Although a significant part of Japanese health policy is dictated by revisions made to the fee schedule, bills passed through the legislative process form the structural base of policy, including the government budget. The Japanese fiscal year starts in April and ends in March. The legislative process follows this timeline, with budget bills prioritized so that they can be passed by the start of the next fiscal year each April. Health legislation and other bills are submitted to the Diet by either the Cabinet or by members of the Diet.[4]

The Cabinet submits bills to the Diet, and barring emergencies, these bills go through a lengthy process of drafting and deliberations that typically include the following steps.^[5,][6]

Problem identification and information gathering

Cabinet members survey stakeholder interests and gauge media reports. To inform discussions, they often consult healthcare practitioners and interview various stakeholders and experts to gather information and sample opinions.

Cabinet council discussions[7]

Inside the Japanese cabinet there is a large number of councils on topics ranging from space policy to suicide prevention. Councils that hear health policy related discussions include standing councils, such as the Social Security Council and the Committee on Health Insurance, and ad-hoc councils, which are convened to address matters that require a particular level of expertise or to gather a broad range of opinions.

Evaluation of bills by the Cabinet Legislation Bureau

Prior to being introduced at Cabinet Meetings, bills submitted by the Cabinet are wholly evaluated by the Cabinet Legislation Bureau. The Cabinet Legislation Bureau conducts preparatory evaluations of bills drafted, as a matter of course, by government agencies and ministries.[8]

Evaluation of proposed bills by ruling party

The Evaluation Committee of the ruling party, which has usually been the Liberal Democratic Party over the course of the modern era in Japan, conducts evaluations of bills. Without support from the ruling party, bills will die at this stage. If the ruling party backs a bill, it is circulated in the Cabinet.

Prior to submission to the Diet, a Cabinet decision on the bill is made

Factors considered in Cabinet decisions include the urgency of the bill and how the bill will fit alongside existing laws. Once the Cabinet decides to proceed with a bill, the bill will be submitted to the Diet in February or March by the Prime Minister.

Other bills are submitted by members of the House of Representatives or by members of the House of Councilors. In addition to the signature of the member who officially proposes a bill, it must also garner the signature of approval of at least a set number of other members. The bill is then given to the Presiding Officer of the proposing member’s House. Once a bill enters the Diet, deliberations take place in both the House of Representatives and the House of Councilors. Deliberation usually includes discussions in a Standing Committee, question and answer sessions involving the proposing member or the Prime Minister, and voting at a public hearing or a committee. Bills which survive these processes may pass into law via one of three paths:

・If at least half of all the members of both the House of Representatives and the House of Councilors vote for a bill, it passes

・If one house approves the bill but the other house rejects it, a Conference Committee comprised of members of both houses may be called to develop a proposal on which both Houses can agree

・A bill rejected by the House of Councilors after approval by the House of Representatives may still pass if it is approved once more by the House of Representatives with the two-thirds or more of the members voting in favor of the bill[9] (this principle is known as the “superiority of the House of Representatives.” This special privilege exists because the House of Representatives is viewed as more reflective of national opinion given that terms are shorter and that the House of Representatives may be dissolved at any time at the discretion of the Prime Minister.)

Once a bill is approved, the Cabinet informs the Emperor. Following that, the bill must be promulgated into law within 30 days.

Another important process that shapes health policy in Japan is the revision of the NHI fee schedule. This takes place once every two years. For further information about this process, please see Cost Control (Section 7.2).

[4] Cabinet Legislation Bureau. How a bill becomes a law. (Accessed 30 January 2018) Retrieved from http://www.clb.go.jp/law/index.html

[5] Cabinet Legislation Bureau. How a bill becomes a law. (Accessed 30 January 2018) Retrieved from http://www.clb.go.jp/law/index.html

[6] Iwabuchi Yutaka (2013). Handbook of Japanese health policy formulation and structure. Chuohoki Publishing. p.32-41

[7] Cabinet Office. Gathering of the deliberative council. (Accessed 30 January 2018) Retrieved from http://www.cao.go.jp/council.html

[8] Cabinet Legislation Bureau. From the drafting of a bill to the passing of a law. (Accessed 20 April 2018) Retrieved from http://www.clb.go.jp/law/process.html

[9] House of Representatives. The prerogatives of the cabinet. (Accessed 1 February 2018) Retrieved from http://www.shugiin.go.jp/internet/itdb_annai.nsf/html/statics/kokkai/kokkai_kengen2.htm