Childbirth Insurance Coverage: System Needed to Support Child-rearing Generation

Editorial

15:45 JST, July 5, 2024

A situation must be avoided in which younger generations hesitate to give birth due to concerns about the financial burden. There is an urgent need to put a system in place to support childbirth and create a society in which it is easy to give birth to and raise children.

A government panel of experts has begun to study ways for childbirth expenses to be covered by insurance. The government aims to consolidate opinions as early as spring next year and introduce the system in fiscal 2026.

Normal childbirth, excluding Cesarean section and other methods of delivery, is not covered by public medical insurance because it is not a disease, and medical institutions set fees on their own.

The cost of childbirth has been rising year by year, with the average in fiscal 2022 standing at about ¥480,000, up more than ¥60,000 from 10 years prior.

The government currently provides pregnant women with a lump-sum allowance for childbirth and childcare instead of insurance coverage. The amount has been raised in stages in line with the average cost of childbirth and currently stands at ¥500,000.

Some medical institutions have increased their fees for childbirth each time the government increases the lump-sum payments. It has been pointed out that these are opportunistic fee hikes.

The fees charged for childbirth vary widely between medical institutions, and the basis for setting the fees is unclear. In some cases, the fees include things that are not directly related to childbirth, such as a celebratory meal and commemorative photos of the newborn.

If uniform official fees for childbirth are set by insurance coverage, there would be no fee increases at the discretion of medical institutions. The cost of childbirth itself would become clearer, and pregnant women would be able to prepare for childbirth with peace of mind.

If insurance is applied, the out-of-pocket expenses for receiving treatment normally will be 30% of the cost of treatment. But the government does not intend to require pregnant women to bear this burden.

However, at what level the official fees should be set is a difficult issue.

The cost of childbirth also varies widely from region to region, with the highest being in Tokyo, with an average of ¥600,000, and the lowest being in Kumamoto Prefecture, with an average of ¥360,000. If the official fees were set at a low level, some medical institutions might close their doors due to financial difficulties.

In Japan, local general practitioners are responsible for nearly half of all childbirths. Even small-scale institutions require doctors, midwives and others to be on call at all times, which tends to increase costs.

If insurance coverage leads to these institutions closing one after another, pregnant women could be overconcentrated in university hospitals and other institutions, leading to shortages of medical personnel and hospital beds.

Even if insurance coverage were to be applied, it would be advisable to consider additional medical service fees for medical institutions that make a large contribution to local medical care.

It is said that the number of doctors who handle childbirth is decreasing due in part to the decline in the number of births. Women are tending to bear children at a later age, and high-risk childbirths have also increased. It is time to seriously consider how to secure medical personnel and develop an environment in which women can give birth to children with peace of mind.

(From The Yomiuri Shimbun, July 5, 2024)