Silviase/jgov_v1.4_full_ann huggingface dataset:
Detailed Data 4 Changes in Number of Nursing personnel

Source: Health Policy Bureau, MHLW

## Detailed Data 5 7th Projection of Estimated Supply and Demand for Nursing Personnel

The “7th Projection of Estimated Supply and Demand for Nursing Personnel” prepared in December 2010 estimated that demand for nursing personnel will reach approx. 1.501 million while supply will be approx. 1.486 million in 2015.

Based on the “Act on Assurance of Work Forces of Nurses and Other Medical Experts” enacted in 1992 and subsequent basic guidelines based on the said Act, comprehensive efforts have been made to improve quality, secure training capacity, promote reemployment, and prevent unemployment.

(Unit: person, regular employee-equivalent)

Category	2011	2012	2013	2014	2015
Demand prospects	1,404,300	1,430,900	1,454,800	1,477,700	1,500,900
[1] Hospitals	899,800	919,500	936,600	951,500	965,700
[2] Clinics	232,000	234,500	237,000	239,400	242,200
[3] Maternity clinics	2,300	2,300	2,400	2,400	2,400
[4] Home-visit nursing care stations	28,400	29,700	30,900	32,000	33,200
[5] Long-term care insurance facilities	153,300	155,100	157,300	160,900	164,700
[6] Social welfare facilities, in-home service facilities (excluding [5])	19,700	20,400	20,900	21,500	22,100
[6] Nursing schools, etc.	17,600	17,700	17,700	17,800	17,900
[8] Health centers and municipal facilities	37,500	37,600	37,800	38,000	38,200
[9] Offices, research institutions, etc.	13,800	14,000	14,100	14,300	14,500
Supply prospects	1,348,300	1,379,400	1,412,400	1,448,300	1,486,000
[1] Number of persons employed at the beginning of the year	1,320,500	1,348,300	1,379,400	1,412,400	1,448,300
[2] Number of persons newly graduated and employed	49,400	50,500	51,300	52,400	52,700
[3] Number of persons reemployed	123,000	126,400	129,600	133,400	137,100
[4] Reduction in number due to retirement, etc.	144,600	145,900	147,900	149,900	152,100
Difference between demand and supply prospects	56,000	51,500	42,400	29,500	14,900
(Demand prospects/supply prospects)	96.0%	96.4%	97.1%	98.0%	99.0%

(Note) The sums of breakdown items, etc. may not equal the total due to rounding.
## Conforming Rate to the Statutory Number of Doctors and Nurses Designated in the Medical Care Act and Sufficiency Status (Results of FY2010 On-Site Inspection)

Detailed Data 1 Regional Conforming Rates

(Unit: %)

Region Classification	Nationwide	Hokkaido Tohoku	Kanto	Hokuriku Koshinetsu	Tokai	Kinki	Chugoku	Shikoku	Kyushu
Doctors	91.8	81.6	95.7	87.3	94.7	97.0	90.8	89.5	92.6
Nurses	99.4	99.6	98.4	99.7	99.7	99.1	99.8	100	99.8

Detailed Data 2 Nationwide Achievement Status

Hospitals with sufficient number of doctors	Hospitals with insufficient number of doctors	Total
Hospitals with sufficient number of nurses	7,440 (90.8)	657 (8.0)	8,097 (98.8)
Hospitals with insufficient number of nurses	80 (1.0)	18 (0.2)	98 (1.2)
Total	7,520 (91.8)	675 (8.2)	8,195 (100.0)

(Note) The figures represent the number of hospitals (excluding dental hospitals) and the figures in parentheses represent the percentage.

(Explanation of terms)

• Numerical standards: Number of doctors and nurses to be deployed at hospitals designated by the Medical Care Law.

• Conforming rate: "Percentage of hospitals satisfying the designated number of doctors/nurses" in "hospitals for which on-site investigation are conducted".

• Sufficient/insufficient: Of hospitals for which on-site investigation are conducted, those satisfying the numerical standards are counted as "sufficient" and those not satisfying the numerical standards are counted as "insufficient".
# Expansion of Matters that can be Advertised with the Revision of Advertisement Regulations (Medical Care Act)

• With regards to regulation of matters that can be advertised under advertisement regulation system, the system has been revised such that items with certain characteristics are grouped and regulated comprehensively as "matters regarding …" instead of listing individual matters one by one as conventionally done.

→ Substantial relaxation of advertisement regulation

• Revision from direct penalties to indirect penalties in case matters that are not advertisable are advertised

## [Example of relaxed advertisements]

$ ^{*} $ Imprisonment with work for a term not exceeding 6 months or a fine not exceeding ¥300,000.

• Specialities of medical professionals • Photographs and visual images of facilities and medical professionals • Treatment policies

• General name/development code of investigational drugs • Offered treatments and its contents in understandable manner

• Matters regarding medical devices, etc.

$ ^{*} $ These information, however, must be in accordance with laws, regulations, and guidelines
## Overview

## Overview of Medical Care Plan

### 1. Purpose

Establish a system for providing high quality and appropriate medical care efficiently by realizing continued medical care in communities through promoting a division of roles and cooperation of medical functions.

### 2. Contents

3. Status of standard number of beds and number of existing beds

(As of April 2013)

Classification	Standard number of beds	Number of existing beds
Long-term care beds and general beds	1,052,631	1,237,464
Psychiatric hospital beds	310,510	340,470
Tuberculosis hospital beds	4,377	6,777
Infectious disease hospital beds	1,899	1,776
## Overview Structural Chart of 11th Measures for Health and Medical Services in Remote Areas (FY2011-2015)

Establish an effective, efficient, and sustainable system that can provide medical services in remote areas mainly via prefectural support centers for medical services in remote areas in cooperation with governments, doctors working in remote areas, facilities and institutions engaged in medical services in remote areas, and residents of remote areas, and through studying advanced cases in other prefectures.

## Current Status of Measures for Health and Medical Services in Remote Areas

### 1. Efforts in plans for health and medical services in remote areas

As does the 10th plan, the new 11th plan for health and medical services in remote areas, which started in FY2011, provides that "prefectural office to support medical services in remote areas" are established in each prefecture to continue promoting broad-based measures for health and medical services in remote areas.

Year of investigation (once every 5 years)	Regions with no doctors	Subject population (10,000 persons)
1966	2,920	119
1973	2,088	77
1984	1,276	32
1999	914	20
2004	787	16.5
2009	705	13.6

$ ^{*} $ Regions with no doctors

Regions with no medical institutions in which population of 50 or more people live within a radius of approximately 4 km from the major location of the region and it takes more than one hour one way to go to medical institutions using ordinary means of transportation.

### 2. Status of Establishment

(1) Prefectural office to support medical services in remote areas (subject to assistance for operational expenses)

Scheduled to be established/operated in 40 prefectures as of January 1, 2013

(2) Core hospitals for medical services in remote areas (subject to assistance of operational expenses, facility establishment expenses, and equipment installment expenses)

295 hospitals are designated as of January 1, 2013

(3) Clinics for medical services in remote areas (subject to assistance of operational expenses, facility establishment expenses, and equipment installment expenses)

1,042 clinics (including National Health Insurance direct managed clinics) are established as of January 1, 2013
## I mproved Quality of Doctors

## Overview

## History of Clinical Training System

○ 1948 1-Year internship system after graduation started (1-year program necessary to be qualified for National Examination)

○ 1968 Creation of clinical training system (effort obligation of more than 2 years after obtaining medical license)

[Issues of the conventional system]

1. Training was voluntary

2. Training programs were not clearly defined

5. Insufficient guidance system

3. Mainly focused on straight training for specialized doctors

6. Insufficient evaluation of training achievements

4. Remarkably large disparities existed among institutions

7. Unstable status/work conditions → part-time jobs

8. Heavy concentration of trainees in large hospitals in urban areas

## ○ 2000 Revision of the Medical Practitioners Act and the Medical Care Act (obligating clinical training)

○ 2004 Enforcement of the new system

○ 2008 Holding of Conference on Ideal Clinical Training System, etc. (September – February 2009)

☐ 2009 Revision of the system (applied at the start of training in FY2010)

## Overview of Clinical Training System

### 1. Medical Education and Clinical Training

o Article 16-2 of the Medical Practitioners Act

Doctors to engage in clinical practice must take clinical training in hospitals attached to universities with medical training courses or hospitals designated by the Minister of Health, Labour and Welfare for no less than 2 years.

### 2. Basic Ideas of Clinical Training

(Ministerial Ordinance on clinical training provided in paragraph 1, Article 16-2 of the Medical Practitioners Act)

Clinical training must offer doctors the opportunity to cultivate the appropriate bedside manner and acquire basic diagnosis and treatment abilities while recognizing the social role to be fulfilled by medicine and medical services regardless of their future specialty so that they can provide appropriate treatment for injuries and diseases that frequently occur.

### 3. Status of Execution

[1] Clinical resident training facilities (FY2012)

Clinical resident training hospitals (core type) 911

Clinical resident training hospitals (cooperative type) 1,507

University hospitals (core type equivalent) 115

University hospitals (cooperative type equivalent) 20

[2] Enrollment status of residents

Classification	University hospitals	Clinical resident training hospitals
Old system (FY2003)	72.5%	27.5%
1st year of new system (FY2004)	55.8%	44.2%
2nd year of new system (FY2005)	49.2%	50.8%
3rd year of new system (FY2006)	44.7%	55.3%
4th year of new system (FY2007)	45.3%	54.7%
5th year of new system (FY2008)	46.4%	53.6%
6th year of new system (FY2009)	46.8%	53.2%
7th year of new system (FY2010)	47.2%	52.8%
8th year of new system (FY2011)	45.0%	55.0%
9th year of new system (FY2012)	44.4%	55.6%
# Outline of System Reform

## (1) Flexible Training Program

• Training program standards are revised to offer more flexibility while maintaining the basic ideas and achievement goals of clinical training.

• “Compulsory courses” comprise of internal, emergency, and community medicine. Surgery, anesthesiology, pediatrics, obstetrics and gynecology, and psychiatry are included in “elective compulsory courses”, of which two courses are selected for training.

• Training periods are no less than 6 months for internal medicine, no less than 3 months for emergency medicine, and no less than 1 month for community medicine.

• Training programs are available for those who wish to become obstetricians or podiatrist (hospitals with 20 or more recruitment quotas for internship).

## (2) Reinforcement of standards for designation of core clinical training hospitals

• Requirements for the annual number of inpatients being 3,000 or more, and placement of 1 or more preceptor for each 5 interns, etc. are included in standards for designation of core clinical training hospitals.

## (3) Revision of recruitment quotas for internship

• Establishment of a limit on the total number of recruitment quotas that reflects the number of training applicants and the limit of recruitment quota in each prefecture for conducting appropriate regional arrangement of medical interns.

• A recruitment quota of each hospital is set after taking into consideration the actual results of accepting interns in the past and dispatching doctors, etc. and making necessary adjustment with the prefectural limit.

## (4) Provision for the review

• Provisions of Ministerial Ordinance on Clinical Training shall be reviewed within 5 years from the enforcement of Ordinance, and necessary measures to be taken

Re-education Training for Administratively Punished Doctors, etc. (Medical Practitioners Act, etc.)
## Medical Corporation System

Overview

Transfer of Non-profit Medical Corporation System with the Revised Medical Care Law (Before enforcement) (On and after April 1, 2007)

Only non-profit medical corporations under the new law can be established on and after April 1, 2007.

• Transitional non-profit medical corporation (non-profit medical corporation under the old law) cannot be established on and after April 1, 2007.

• Articles of incorporation can be modified from non-profit medical corporation with contribution to contribution limit corporation on and after April 1, 2007.
# (3) Health Promotion/Disease Measures

## Health Centers, etc

## Overview

## Activities of Health Centers

Health centers are front-line comprehensive public health administrative institutions that offer both personal and objective health services. Personal health services include broad-based services, services requiring specialized technologies, and services requiring team work of various health care professionals. In addition, health centers provide required technical assistance for health services provided by municipalities.

Health centers are established in 370 locations in 47 prefectures, 101 locations in 70 designated cities, and 23 locations in 23 special wards under the Community Health Act (As of April 1, 2013).

##

Health checkups, reporting emergence of patients, etc.

Non-regular health checkups of Tuberculosis, preventive vaccination, home-visit guidance, controlled medical examination, etc.

(Infectious Diseases Act)

AIDS individual counselling programs (including free anonymous examination), AIDS consultation

(AIDS guidelines)

Medical consultation of

intractable diseases, etc.

(Outlines of infectious disease

neasures)

Identification of current situation regarding mental health, mental health and welfare consultation, home-visit guidance of mental health, office works regarding medical care and protection, etc.

(Mental Health and Welfare Act)

Home-visit guidance for premature infants, providing medical aid for premature infants, etc.

(Maternal and Child Health Act)

##

##

Providing business license for restaurants, supervising business facilities, guidance, etc. (Food Sanitation Act)

##

Providing business license, notification, on-site investigation, etc.

(Act on Coordination and Improvement of Environmental Health Industry, Entertainment Places Act, Public Bath Houses Act, Inns and Hotels Act, Barbers Act, Cosmetologists Act, Laundries Act)

## Health centre administration council Directors of health centers (doctors)

• Health risk management

• Technical support/advice for municipalities

• Adjustment between municipalities

• Formulation/promotion of regional health/medical care plans

## 494 health centers

370 in prefectures 101 in designated cities

23 in special wards

Doctors

Physical therapists

Dentists

Occupational therapists

Pharmacists

Public health nurses

Veterinarians

Midwives

Clinical radiologic technologists

Nurses

Medical social workers

Certified psychiatric social workers

Laboratory-medical technologists

Medical technologists

Food sanitation inspectors

Environmental sanitation inspectors

Registered dieticians

Dieticians

Dental hygienists

Abattoir inspectors, etc.

###

On-site investigation of hospitals, clinics, medical corporations, dental clinics, clinical laboratories, etc. (Medical Care Act, Dental Technicians Act, Act on Clinical Laboratory Technicians, etc.)

### <>

Publicity

Dissemination and

enlightenment

Health statistics

Health consultation
Changes in Number of Health Centers

FY	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013
Total number of health centers	663	641	594	592	582	576	571	549	535	518	517	510	494	495	495	494
Prefectures	490	474	460	459	448	438	433	411	396	394	389	380	374	373	372	370
Cities	137	136	108	109	111	115	115	115	116	101	105	107	97	99	100	101
Special wards	36	31	26	24	23	23	23	23	23	23	23	23	23	23	23	23

Source: Health Service Bureau, MHLW

(Note) The number of clinics is as of April 1 of each year.

Detailed Data 1 Number of Medical Personnel at Health Centers by Occupation

Occupation	Number of personnel
Doctors	808
Dentists	88
Pharmacists	2,795
Veterinarians	2,217
Public health nurses	7,806
Midwives	67
Nurses	251
Assistant nurses	11
Radiology technicians, etc.	567
Medical technologists, etc.	799
Registered dietitians	1,066
Nutritionists	141
Dental hygienists	321
Physical/occupational therapists	90
Others	11,248
<Included in the upper column>
Medical social workers	80
Mental health welfare counselors	1,164
Nutrition counselors	1,043
Total	28,275

Source: “Report on Regional Public Health Services and Health Promotion Services”, Statistics and Information Department, Minister's Secretariat, MHLW

(Modified by Health Service Bureau) (as of the end of FY2011)

Detailed Data 2 Changes in Number of Public Health Nurses

(Unit: person)

FY1998	FY1999	FY2000	FY2001	FY2002	FY2003	FY2004	FY2005	FY2006	FY2007	FY2008	FY2009	FY2010	FY2011
Municipalities	15,355	15,366	15,643	15,856	16,004	15,908	15,629	15,315	14,519	14,483	14,498	14,613	14,179	15,015
Designated cities/ special wards	4,167	4,450	4,584	4,696	4,907	5,047	5,281	5,524	5,563	5,604	5,964	6,094	6,081	6,280
Subtotal	19,522	19,816	20,227	20,552	20,911	20,955	20,910	20,839	20,082	20,087	20,462	20,707	20,260	21,295
Prefectures	4,620	4,535	4,481	4,439	4,311	4,242	4,178	4,014	3,935	3,889	3,800	3,737	3,640	3,689
Total	24,142	24,351	24,708	24,991	25,222	25,197	25,088	24,853	24,017	23,976	24,262	24,444	23,900	24,984

Source: FY1998: "Report on Regional Public Health Services", Statistics and Information Department, Minister's Secretariat, MHLW

FY1999-2007: "Report on Regional Public Health Services and Health Services for the Aged", Statistics and Information Department, Minister's Secretariat, MHLW

FY2008 onward: "Report on Regional Public Health Services and Health Promotion Services", Statistics and Information Department, Minister's Secretariat, MHLW

(Note) The figures from FY1998 onward as of the end of March of the next year.

The figures for FY2010 do not include some municipalities in Iwate Prefecture (Kamaishi City, Otsuchi Town, Miyako City, and Rikuzentakata City), clinics and municipalities in Miyagi Prefecture apart from Sendai City, and some municipalities in Fukushima Prefecture (Minamisoma City, Naraha Town, Tomioka Town, Kawauchi Village, Futaba Town, Itate Town, and Aizuwakamatsu City) due to the effect of the Great East Japan Earthquake.
## Measures against Hepatitis

## Basic Act on Hepatitis Measures

Basic Act on Hepatitis Measures (Act No.97 of 2009)

Comprehensive formulation/enforcement of measures against hepatitis

• To stipulate basic principles for measures against hepatitis;

• To clarify responsibilities of the government, local governments, medical insurers, citizens, and doctors, etc.;

• To formulate guidelines concerning promotion of measures against hepatitis; and

Basic measures

Promotion of prevention and early detection

• To comprehensively promote measures against hepatitis by stipulating basic articles for them.

• Prevention of hepatitis

• Quality improvement of hepatitis examinations, etc.

Research promotion

• Establishment and improvement of medical institutions

## Promotion of equalization of medical services for hepatitis patients, etc

• Training of doctors and other medical professionals to acquire the expertise

• The medical profession engaged in hepatitis care

• Representatives of hepatitis patients, etc.

• Persons with relevant knowledge and experience

Relevant administrative organizations

• Financial support for medical care expenses on hepatitis patients

## Formulation of basic measures against hepatitis

The Council for Promotion of Hepatitis Measures

• Securing opportunities for hepatitis care

Measures must be taken with careful consideration given to the human rights of patients and elimination of discrimination against them

• Establishment and improvement of systems for collecting and providing information on hepatitis care, etc.

Minister of Health, Labour and Welfare

Basic measures against hepatitis

## Response to cirrhosis and liver cancer

## ● Creation of an environment for improved treatment level

● Review the patient support system as necessary taking into consideration the situation of medical treatments
# Outline of the Health Promotion Act

### Chapter 1. General Provisions

## (1) Purpose

Provide basic matters regarding comprehensive promotion of people's health and make the effort to improve public health through implementation of measures for health promotion.

## (2) Responsibilities

1. People: Improved interest and understanding of the importance of healthy lifestyle habits in being aware of one's own health status and make the effort to stay healthy throughout life.

2. The government and local governments: Make efforts to disseminate the appropriate knowledge on health promotion, collect/organize/analyze/make available information, promote researches, develop and improve the quality of human resources, and provide the required technical support.

3. Health promotion service providers (insurers, business operators, municipalities, schools, etc.): Make an active effort to promote health promotion programs for people including health consultations.

(3) Cooperation between the government, local governments, health promotion service providers, and other related entities.

### Chapter 2. Basic Policies (legally establish “Health Japan 21”)

## (1) Basic policies

Basic policies for comprehensive promotion of people's health are formulated by the Minister of Health, Labour and Welfare.

1. Basic direction with promoting people's health

2. Matters regarding goals in promoting people's health

3. Basic matters regarding formulation of health promotion plans of prefectures and municipalities

4. Basic matters regarding national health and nutrition surveys in Japan and other surveillance and researches

5. Basic matters regarding cooperation between health promotion service providers

6. Matters regarding dissemination of the appropriate knowledge on dietary habits, exercise, rest, smoking, alcohol drinking, dental health, and other lifestyle habits

7. Other important matters regarding promotion of people's health

(2) Formulation of health promotion plans for prefectures and municipalities (plans for health promotion measure to the people)

(3) Guidelines on implementation of health checkups

Guidelines on implementation of health checkups by health promotion service providers, notification of the results, a health handbook being issued, and other measures are formulated by the Minister of Health, Labour and Welfare in supporting people's lifelong self management of health.