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Changes in Referral Rates After the Mandate of Charging Additional Fees for Non-referral First Visits: A Controlled Interrupted Time-series Analysis. Journal of Epidemiology. 2026;36(5):155. https://pmc.ncbi.nlm.nih.gov/articles/PMC13085651/", "country_ids": [ "JPN" ], "coverage_domains": [ "governance", "hospital_organization", "observed_referral", "patient_flows", "primary_care", "referral_design", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": "referral rates increased when the additional fee was mandated", "institution": "Journal of Epidemiology", "locator": { "locator_type": "web_heading_and_paragraph", "source_word_anchor": "referral rates increased when the additional fee was mandated", "source_word_count": 9 }, "material_id": "material:50b11b023ef2b22860e839de", "notes": [ "Keep this one-prefecture claims result distinct from a national referral or counter-referral completion rate." ], "origin": "country-evidence-improvement-sources", "period": "Claims observations April 2014 to March 2022; mandates in 2016, 2018 and 2020", "publication_date": null, "publication_year": 2026, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "research_literature" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "4556fe2b9bfeb4a17897acf559f935ffd6660b6cdb58a6128be33c72cb11fde8" }, "statement": "In one Japanese prefecture, a controlled interrupted time-series study found referral-rate increases for specified hospital groups after mandates.", "tags": [], "territory": "One prefecture in Japan", "title": "Changes in Referral Rates After the Mandate of Charging Additional Fees for Non-referral First Visits: A Controlled Interrupted Time-series Analysis", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13085651/" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Zhang X, Oyama T. Investigating the health care delivery system in Japan and reviewing the local public hospital reform. 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Japan 2035: Leading the World through Health. 2015. https://www.mhlw.go.jp/seisakunitsuite/bunya/hokabunya/shakaihoshou/hokeniryou2035/future/en/", "country_ids": [ "JPN" ], "coverage_domains": [ "actors", "decision_rights", "governance", "government_responsibilities", "networks", "primary_care", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "responsive to variations in regional characteristics", "institution": "Ministry of Health, Labour and Welfare, Japan", "locator": { "locator_type": "web_heading_and_paragraph", "source_word_anchor": "responsive to variations in regional characteristics", "source_word_count": 6 }, "material_id": "material:34111596eecc2910dce46db2", "notes": [ "A future-oriented vision is not treated as proof of implementation or observed patient flow." ], "origin": "country-evidence-improvement-sources", "period": "Japan Vision: Health Care 2035 publication context", "publication_date": null, "publication_year": 2015, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "76850e989a9e952126969661a2537b7be1e6edb11060b04a1d1e1b65dc29f968" }, "statement": "MHLW presents Health Care 2035 as a forward-looking vision responsive to regional characteristics, not evidence of implemented delivery effects.", "tags": [], "territory": "Japan", "title": "Japan 2035: Leading the World through Health", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.mhlw.go.jp/seisakunitsuite/bunya/hokabunya/shakaihoshou/hokeniryou2035/future/en/" }, { "kind": "resolved_document", "source": "single-country score-improvement acquisition", "url": "https://www.mhlw.go.jp/seisakunitsuite/bunya/hokabunya/shakaihoshou/hokeniryou2035/assets/file/healthcare2035_proposal_150703_summary_en.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Sakamoto H, Rahman M, Nomura S, et al. Japan health system review. Health Systems in Transition, Vol. 8 No. 1. 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Japan's healthcare delivery system: From its historical evolution to the challenges of a super-aged society. 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Overview of health insurance policy in Japan. English version as of July 2025. https://www.mhlw.go.jp/content/12400000/001406614.pdf", "country_ids": [ "JPN" ], "coverage_domains": [ "actors", "autonomy", "decision_rights", "governance", "government_responsibilities", "market_structure" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "Review payment agency", "institution": "Ministry of Health, Labour and Welfare, Japan", "locator": { "locator_type": "pdf_page_and_heading", "source_word_anchor": "Review payment agency", "source_word_count": 3 }, "material_id": "material:014c7081e9aa06369291d3bd", "notes": [ "The diagram describes a payment pathway, not every insurer-provider contract or compliance outcome." ], "origin": "country-evidence-improvement-sources", "period": "English version as of July 2025", "publication_date": null, "publication_year": 2025, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "0811e54ccf02fc60fd7cbb8579d006b6e0bd1670d157de4ac7b0bcf74746a381" }, "statement": "MHLW's July 2025 overview depicts claims from insurance medical institutions through review payment agencies to insurers.", "tags": [], "territory": "Japan", "title": "Overview of health insurance policy in Japan", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.mhlw.go.jp/content/12400000/001406614.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ministry of Health, Labour and Welfare, Japan. Regional Medical Care Vision toward 2040. 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Silver Opportunity: Building Integrated People-Centered Care for an Aging Population. 2025. https://documents1.worldbank.org/curated/en/099025503072337503/pdf/P17583208782960a40bf6804d1758e50f1e.pdf", "country_ids": [ "JPN" ], "coverage_domains": [ "authoritative_review", "governance", "hospital_organization", "networks", "observed_referral", "patient_flows", "primary_care", "referral_design", "reform_history", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "Community-Based Integrated Care System in Japan", "institution": "World Bank", "locator": { "locator_type": "pdf_page_and_heading", "source_word_anchor": "Community-Based Integrated Care System in Japan", "source_word_count": 6 }, "material_id": "material:bc81b939d5811e5f031729bd", "notes": [ "This is case-study context, not a measured national referral-completion estimate." ], "origin": "country-evidence-improvement-sources", "period": "Japan community-based integrated care case-study context in 2025 report", "publication_date": null, "publication_year": 2025, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "grey_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "8d93abbbac46b05c16ccdd68c3ae4b7a963d81bb1b99446b10b42c703092d490" }, "statement": "The World Bank case study describes medical, long-term care, prevention, housing and daily-living support, not a national flow denominator.", "tags": [], "territory": "Japan", "title": "Silver Opportunity: Building Integrated People-Centered Care for an Aging Population", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://documents1.worldbank.org/curated/en/099025503072337503/pdf/P17583208782960a40bf6804d1758e50f1e.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ministry of Health, Labour and Welfare, Japan. The Japan Vision: Health Care 2035 Brief Summary. 2015. https://www.mhlw.go.jp/seisakunitsuite/bunya/hokabunya/shakaihoshou/hokeniryou2035/assets/file/healthcare2035_proposal_150703_slide_en.pdf", "country_ids": [ "JPN" ], "coverage_domains": [ "autonomy", "decision_rights", "government_responsibilities", "hospital_organization", "networks", "primary_care", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "Japan Vision Health Care 2035", "institution": "Ministry of Health, Labour and Welfare, Japan", "locator": { "locator_type": "pdf_page_and_heading", "source_word_anchor": "Japan Vision Health Care 2035", "source_word_count": 5 }, "material_id": "material:9e596592f41056148084dbba", "notes": [ "Do not convert a policy proposal into an observed organisational arrangement or performance result." ], "origin": "country-evidence-improvement-sources", "period": "2015 policy proposal for 2035", "publication_date": null, "publication_year": 2015, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "b949b24ec35060978c3d4de0904e27f61f3c11aff99d24fe085de374c5281ae3" }, "statement": "The MHLW brief records a 2015 proposal for 2035, not provider autonomy or achieved outcomes.", "tags": [], "territory": "Japan", "title": "The Japan Vision: Health Care 2035 Brief Summary", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.mhlw.go.jp/seisakunitsuite/bunya/hokabunya/shakaihoshou/hokeniryou2035/assets/file/healthcare2035_proposal_150703_slide_en.pdf" } ] }, { "annotation_status": "open", "authors": [], "availability": { "direct_text_checkable": true }, "citation": "per capita transfers for health and education with federal conditions on accessibility. https://documents1.worldbank.org/curated/en/406481468771272831/pdf/multi-page.pdf", "country_ids": [ "JPN" ], "coverage_domains": [], "display_status": "shown_in_full", "document_type": "evidence_context", "evidence_mode": "unclassified", "excerpt": "per capita transfers for health and education with federal conditions on accessibility", "institution": null, "locator": { "paragraph_index_on_page": 1, "physical_pdf_page": 12, "source_word_anchor": "per capita transfers for health and education with federal conditions on accessibility", "source_word_count": 12 }, "material_id": "display-evidence:JPN:972cae1bba8333fd46fc", "notes": [ "Treat this short excerpt as source context, not as a complete country fact.", "Confirm country applicability, surrounding qualifications, and period before drafting a fact." ], "origin": "current-public-fact-projection", "period": "1997", "publication_date": null, "publication_year": null, "record_kind": "displayed_exact_context", "record_kind_label": "Displayed exact context", "screening": { "previous_visibility": "previously_projected" }, "source_layers": [ "grey_literature" ], "source_system": "grey_literature", "source_version": { "detected_media_type": "application/pdf", "file_sha256": "101513f04a64e156597c875a9e9323862c096ec4a3dac11bae5e323ade67a79f", "page_count": 86, "text_sha256": "33dc1ae64dc1ab26da2d66f204d43d17cccc549e7d4b59a0c038aa3a6b231a05" }, "statement": null, "tags": [], "territory": "country_applicability_pending", "title": "per capita transfers for health and education with federal conditions on accessibility", "urls": [ { "kind": "source_reference", "source": "Intergovernmental fiscal transfer in nine countries : lessons for developing countries", "url": "https://documents1.worldbank.org/curated/en/406481468771272831/pdf/multi-page.pdf" } ] }, { "annotation_status": "open", "authors": [], "availability": {}, "citation": "World Bank Documents and Reports. Health systems in East Asia : what can developing countries learn from Japan and the Asian tigers ?. 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