The Ministry of Health, Labour and Welfare (MHLW) proposes a fee schedule, which is subsequently negotiated by the Central Social Insurance Medical Council, comprising providers, insurers, patient representatives and other stakeholders. Formal revision of the fee schedule happens every other year, applies to all providers, and determines the revenue of over 95% of clinics and hospitals. This latter fact means that the fee schedule also serves as a major policy lever to steer the whole system towards desired goals.