The Ministry of Health, Labour and Welfare (MHLW) is responsible for writing the policies and
developing the structure of the National Health Care Plan, and provides national oversight. The
Prefectural Departments of Health develop 5 yearly health delivery plans according to their
prefectural health situation, deliver medical services, and report to the MHLW. Municipalities are
primarily responsible for delivering public health services. The private sector owns over half of the
total number of health institutions, and hospital care delivery in Japan has depended largely on
the private sector. There are many non-profit organizations that provide health services such as
medical interpretation for foreigners, HIV-AIDS prevention and health promotion, and a
temperance society for alcoholic patients.
There are some models of community participation in health service delivery. For example, in one
prefecture local citizens joined as members of the hospital and had a representative voice to the
president of the hospital. These members also contributed to purchasing hospital equipment.