Silviase/jgov_v1.4_full_ann huggingface dataset:
## 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, 2012)

Classification	Standard number of beds	Number of existing beds
Long-term care beds and general beds	1,108,741	1,255,192
Psychiatric hospital beds	307,450	349,341
Tuberculosis hospital beds	6,256	9,867
Infectious disease hospital beds	1,889	1,725
## 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 4km 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 39 prefectures as of January 1, 2012

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

281 hospitals are designated as of January 1, 2012

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

1,066 clinics (including National Health Insurance direct managed clinics) are established as of January 1, 2012
## 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

○ 2007 Holding of Conference on Ideal Clinical Training System, etc. (September – February 2008)

○ 2008 Revision of the system (applied at the start of training in FY2010)

Overview of Clinical Training System

### 1. Medical Education and Clinical Training

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 (FY2011)

Clinical resident training hospitals (core type) 924

Clinical resident training hospitals (cooperative type) 1,473

University hospitals (core type equivalent) 114

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%
# 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 Âgelective compulsory coursesÂh, 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 of 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.)
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 372 locations in 47 prefectures, 100 locations in 69 designated cities, and 23 locations in 23 special wards under the Community Health Act (As of April 1, 2012).

##

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

## 495 health centers 373 in prefectures 99 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
Total number of health centers	663	641	594	592	582	576	571	549	535	518	517	510	494	495	495
Prefectures	490	474	460	459	448	438	433	411	396	394	389	380	374	373
Cities	137	136	108	109	111	115	115	115	116	101	105	107	97	99
Special wards	36	31	26	24	23	23	23	23	23	23	23	23	23	23

Source: Health Service Bureau, MHLW

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

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

Occupation	Number of personnel
Persons
Doctors	810
Dentists	82
Pharmacists	2,732
Veterinarians	2,179
Public health nurses	7,739
Midwives	54
Nurses	216
Assistant nurses	17
Radiology technicians, etc.	606
Medical technologists, etc.	853
Registered dietitians	1,057
Nutritionists	117
Dental hygienists	337
Physical/occupational therapists	78
Others	10,922
<Included in the upper column>
Medical social workers	93
Mental health welfare counselors	1,335
Nutrition counselors	1,026
Total	27,799

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 FY2009)

(Note) Clinics in Miyagi Prefecture, apart from Sendai City, are not included due to the impact of the Great East Japan Earthquake.

Changes in Number of Public Health Nurses

(Unit: person)

1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010
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
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
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
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
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

FY 1995-1996: "Report on Statistics of Activities of Health Centers", Statistics and Information Department, Minister's Secretariat, MHLW

FY1997-1998: "Report on Regional Public Health Services", Statistics and Information Department, Minister's Secretariat, MHLW

FY 1999-2007: "Report on Regional Public Health Services and Health Services for the Aged", Statistics and Information Department, Minister's Secretariat, MHLW

FY 2008 onward: “Report on Regional Public Health Services and Health Promotion Services”, Statistics and Information Department, Minister's Secretariat, MHLW

(Note) The figures up to FY1996 as of the end of December of each year and figures from FY1997 onward as of the end of March of the next year. The figures of 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, Litate Town, and Aizuwakamatsu City) due to the impact of the Great East Japan Earthquake.
## Measures against Hepatitis

## Overview

## 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

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

Promotion of prevention and early detection

• Prevention of hepatitis

• Quality improvement of hepatitis examinations, etc.

Research promotion

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

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

• Establishment and improvement of medical institutions

• Financial support for medical care expenses on hepatitis patients

• Securing opportunities for hepatitis care

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

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

## Formulation of basic measures against hepatitis

The Council for Promotion of Hepatitis Measures

• Representatives of hepatitis patients, etc.

• The medical profession engaged in hepatitis care

• Persons with relevant knowledge and experience

Relevant administrative organizations

Request for documents, etc.

Discussion

Minister of Health, Labour and Welfare

Basic measures against hepatitis

● Review at least every 5 years

→ Revise if necessary

## 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 promoting people's health.

## (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 (health promotion measure plans for 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.
## Detailed Data 1 Status of Formulating Health Promotion Plans in Prefectures/Municipalities

[Status of formulating health promotion plans in prefectures] Already formulated in every prefecture (at the end of March 2002)

[Status of formulating health promotion plans in municipalities and special wards]

Total	Formulated	Plan to formulate in FY2011	Plan to formulate in FY2012	Plan to formulate in FY2013 or later	No plan
Health center-designated cities	68	67	0	0	1	0
Special wards in Tokyo	23	23	0	0	0	0
Other municipalities	1,651	1,270	67	79	170	65

(As of Dec. 1, 2011)

[Status of formulating health promotion plans in municipalities by prefectures]

Prefecture	No. of municipalities	Formulated	Formulation rate	FY2011	FY2012	FY2013 or later	No plan
Hokkaido	175	95	54.3%	2	15	56	7
Aomori	39	39	100.0%	0	0	0	0
Iwate	32	31	96.9%	0	1	0	0
Miyagi	34	33	97.1%	1	0	0	0
Akita	24	21	87.5%	0	1	2	0
Yamagata	35	35	100.0%	0	0	0	0
Fukushima	57	33	57.9%	4	3	17	0
Ibaraki	44	26	59.1%	7	7	4	0
Tochigi	25	25	100.0%	0	0	0	0
Gunma	33	31	93.9%	1	1	0	0
Saitama	61	38	62.3%	6	3	14	0
Chiba	51	24	47.1%	1	0	8	18
Tokyo	37	26	70.3%	1	2	8	0
Kanagawa	28	16	57.1%	3	3	3	3
Niigata	29	29	100.0%	0	0	0	0
Toyama	14	13	92.9%	1	0	0	0
Ishikawa	18	16	88.9%	1	1	0	0
Fukui	17	17	100.0%	0	0	0	0
Yamanashi	27	26	96.3%	1	0	0	0
Nagano	76	59	77.6%	1	6	7	3
Gifu	41	38	92.7%	0	1	2	0
Shizuoka	33	33	100.0%	0	0	0	0
Aichi	50	49	98.0%	1	0	0	0
Mie	28	16	57.1%	2	0	8	2
Shiga	18	17	94.4%	0	0	1	0
Kyoto	25	13	52.0%	5	1	2	4
Osaka	39	33	84.6%	1	1	3	1
Hyogo	37	37	100.0%	0	0	0	0
Nara	38	33	86.8%	1	1	1	2
Wakayama	29	18	62.1%	1	1	6	3
Tottori	19	18	94.7%	0	1	0	0
Shimane	19	19	100.0%	0	0	0	0
Okayama	25	25	100.0%	0	0	0	0
Hiroshima	20	20	100.0%	0	0	0	0
Yamaguchi	18	14	77.8%	2	2	0	0
Tokushima	24	19	78.3%	0	1	4	0
Kagawa	16	16	100.0%	0	0	0	0
Ehime	19	19	100.0%	0	0	0	0
Kochi	33	24	72.7%	7	1	1	0
Fukuoka	56	24	41.1%	2	1	13	16
Saga	20	14	70.0%	0	4	2	0
Nagasaki	19	19	100.0%	0	0	0	0
Kumamoto	44	28	63.6%	3	11	2	0
Oita	17	17	100.0%	0	0	0	0
Miyazaki	25	13	52.0%	8	2	2	0
Kagoshima	42	32	76.2%	2	3	0	5
Okinawa	41	29	70.7%	2	5	4	1
1,651	1,270	76.8%	67	79	170	65

(Note) Excluding health center-designated cities and special wards.
Detailed Data 2 Number of Patients and Deaths Related to Lifestyle Diseases

Total number of patients (1,000 persons)	Number of deaths (Person)	Mortality rate (to the population of 100,000)
Malignant neoplasm	1,518	357,185	283.1
Diabetes	2,371	14,634	11.6
Hypertensive diseases	7,967	7,018	5.6
Heart diseases	1,542	194,761	154.4
Cerebrovascular diseases	1,339	123,784	98.1

Source:

“Patient Survey 2008”, Statistics and Information Department, Minister's Secretariat, MHLW “Summary of Monthly Report of Vital Statistics”, Statistics and Information Department, Minister's Secretariat, MHLW

(Note) The number of deaths and mortality rate were approximate figures in 2011.

Detailed Data 3 Estimated Numbers on Diabetes

Males (survey samples: 1,619)	Females (survey samples: 2,384)
Age	Strongly suspected of having diabetes	With possibilities of having diabetes	Strongly suspected of having diabetes	With possibilities of having diabetes
20-29	1.1%	0%	0%	0.9%
30-39	3.0%	3.0%	0.5%	5.4%
40-49	7.6%	11.0%	2.9%	10.4%
50-59	12.1%	16.7%	5.6%	20.8%
60-69	22.1%	17.3%	14.1%	18.2%
70 or older	22.6%	18.4%	11.0%	23.8%

When the above figures are applied to the estimated population as of October 1, 2007, the estimated numbers nationwide are as follows:

• Those strongly suspected of having diabetes: approx. 8.9 million persons

• Those with possibilities of having diabetes: approx. 13.2 million persons

Source: "National Health and Nutrition Survey Japan, 2007", Health Service Bureau, MHLW
Source: “National Health and Nutrition Survey Japan, 2010”, Health Service Bureau, MHLW

(Note) Persons with exercise habits: Those who have been continuing daily exercise of 30 minutes or longer at least 2 days a week for at least a year.

Detailed Data 5 Changes in Distribution of Fat Energy Ratio (20 or Older)

Source: "National Health and Nutrition Survey Japan, 2009", Health Service Bureau, MHLW

Males
2009	57.0	23.0	20.0

2008	61.4	21.1	17.4

2007	55.8	23.6	20.6

2006	59.0	22.9	18.1

2005	58.5	23.3	18.2

2004	58.6	22.6	18.8

2003	60.9	21.8	17.3

(Note) Fat energy ratio: Percentage of energy intake from fat

Females
2009	46.4

2008	50.0

2007	46.5

2006	48.0

2005	48.4

2004	49.4

2003	50.9

Less than 25%	25% or more but less than 30%	30% or more
Detailed Data 6 Average Intake of Vegetables, etc. (20 or Older, by Gender/Age)

Source: "National Health and Nutrition Survey Japan, 2010", Health Service Bureau, MHLW (Note) The figures in parentheses indicate the total intake of "bright red, green or yellow vegetables" and "other vegetables (excluding bright red, green or yellow vegetables)".

Source: "National Health and Nutrition Survey Japan, 2010", Health Service Bureau, MHLW