so on, can say (restrictions on false or exaggerated claims)
Cabinet Order to revise part of enforcement ordinance for the Health Insurance Act・Revised calculation criteria for high-cost medical expenditures among insured people over 70 years old
Establishment of the Act Revising a Portion of the Long-Term Care Insurance Act to Strengthen the Integrated Community Care System・Created a system to make it possible for municipal governments to make use of insurer functions and work toward helping patients live independently and toward preventing sick patients from growing worse
・Established a new kind of nursing-care insurance facility that combines functions such as daily medical management and end-of-life care and terminal care with living facilities
・Set out requirements for people using Long-Term Care Insurance with high-cost medical expenditures who were previously asked to cover 20% of their expenses to now cover 30%
2018Prefectural Unitization of NHI・Transferred responsibility for fiscal management of NHI from municipal governments to prefectural governments

Reference

[20] Eight welfare-related acts: (1) Act on Social Welfare for the Elderly, (2) Act on Welfare for Physically Disabled Persons, (3) Act on Welfare for Mentally Retarded Persons, (4) Child Welfare Act, (5) Act on Welfare for Mothers with Dependents and for Widows, (6) Social Welfare Act, (7) Aid for the Aged Act, and (8) Social Welfare and Medical Business Corporation Act