Silviase/jgov_v1.4_full_ann huggingface dataset:
## Medical Care Expenditure

Overview Changes in Medical Care Expenditure

1985	1990	1995	2000	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012
National medical care expenditure	6.1	4.5	4.5	$ \Delta $ 1.8	$ \Delta $ 0.5	1.9	1.8	3.2	$ \Delta $ 0.0	3.0	2.0	3.4	3.9	3.1	1.7
Medical expenditure for the elderly	12.7	6.6	9.3	$ \Delta $ 5.1	0.6	$ \Delta $ 0.7	$ \Delta $ 0.7	0.6	$ \Delta $ 3.3	0.1	1.2	5.2	5.9	4.5	2.8
National Income	7.2	8.1	$ \Delta $ 0.3	2.0	$ \Delta $ 0.8	1.2	0.5	1.1	1.1	0.8	$ \Delta $ 6.9	$ \Delta $ 3.0	2.3	$ \Delta $ 1.6	—
GDP	7.2	8.6	1.7	0.9	$ \Delta $ 0.7	0.8	0.2	0.5	0.7	0.8	$ \Delta $ 4.6	$ \Delta $ 3.2	1.3	$ \Delta $ 1.4	—

(Note) 1. The national income and GDP are based on the national accounting announced by the Cabinet Office. Total health and medical expenditure is the item used to compare the medical expenses among OEDC countries. It includes preventative services, etc. and has a wider range of coverage than national medical care expenditure. The average ratio of medical expenditure of OECD allies in 2011 was 9.3% of GDP.

2. The national health expenditure (and health expenditure for the elderly in their latter stage of life; hereinafter the same) of FY2012 are estimated figures. The FY2012 figures were calculated by multiplying the FY2011 figures by the growth rate of approximate medical expenditure of FY2012 (the figures in italics in the above table).
Detailed Data 1 National Medical Care Expenditure of OECD Countries (2011)

Country	Total medical care expenditure in GDP (%)	Per capita medical care expenditure ($)	Remarks
U.S.A.	17.7	1	8,508
Netherlands	11.9	2	5,099
France	11.6	3	4,118
Germany	11.3	4	4,495
Canada	11.2	5	4,522
Switzerland	11.0	6	5,643
Denmark	10.9	7	4,448
Austria	10.8	8	4,546
Belgium	10.5	9	4,061
New Zealand	10.3	10	3,182
Portugal	10.2	11	2,619
Japan	9.6	12	3,213
Sweden	9.5	13	3,925
U.K.	9.4	14	3,406
Norway	9.3	15	5,669
Spain	9.3	15	3,072
Italy	9.2	17	3,012
Greece	9.1	18	2,361

Source: “OECD HEALTH DATA 2013”

Country	Total medical care expenditure in GDP (%)	Per capita medical care expenditure ($)	Remarks
Finland	9.0	19	3,374
Iceland	9.0	19	3,305
Australia	8.9	21	3,800
Ireland	8.9	21	3,700
Slovenia	8.9	21	2,421
Slovakia	7.9	24	1,915
Hungary	7.9	24	1,689
Israel	7.7	26	2,239
Czech Republic	7.5	27	1,966
Chile	7.5	27	1,568
Korea	7.4	29	2,199
Poland	6.9	30	1,452
Luxembourg	6.6	31	4,246
Mexico	6.2	32	977
Turkey	6.1	33	906
Estonia	5.9	34	1,303

OECD average	9.3	3,322

(Note) 1. The rank in this table indicates the rank among OECD member countries.

2. The figures marked with “*” indicate the figures for 2010 (the figures for 2008 for Turkey).

## Detailed Data 2 Structure of National Medical Care Expenditure (FY2011)

Distribution of national medical care expenditure

• Insured persons' burden includes National Health Insurance premiums

National medical care expenditure ¥38,585.0 billion

Per capita medical care expenditure ¥301,900

Medical fee structure of medical institutions

• Estimates based on the results of Estimates of National Medical Care Expenditure FY2011 and Survey on Economic Conditions in Health Care (June 2011), etc.
[At the beginning (from 1948)]

• Progress of aging

• Changes in disease structure

[Introduction of specially authorized geriatrics wards (1983)]

• In order to cope with the progress in aging and changes in disease structure, it was necessary to create facilities to provide medical care not only for elderly but for "patients requiring long-term care" in general.

[Creation of long-term care-type bed group system (1992)]

• The number of patients requiring long-term care increased due to changes in disease structure caused by the rapid progress in the birth rate decline and aging. Although various systems have been created, including long-term care-type bed group system, patients with various symptoms are still intermingled.

[Creation of general beds and long-term care beds (2000)]

Provide medical care that is suitable for patients' symptoms

• In order to promote division/cooperation of medical functions, identifying and analyzing information on medical functions implemented by the respective medical institutions in regions is important.

[Creation of a hospital bed function reporting system (2014)]

A system for selecting one of highly acute phase, acute phase, recovery phase, and chronic phase functions and reporting the function of general hospital beds and long-term care beds in each hospital ward was created.
Changes in Number of Medical Institutions (Hospitals and Clinics)

Year	Hospitals	National (included)	Public (included)	Others (included)	General clinics	Dental clinics
1877	159	12	112	35
1882	626	(330)	296
1892	576	(198)	378
1897	624	3	156	465
1902	746	4	151	591
1907	807	5	101	691
1926	3,429	(1,680)	1,749
1930	3,716	(1,683)	2,033
1935	4,625	(1,814)	2,811	35,772	18,066
1940	4,732	(1,647)	3,085	36,416	20,290
1945	645	(297)	348	6,607	3,660
1950	3,408	383	572	2,453	43,827	21,380
1955	5,119	425	1,337	3,357	51,349	24,773
1960	6,094	452	1,442	4,200	59,008	27,020
1965	7,047	448	1,466	5,133	64,524	28,602
1970	7,974	444	1,388	6,142	68,997	29,911
1975	8,294	439	1,366	6,489	73,114	32,565
1980	9,055	453	1,369	7,233	77,611	38,834
1985	9,608	411	1,369	7,828	78,927	45,540
1990	10,096	399	1,371	8,326	80,852	52,216
1995	9,606	388	1,372	7,846	87,069	58,407
1996	9,490	387	1,368	7,735	87,909	59,357
1997	9,413	380	1,369	7,664	89,292	60,579
1998	9,333	375	1,369	7,589	90,556	61,651
1999	9,286	370	1,368	7,548	91,500	62,484
2000	9,266	359	1,373	7,534	92,824	63,361
2001	9,239	349	1,375	7,515	94,019	64,297
2002	9,187	336	1,377	7,474	94,819	65,073
2003	9,122	323	1,382	7,417	96,050	65,828
2004	9,077	304	1,377	7,396	97,051	66,557
2005	9,026	294	1,362	7,370	97,442	66,732
2006	8,943	292	1,351	7,300	98,609	67,392
2007	8,862	291	1,325	7,246	99,532	67,798
2008	8,794	276	1,320	7,198	99,083	67,779
2009	8,739	275	1,296	7,168	99,635	68,097
2010	8,670	274	1,278	7,118	99,824	68,384
2011	8,605	274	1,258	7,073	99,547	68,156
2012	8,565	274	1,252	7,039	100,152	68,474

Source: 1875-1937: “Annual Report of Public Health”, Ministry of Internal Affairs

1938-1952: “Annual Report of Public Health”, Ministry of Health and Welfare

From 1953 on: “Survey of Medical Institutions”, Statistics and Information Department, Minister's Secretariat, MHLW

(Note) The figures in parentheses indicate the total number of public sector medical institutions.

Changes in Number of Hospitals by Establisher and by Number of Beds

2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012
Total	9,239	9,187	9,122	9,077	9,026	8,943	8,862	8,794	8,739	8,670	8,605	8,565
National	349	336	323	304	294	292	291	276	275	274	274	274
Public medical institutions	1,375	1,377	1,382	1,377	1,362	1,351	1,325	1,320	1,296	1,278	1,258	1,252
Social insurance organizations	130	130	129	129	129	125	123	122	122	121	121	118
Medical corporations	5,445	5,533	5,588	5,644	5,695	5,694	5,702	5,728	5,726	5,719	5,712	5,709
Private	1,085	954	838	760	677	604	533	476	448	409	373	348
Others	855	857	862	863	869	877	888	872	872	869	867	864
20-99 beds	3,781	3,726	3,667	3,616	3,558	3,482	3,391	3,339	3,296	3,232	3,182	3,147
100-299 beds	3,851	3,862	3,860	3,855	3,865	3,862	3,875	3,876	3,875	3,882	3,877	3,882
300-499 beds	1,111	1,110	1,110	1,125	1,118	1,120	1,123	1,111	1,106	1,096	1,090	1,087
500+ beds	496	489	485	481	485	479	473	468	462	460	456	449

Source: “Survey of Medical Institutions”, Statistics and Information Department, Minister's Secretariat, MHLW
## Overview Number of Doctors, etc

The number of doctors and dentists are increasing every year. As of December 31, 2012, there are 303,268 doctors and 102,551 dentists.

Number of Medical Professionals

· Doctors
303,268 persons
· Dentists
102,551 persons
· Pharmacists
280,052 persons
Source: 'Survey of Physicians, Dentists and Pharmacists 2012', Statistics and Information Department, Minister's Secretariat, MHLW
· Public health nurses
57,112 persons
· Midwives
35,185 persons
· Nurses
1,067,760 persons
· Assistant nurses
377,756 persons
Source: Health Policy Bureau, MHLW (2012)
· Physical therapists (PT)
61,620.8 persons
· Occupational therapists (OT)
35,427.3 persons
· Orthoptists
6,818.7 persons
· Speech language hearing therapists
11,456.2 persons
· Orthotists
138.0 persons
· Clinical radiologic technologists
49,105.9 persons
· Medical technicians
62,458.5 persons
· Clinical engineers
20,001.0 persons
Source: 'Survey of Medical Institutions and Hospital Report 2011', Statistics and Information Department, Minister's Secretariat, MHLW * Full-time equivalent numbers
· Dental hygienists
108,123 persons
· Dental technicians
34,613 persons
· Massage and finger pressure therapists
109,309 persons
· Acupuncture therapists
100,881 persons
· Moxibustion therapists
99,118 persons
· Judo therapists
58,573 persons
Source: 'Report on Public Health Administration and Services 2012', Statistics and Information Department, Minister's Secretariat, MHLW
· Emergency medical technicians
37,567 persons
Source: Health Policy Bureau, MHLW (as of December 31, 2009)
Detailed Data 1 Changes in Number of Doctors

Source: "Survey of Physicians, Dentists and Pharmacists", Statistics and Information Department, Minister's Secretariat, MHLW

Detailed Data 2 Changes in Number of Dentists

Source: "Survey of Physicians, Dentists and Pharmacists", Statistics and Information Department, Minister's Secretariat, MHLW

Detailed Data 3 Changes in Number of Pharmacists

Source: "Survey of Physicians, Dentists and Pharmacists", Statistics and Information Department, Minister's Secretariat, MHLW
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	92.5	83.3	96.4	87.7	94.7	96.8	92.4	90.1	93.3
Nurses	99.4	99.4	98.8	99.2	99.9	99.3	99.7	99.6	99.9

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	7,466 (91.5)	597 (7.3)	8,063 (98.8)
Hospitals with insufficient number of nurses	80 (1.0)	15 (0.2)	95 (1.2)
Total	7,546 (92.5)	612 (7.5)	8,158 (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
Emergency Medical Service System
## 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, 2014

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

296 hospitals are designated as of January 1, 2014

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

1,038 clinics (including National Health Insurance direct managed clinics) are established as of January 1, 2014
(Ministerial Ordinance on clinical training provided in paragraph 1, Article 16-2 of the Medical Practitioners Act)

## 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 interns 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

☐ 2010 Revision of the system

○ 2015 Revision of the system

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

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 (FY2013)

Clinical resident training hospitals (core type) 903

Clinical resident training hospitals (cooperative type) 1,514

University hospitals (core type equivalent) 116

University hospitals (cooperative type equivalent) 19

[3] Changes in enrollment status of interns (by 6 prefectures with large cities (Tokyo, Kanagawa, Aichi, Kyoto, and Osaka) and other prefectures)

Classification	6 prefectures	Other prefectures
Old system (FY2003)	51.3%	48.7%
1st year of new system (FY2004)	47.8%	52.2%
6th year of new system (FY2009)	48.6%	51.4%
7th year of new system (FY2010)	47.8%	52.2%
10th year of new system (FY2013)	45.5%	54.5%

[2] Changes in enrollment status of interns (by university hospitals and clinical training hospitals)

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%
6th year of new system (FY2009)	46.8%	53.2%
7th year of new system (FY2010)	47.2%	52.8%
10th year of new system (FY2013)	45.0%	55.0%
## Medical Corporation System

## Overview

## Transfer of Non-profit Medical Corporation System with the Revised Medical Care Act

## Outline of Medical Corporation System

### 1. Purpose of the system

Corporate bodies based on the Medical Care Act. The system was created by the 1950 revision of the Medical Care Act.

Enabling administrative bodies of medical care service programs to become corporate bodies without losing the non-profit status of medical practices.

[Around the time of the system establishment]

Reducing the difficulties of administering medical

institutions by private persons

(aiming to make fund collection easier)

Granting continuity of administration of

medical institutions

→ Securing stability of regional medical care

### 2. Establishment

Associations or foundations based on the Medical Care Act.

○ Approved by prefectural governors. However, those establishing medical institutions in 2 or more prefectures are approved by the Minister of Health, Labour and Welfare.

(Number of corporations)

• Medical corporations 49,889 (as of March 31, 2014)

Of which 49,498 are associations (8,022 without contribution and 41,476 with contribution) and 391 are foundations.

* Medical corporation without contribution

• Medical corporation for which the ownership of residual assets in the event of dissolution is stipulated to be the government, local governments, or other medical corporations without contribution, etc. and exclude individuals (investors).

• The revised Medical Care Act of 2006 limits newly established medical corporations to be those without contribution. The existing medical corporations, however, shall voluntarily transfer while applying the previous provisions.

• Social medical corporations 225 (as of April 1, 2014)

### 3. Operation

○ In addition to medical practices (operation of hospitals, clinics, and health service facilities for the elderly, etc.), associated practices related to public health and social welfare, etc. are allowed.

☐ Medical corporations certified as social medical corporations may engage in profit-making practices for the purpose of appropriating the profits to the administration of hospitals, etc.

☐ Dividend of surplus is not allowed.

* Social medical corporations

• Established by the 2006 revision of the Medical Care Act as medical corporations with high public interest that take roles of providing emergency medical care and medical services in remote areas while utilizing high vitality of the private sector.

• Must meet the requirements such that family corporation members are excluded from being officers, etc. and limiting the ownership of residual assets, in the event of dissolution, to the government and local governments, etc.

• Exempt from corporation tax on medical and health practices. Exempt from fixed assets tax on hospitals/clinics that engage in practices for securing emergency medical care, etc.