Silviase/jgov_v1.4_full_ann huggingface dataset:
## Chapter 2, Section 6: Change in government and social security (1)

A change of government took place in September 2009. The new regime resulted in a policy of reducing 220 billion yen every year from the natural increase in the cost of social security being abolished. The combined reformation of the social security and tax systems has been discussed since 2010, resulting in the 'plan for combined reformation of the social security and tax systems' being compiled at the end of June 2011.

Remuneration for medical treatment was revised using net positive figures for the first time in ten years in 2010 in recognition of the need for reassuring medical care for Japanese citizens. The revised remuneration, with the focus on reconstruction of medical services that include emergency treatment, pediatrics, and surgery, resulted in evaluations having been raised for critical care centers which have extensive capacity for emergency patients, acceptance of emergency cases involving pregnant women, and interdisciplinary team efforts.

A final report was compiled in December 2010 on a new institution to replace the medical care system for persons aged 75 or older.
## Chapter 2, Section 6: Change in government and social security (2)

The total fertility rate reached 1.39 (approximate figure) in 2010, thereby exceeding the rate of the previous year. However, reversing the trend of the declining birth rate will require that the child rearing environment be improved in thus allowing people to peacefully give birth to and raise their children; payment of a new 'child allowance' was therefore commenced upon because of the recognition that society as a whole needs to support the children who will be responsible as the next generation, as well as reducing the burden of child rearing. Further consideration has been made to the construction of a new comprehensive and unified system for raising the next generation, and which includes unification of kindergartens and nursery schools. In addition, support systems for single-parent families have been reconsidered.

Focused efforts have been made on a 'national project' involving the much criticized issue of the national pension records, resulting in 16 million records having been integrated into the Basic Pension Numbers, as well as shortening the period of time until pension payments can be made after recovering the pertinent records. Moreover, the Pension Support Act was enacted that addresses no-pension or low-pension issues, and thus further aiding in ensuring the income of Japanese citizens in their old age.

As well as reconsideration of long-term care insurance in thereby reinforcing the long-term care service infrastructure, reformation of the systems for persons with disabilities are being studied. In addition, a 'suicide prevention and measures for depression project' has been commenced upon that addresses various issues.

A support system for job seekers has been created, thereby helping any job seekers that do not benefit from unemployment insurance.
## Chapter 3, Section 1: Improvements in social security to date

### Chart 3-1-1 Changes in cost of social security benefits (text p. 88)

FY1970	FY1980	FY1990	FY2000	FY2011 (budget basis)
National income (trillion yen) A	61.0	203.9	346.9	371.8	351.1
Cost of social security benefits (trillion yen) B	3.5 (100.0%)	24.8 (100.0%)	47.2 (100.0%)	78.1 (100.0%)	107.8 (100.0%)
(Breakdown) Pension	0.9 (24.3%)	10.5 (42.2%)	24.0 (50.9%)	41.2 (52.7%)	53.6 (49.7%)
Medical care	2.1 (58.9%)	10.7 (43.3%)	18.4 (38.9%)	26.0 (33.3%)	33.6 (31.2%)
Other welfare	0.6 (16.8%)	3.6 (14.5%)	4.8 (10.2%)	10.9 (14.0%)	20.6 (19.1%)
B/A	5.77%	12.15%	13.61%	21.01%	30.70%

(trillion yen)

(ten thousand yen)

Source: 'Cost of Social Security Benefits 2008', National Institute of Population and Social Security, except for FY 2011 (budget basis) where the figures were estimated by MHLW using national incomes obtained from the 'Economic Forecast and Basic Attitude to Economic and Fiscal Management' (Cabinet decision, January 24, 2011)

Note: Figures in the chart provide the cost of social security benefits (trillion yen) in 1950, 1960, 1970, 1980, 1990, 2000, 2008, and 2011 (budget for 2011).

O Social insurance systems have merits in terms of rights and universality due to the clear relationship between benefits and contributions and hence Japanese social security has been mainly expanded into social insurance systems.

Chart 3-1-5 Time-series change in income of elderly households (text p. 91)

● Elderly household incomes have been improving more than the average of all households, with an increasing proportion of 'Public pensions' due to the improved pension systems.

Source: Calculated by Counselor Office for Policy Evaluations, MHLW, and based on 'Comprehensive Survey of Living Conditions', Statistics and Information Department, MHLW

Note: 1. 'Working incomes' denotes employee's incomes, business incomes, farming and livestock incomes, and family business incomes.

2. 'Personal pensions' is included as 'Other incomes' in 1978 and 1993.

3. In 2008 'Rent income' and 'Interest and dividends' were summarized into 'Property incomes'.

○ Pension benefits have been repeatedly improved through being linked to commodity prices and wages, thus having improved the economic conditions of elderly households. In addition, the new long-term care insurance system, which is a way nursing care is supported by the whole of society, provides comprehensive services in areas of health care, medical, and welfare that the user can choose from.
## Chapter 3, Section 3: Response to changes in the social security environment

Chart 3-3-1 Percentage distribution of National Health Insurance policyholders by occupation (text p. 99)

Although most National Health Insurance policyholders were farmers, forestry workers, fishers, and the self-employed in the past more than half are employees and the unemployed now.

Source: 'National Health Insurance Survey Report', Health Insurance Bureau, MHLW

Note: The change in percentage distribution of policyholders between the 2007 and 2008 figures reflects the fact that since 2008 all National Health Insurance policyholders can be no more than 75 years old due to enforcement of the elderly health care system.

Changes in the industrial structure have led to insurance having different characteristics. Originally, most National Health Insurance and National Pension policyholders were farmers, forestry workers, fishermen, and self-employed. Most National Health Insurance policyholders are now elderly people and people with low incomes and hence reconstruction of the system is under way.

### Chart 3-33 Changes in number of deaths by age group (text p. 101)

● The number of deaths used to be significant for the 0-14 and 15-64 age groups in the past but most now occur in the 65-79 and 80+ age groups. The aging population has resulted in the per capita mortality rate increasing.

Source: 'Vital Statistics', Statistics and Information Department, MHLW

Note: Approximate figures for 2010.

○ Disease structures have changed and the proportion of elderly people to total deaths increased. In many cases elderly people require nursing care in the wake of diseases. Measures are therefore being used that include reconsideration of the role of medical institutions and improving medical care at home as well as the institution of a long-term care insurance system.
## Chapter 3, Section 4: Insurance premiums and public expenses

Chart 3-4-1 Changes in pension premiums (text p. 103)

The premium, or premium rate, of pension systems has been gradually raised.

Source: 'Annual Report' of the former Social Insurance Agency and materials prepared by the Pension Bureau, MHLW

Note: 1. The same rate as insurance premium rates of a employees' pension is being applied to bonuses, as well as monthly salaries, following the introduction of the total remuneration system in April 2003.

2. The premium rate of the employees' pension is of insured persons (men); with the monthly premium of the National Pension in FY 1961-69 being for persons aged 20-34.

3. The premium rate of the employees' pension and the monthly premium of the National Pension figures are after any applicable increase.

○ Increased benefits due to improvements and aging have resulted in an increasing proportion of pension funds now operated in the form of pay-as-you-go method. In addition, insurance premiums for the working generation have been increasing.

Chart 3-4-3 Changes in reception rate of National Health Insurance and National Pension (text p. 105)

Source: 'Annual Report of the National Health Insurance' of the Health Insurance Bureau, MHLW, and 'Annual Report' of the former Social Insurance Agency

1. The reception rate was calculated using an adjusted amount from which the amount for anyone with an unknown address was deduced (rounded to two decimal places).

2. The adjusted amount after 2000 includes payments for nursing care; in addition, persons aged 75 or older are not included in the 2008 figures on and therefore care should be taken with any comparison with the figures up to 2007.

1. The reception rate denotes the proportion of paid months to months to be paid.

2. The probation rate (sum of 'accumulated months probated' and 'accumulated months paid in cash' divided by 'accumulated months to be probated') is provided up to 2001.

The social insurance systems are based on social solidarity, and low reception rates are a problem that will affect the overall system. However, the reception rate of insurance premiums for the National Pension has been gradually decreasing over time.
## Chapter 4: Future prospects of Social Security

## (Future social security requirements)

## (1) Increasing need for social security of the working generation

• Maintaining pace with the surfacing problem of the working generation facing poverty and increasing child rearing needs; the problem has also been pointed out that too much precedence is being given to the elderly generation with respect to the redistributive aspect of social security functions.

(2) Increasingly complex living difficulties

• The complexity of our current society often makes solving a problem using only one support menu within one system difficult, thus necessitating comprehensive support.

aging, poverty, and suicides, ...

## (3) Transition from 'relief for the poor' to 'prevention against being poor' to 'participation'

• Establishment of universal health insurance and universal pension systems converted 'relief for the poor' into 'prevention against being poor', and further transition to 'participatory social security' will be required, which guarantees social participation by all elements of society.

(4) The working generation is not comfortable with the both the burden and benefits of the current social security systems

• With regard to "lifetime benefits and the burden of the social security systems" more than 70 percent of persons in their 40s or younger have responded by stating "benefits less than the overall burden will be received".

- It has also been pointed out that the social security systems are not neutral, even among the same generation.

(5) The increasing cost of social security benefits and worsening financial situation of the state government

- The cost of social security benefits have significantly increased, thus imposing a burden upon the working generation. Moreover, both state and local governments face severe financial situations.

• In a survey questionnaire more than 60 percent of people, mainly of the younger generations, answered that "the status quo cannot be maintained".

## (Problems to be solved using the social security systems in the future)

• New social security needs have to be supported, particularly those of the working generation, and for example child rearing.

→People of the working generation living peaceful lives with rewarding jobs, and as consumers need to be the infrastructure of society.

• Everyone must be supported, regardless of generation, and with or without a disability, thus necessitating both individual and comprehensive support via the idea of participatory social security. Existing medical and nursing security and income compensation after retirement will also remain important.

- It is essential that stable sources of finance be established in thereby ensuring the long-term sustainability of the systems, as well as prioritized payments and more efficient operation.

- All-encompassing reformation is necessary in ensuring the required level of functional enhancement of the social security systems, as well as the overall sustainability of social security.
## Chapter 4, Section 1: Future social security requirements

Chart 4-1-6 Awareness of and experience with social security systems (text p. 113)

Chart 4-1-9 Awareness of each generation regarding the lifetime balance of benefits and the burden (text p. 117)

Source: 'Questionnaire Survey of Social Security' (2010), commissioned by the Counselor Office for Policy Evaluation under the Director-General for Policy Planning and Evaluation, MHLW

Chart 4-1-15 Opinions on future benefits of the social security systems (text p. 123)
## Chapter 4, Section 2: Ongoing discussions about social security reformation

[History of studies on social security reformation]

History of studies on social security reformation]
2008:	Final report of the National Council for Social Security
· Specific recommendations were made regarding the functional enhancement of social security, with simulated medical and nursing costs and a quantitative simulation of the public pension system having been published
2009:	Report on Conference for Establishing a Peaceful Society
· Outlook for a peaceful society in view of cooperative efforts in social security, employment, and education
2010:	Establishment of a social security reform study group of the government and ruling parties
'Advisory Committee on Social Security Reform' was created within the study group, and the report 'Vision of Social Security toward a Peaceful and Vital Society' published in December.
'Research Commission for Radical Reformation of the Tax and Social Security Systems' was created within the Democratic Party, and an interim report published in December.
The reports resulted in 'Promotion of Social Security Reform' being determined upon by the social security reform study group, and then by the Cabinet.
Those decisions then resulted in a social security reform study group being created within the MHLW.
2011:	An 'Intensive Study Commission on Social Security Reform' was created within the social security reform study group of the government and ruling parties.
The direction and specific measures for reformation of the social security systems were published by the MHLW in May.
A 'Plan for Combined Reformation of the Social Security and Tax Systems' was determined upon by the social security reform study group on June 30, which in turn was reported to the Cabinet on July 1.
## Conclusion

The social security systems have a great impact on lives of Japanese citizens, as indicated by the fact that 'Improvement of the social security systems, including health care and pensions' holds first place in a list of 'Requests to the government'.

Social security basically involves the provision of mutual support to each other, thus making discussions that involve the entire country and which are based on objective data and accurate knowledge necessary in when decisions on social security systems are made in the future.

Younger generations have very little interest in social security, as more than 10 percent of persons in their 20s responded in a 'Questionnaire Survey on Social Security' that they have basically no knowledge on social security.

O Reform of the social security systems will primarily necessitate Japanese citizens, who are all involved, possessing accurate knowledge on the purposes of the different social security systems and their current situations.

Achieving social security reformation will require the understanding and cooperation of Japanese citizens and will have to be based on a wide range of discussions involving various perspectives.

Chart Requests to the government (text p. 129)

Source: 'Public Opinion Survey Concerning People's Lifestyles', Cabinet Office

Note: 1. Top 10 items in the June 2010 survey were extracted from 28 choices.

2. In the June 2009 survey these items were 'Structural reform of the social security systems, including health care and pensions', 'Employment and labor problems', 'Protection of the natural environment', 'Educational reform and measures for youth', respectively.
## Part 2

Response to current policy issues
This second part, which is an annual administrative report, presents MHLW's activities in response to various current policy issues with charts and graphs, as well as 33 columns on endeavors from the fields of health, labor, and welfare.

In addition, the MHLW's response to the Great East Japan Earthquake that occurred on March 11th, 2011 is featured at the beginning of Part 2 of the Annual Report.

## [Content of Part 2]

Feature: MHLW's response to the Great East Japan Earthquake

Chapter 1: Creating an environment that enables carefree child rearing

Chapter 2: Securing employment and stable livings under severe economic conditions

Chapter 3: Toward reliable pension systems

Chapter 4: Stable provision of high-quality medical services

Chapter 5: Securing healthy and safe lives

Chapter 6: Securing quality nursing care services

Chapter 7: Comprehensive support for assisting persons with disabilities

Chapter 8: Creating an environment where people can work with peace of mind

Chapter 9: Securing peaceful lives

Chapter 10: Promoting measures for the peacefulness of Japanese citizens

Chapter 11: Contributions to the international community and appropriate responses to issues such as foreign national workers

Chapter 12: Development of administrative system
## Reference material 1

Major changes in social security systems
Historical period	Historical background	Major changes in social security systems
(1) Social security systems before Japan had the universal health insurance and universal pension systems (up to 1954)	1945 End of WWII Establishment of the United Nations	1922 Health Insurance Act enacted1938 National Health Insurance Act enacted1939 Mariners Insurance Act enacted1941 Workers' Pension Insurance Act enacted (which was renamed as 'Employees' Pension Insurance Act' in 1944)1942 'Beveridge Report' issued in Great Britain
● Early stage of social insurance● Care for the poor in the postwar period● Formation of the foundation for social security administration	1945	1946 (Former) Public Assistance Act enactedThe Constitution of Japan enacted1947 Industrial Accident Compensation Insurance Act enactedThe Constitution of Japan enforced
1947 Revision of Civil Code	1948 Medical Care Act enactedEmployees' Pension Insurance Act revised (in response to inflation)
Life expectancy at birth was 50 for males and 54 for females	1950 Public Assistance Act enacted'Recommendations on Social Security Systems', Social Security CouncilMedical Care Act revised (introduction of medical corporation)
First baby boom (1947-1949)
1950 Korean War (special procurement boom)
1951 Japan joined the ILO	1951 Local Tax Act revised (introduction of National Health Insurance tax)
1952 San Francisco Peace Treaty (Independence from GHQ occupation) and Security Treaty between Japan and the United States
1954 Employees' Pension Insurance Act fully revised (which then became the current Employees' Pension)1955 National Health Insurance Act revised (introduction of state subsidies)
Historical period	Historical background	Major changes in social security systems
(2) Establishment of universal health insurance and universal pension systems (from 1955 to the oil shock)	The 'Jinmu Keiki' (1954-1957)Japan joined the United Nations "The postwar period is over", Economic White Paper"Is the postwar period really over", the first Health and Welfare Report	1958National Health Insurance Act revised (universal health care system)
● High economic growth and improved living standards● Development of fundamental institutions for social security systems	1959The 'Iwato Keiki' (1958-1960)	1959National Pension Act enacted (universal pension system)
● Focus on social insurance (from relief of the poor to prevention against being poor)● Improvement of various benefits● The first welfare year	1960National Income Doubling PlanStruggle over the Security Treaty Mitsui Miike dispute	1961Establishment of universal health insurance and universal pension systemsAct on General Rules of Aggregate Pension (which was abolished with introduction of the basic pensions)
1962Comprehensive National Development Plan1963Assassination of the U.S. President, John F. Kennedy1964Japan joined the OECD	1963Act on Social Welfare Service for Elderly enacted1964Act on Welfare of Mothers with Dependents (six welfare laws)
1965Tokyo Olympic Games took placeThe Tokaido Shinkansen trains commenced operationU.S. Forces began bombing North Vietnam	1965Employees' Pension Insurance Act revised (pension benefits amounted to ten thousand yen)
First year of nine consecutive national championships of Tokyo Yomiuri Giants (a professional baseball team)The average age of Japanese citizens exceeded 30 years	1966Act on Partial Revision of the National Health Insurance Act enacted (70 percent payment)
1966The 'Izanagi Keiki' (1965-70)	196670 percent payment from National Health Insurance
1968Japan's GNP ranked third in the world
Historical period	Historical background	Major changes in social security systems
1969 University disputes intensifiedMoon landing of Apollo 11	1969 Employees' Pension Insurance Act revised (pension benefits amounted to twenty thousand yen)
1970 Signs of aging society (elderly population exceeded seven percent)
1971 Establishment of Environment AgencyDollar shock ($1 became 308 Yen)Second baby boom (1971-74)	1971 Child Allowance Act enacted
1972 Sapporo Olympic Games took placeReversion of OkinawaNormalization of diplomatic relations with China	1973 (The first welfare year)Act on Social Welfare Service for Elderly revised (free medical care for the elderly)Health Insurance Act revised (70 percent payments to families from medical insurance and institutionalization of major medical expenses)Pension systems revised (Pension benefits amounted to fifty thousand yen, index-linked payments introduced)
1973 The first oil shockSkyrocketing prices
End of the Vietnam War
Transition to floating exchange rate of the yen
(3) Institutional reconsideration period (1975-1988)	1974 Economic growth rate fell into negative figures for the first time after WWII	1974 Employment Insurance Act enacted
1975 International Women's YearPeople born after WWII accounted for more than half the total Japanese population
● Transition to steady growth● Normalization of social security costs● Equitable benefits and burden-sharing● Establishment of a stable and efficient institutional infrastructure	1978 Narita Airport commenced operationInternational Year of the ChildThe second oil shockThe second Ad Hoc Commission on Administrative ReformJapan became the largest car producing countryInternational Year of Disabled Persons Japan-US trade friction
1980
1981