General Medicine/Care and Social Security

The Hippocratic Oath is a professional ethics oath for physicians originating in ancient Greece, including the priority of the patient's interests and the duty of confidentiality, and is regarded as the origin of medical ethics. The declaration on patients' rights is the Declaration of Lisbon, the ethical principles for research involving human subjects are the Declaration of Helsinki, and the 1948 code of physicians' ethics is the Declaration of Geneva.

The Declaration of Geneva is a code of physicians' ethics adopted by the World Medical Association (WMA) in 1948, regarded as the Hippocratic Oath expressed in modern language. Patients' rights were established by the Declaration of Lisbon, the ethics of research involving human subjects (including ethical review) by the Declaration of Helsinki, and the ancient Greek oath is the Hippocratic Oath.

The Declaration of Helsinki, adopted by the World Medical Association in 1964, sets the ethical principles for medical research involving human subjects, requiring informed consent from subjects and review of research plans by ethics committees. The declaration of patients' rights is the Declaration of Lisbon, the ancient physicians' oath is the Hippocratic Oath, and it is not an international regulation on infectious diseases.

The Declaration of Lisbon, adopted by the World Medical Association in 1981, concerns the rights of patients, establishing the right to good-quality medical care, freedom of choice, self-determination, the right to information, and more. The principles of subject protection in research belong to the Declaration of Helsinki, the origin of physicians' professional ethics is the Hippocratic Oath, and the 1948 code of physicians' ethics is the Declaration of Geneva.

The IRB is the institutional ethics review board (or clinical trial review board) that reviews the ethical and scientific validity of research plans before implementation, to protect the rights and safety of research subjects. Investigating medical accidents involves the Japan Medical Safety Research Organization, claim examination is done by examination and payment organizations such as the Payment Fund, and it is not a third-party evaluator of hospital functions and management.

Informed consent means the patient consents of their own will after receiving and understanding sufficient explanation of the condition, the treatment, its risks, and the alternatives. Japan's Medical Care Act also provides that medical professionals should give appropriate explanations and strive to obtain the patient's understanding. After-the-fact notification does not qualify, consent is not limited to written form, and a patient can withdraw consent once given.

A second opinion means seeking the view of a physician other than the attending physician about the diagnosis or treatment plan, so that the patient can choose a treatment with conviction. It does not presuppose transferring hospitals or changing physicians, and it is usually received with a referral letter from the attending physician. The consultation is generally outside public health insurance coverage (fully self-paid).

The WHO Constitution defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Its distinguishing feature is that the concept includes mental and social dimensions, not just absence of disease or physical soundness, and capacity for work is not part of the definition.

Of the three levels of preventive medicine, primary prevention stops disease onset itself through health promotion and vaccination, secondary prevention is early detection and early treatment through checkups and the like, and tertiary prevention is functional recovery and relapse prevention through rehabilitation. Early detection through checkups is secondary prevention; vaccination and lifestyle improvement are primary, and rehabilitation is tertiary.

Health Japan 21 (健康日本21) is the national health promotion campaign for the 21st century, legally grounded in the Health Promotion Act and emphasizing primary prevention of lifestyle-related diseases and extension of healthy life expectancy; its third phase has been under way since fiscal 2024. It is not an infectious disease reporting system, an advertising regulation, or a birthrate policy.

Specific health checkups are conducted by health insurers under the Act on Assurance of Medical Care for Elderly People, focusing on metabolic syndrome and covering insured persons and dependents aged 40 to 74. Those 75 and over are not covered, and the prefectures are not the implementing bodies. There is no attendance obligation backed by penalties. Specific health guidance is provided according to the results.

The community-based integrated care system provides medical care, long-term care, prevention, housing, and daily-life support in an integrated way within daily living areas, so that elderly people can keep living in the communities they know. It is not concentration into large hospitals or uniform direct provision by the national government; municipalities and others build it to suit local conditions. Its hallmark is that it includes medical care and daily-life support, not only long-term care.

Under the bed function reporting system, hospitals and clinics with beds (general or long-term care beds) report the function of each ward's beds to the prefectural governor in 4 categories — advanced acute, acute, recovery, and chronic — providing the base data for regional healthcare visions. The recipient is not the Minister of Health, Labour and Welfare, it does not cover only psychiatric beds, and it is not a fee-claiming system.

Japan's social security system consists of 4 sectors: social insurance, public assistance (livelihood protection), social welfare, and public health. Life insurance is private insurance and is not part of the social security system. Note that social insurance comprises 5 types: health insurance, pension insurance, long-term care insurance, employment insurance, and workers' compensation insurance.

The universal health insurance system means every citizen is enrolled in one of the public health insurance schemes; Japan achieved it in 1961. Enrollment is not voluntary, and the funding is built mainly on premiums, supplemented by public funds and patients' copayments — it is not all taxes.

Employee (workplace) insurance includes Kyokai Kenpo, mainly for employees of small and medium companies; society-managed health insurance, mainly for employees of large companies; mutual aid associations for public servants and the like; and seamen's insurance. National Health Insurance is community-based insurance for the self-employed and others, and is not employee insurance.

The insurer is the body that runs the health insurance program, collecting premiums and providing benefits. A health insurance society is the insurer of society-managed health insurance. The insured person is the enrolled individual, an insurance-covered institution is a healthcare provider delivering insured care, and the Social Insurance Medical Fee Payment Fund examines and pays claims; none of them is an insurer.

The insured under the latter-stage elderly healthcare system are those aged 75 and over, and those aged 65 to under 75 certified by the regional union as having a specified degree of disability. Excluding disability certification, the threshold is in principle 75. It is not 70 and over, 65 and over, or 80 and over.

Excluding patient copayments, the system's funding consists of roughly 50% public funds, roughly 40% support contributions from the working generations, and roughly 10% premiums paid by the insured — so the insured do bear premiums. It is correct that prefecture-level regional unions operate it, that the copayment is in principle 10% (20% for those above a certain income, 30% for those with working-level income), and that it is based on the Act on Assurance of Medical Care for Elderly People.

Under Japan's health insurance, the rule is benefits in kind (the provision of care itself — treatment, drugs, and so on), with patients paying only the copayment at the counter. Patients choose their healthcare institution freely (free access). Combining insured and uninsured care (mixed billing) is prohibited in principle, allowed only under exceptions such as the system of coverage for combined designated care.

Category 2 insured persons of long-term care insurance are health insurance enrollees aged 40 to under 65, while category 1 insured persons are those aged 65 and over. Category 2 insured persons can receive benefits only when they need long-term care or support due to specified age-related diseases. Groupings such as all citizens aged 20 and over, or those 75 and over, are not long-term care insurance categories.

Care-need certification is performed by the municipality — the insurer — based on the review and judgment of the municipal certification review board, not by the prefectural governor. Those judged to need support receive preventive benefits, so it is not true that they get nothing. Care plans are generally drawn up by care managers (long-term care support specialists), and individuals may draw up their own; they are not something physicians must write.

Fee-for-service accumulates points for each medical act performed, based on the medical fee schedule, and is widely used in outpatient care in Japan. While it readily reflects the content of care, income grows with more tests and prescriptions, so it is said to invite excessive care. A fixed amount per admission does not describe fee-for-service.

DPC/PDPS is a payment system for acute inpatient care that applies bundled per-day points defined for each diagnosis procedure combination (DPC). It covers inpatient care at participating hospitals and is not mandatory for all hospitals. Outpatient care is outside its scope, and surgery, anesthesia, and the like are excluded from the bundle and charged fee-for-service.

Claims under employee insurance are examined and paid by the Social Insurance Medical Fee Payment Fund, while those under National Health Insurance and the latter-stage elderly system are handled by the National Health Insurance Federations. The Central Social Insurance Medical Council (Chuikyo) deliberates medical fee revisions, and the regional bureaus of health and welfare are administrative bodies that guide and audit insurance-covered institutions.

The medical fee schedule is set by the Minister of Health, Labour and Welfare after deliberation by the Central Social Insurance Medical Council (Chuikyo), and is revised in principle once every 2 years. The unit price is 1 point = 10 yen, uniform nationwide, and institutions cannot set their own values. Nor is it revised monthly.

The drug price standard defines the drug items that may be used in insured care together with their prices (yakka), announced by the Minister of Health, Labour and Welfare, and forms the basis for pricing drugs in insurance claims. It is not a manufacturing standard or a free market price list, nor does it set prices for OTC drugs, which are outside insurance coverage.

Copayments are in principle 30% for those under 70, 20% before compulsory school age, 20% for ages 70 to 74 (30% for those with working-level income), and in principle 10% for those 75 and over (20% above a certain income, 30% at working level). The rate varies by age and other factors, and the high-cost medical care benefit system also sets out-of-pocket ceilings according to income.

Under Japan's Medical Care Act, a hospital is a medical facility with 20 or more beds, and a clinic has no beds or 19 or fewer. Advanced treatment hospitals provide, develop, and teach advanced medicine and are approved by the Minister of Health, Labour and Welfare. Regional medical care support hospitals aim to support family doctors and treat referred patients and are approved by the prefectural governor; developing advanced medicine is the advanced treatment hospital's role.

The public health nurse has a protected title but no exclusive right of practice: health guidance itself can be given without the qualification. Physicians, nurses, and midwives hold practice-exclusive qualifications, and unqualified persons are prohibited from performing their work (nurses and the like also have title protection). Physical therapists and occupational therapists are also title-protection-only qualifications.