Rising Hospital Costs Worry Pregnant Women... Japan Pushes for Medical Insurance Coverage of Childbirth Expenses

Japan currently gives 4.37 million won for childbirth
But hospital delivery costs surge causing 'side effects'
"Reducing out-of-pocket expenses to strengthen low birthrate measures... cost transparency"

The Japanese government, which has been rolling out various policies to address the low birthrate issue, has now begun considering applying health insurance to cover the costs incurred during childbirth.

According to NHK and Nihon Keizai Shimbun on the 19th, Japan's Ministry of Health, Labour and Welfare recently announced at the Social Security Council's Health Insurance Subcommittee that it is considering strengthening childbirth support, including the introduction of insurance coverage for childbirth costs, aiming for implementation in 2026. The Ministry of Health, Labour and Welfare and the Children and Families Agency plan to soon form a committee centered around obstetricians and other experts to start related discussions.

[Image source=AFP Yonhap News]

Currently in Japan, health insurance only covers certain procedures such as cesarean sections during childbirth. Natural births are excluded from insurance coverage. Instead, when some insured individuals under health insurance give birth, the government provides a lump-sum cash payment called "Shussan Ikuji Isshikin" (Childbirth and Childcare Lump-Sum Grant). The current lump sum is 500,000 yen (approximately 470,000 KRW). This amount was raised from 420,000 yen last April.

The reason the government is considering reflecting childbirth costs in health insurance rather than just providing lump-sum support is that the cost of having children is steadily increasing. With the birthrate declining, the Japanese government believes it is increasingly necessary to prevent childbirth costs from becoming a barrier.

Between April 2022 and April last year, about 44.5% of medical institutions raised childbirth costs. Hospitals claim these increases are unavoidable due to management issues. The increase per hospital ranges from 30,000 to 50,000 yen. According to a previous survey by the Ministry of Health, Labour and Welfare, the average childbirth cost across Japan in 2022 was 480,000 yen. In central Tokyo, where prices are high, the lump sum of 500,000 yen is insufficient, and mothers must pay an additional 100,000 to 200,000 yen out of pocket.

Because hospitals have been rapidly increasing childbirth-related costs, there have been cases where hospitals that signed contracts with pregnant women early in pregnancy suddenly notify them of cost increases without explanation just before delivery. In fact, one pregnant woman in Japan shared her experience of being startled when her hospital, with which she had contracted at three months pregnant, informed her of a 50,000 yen price increase just before childbirth. She reportedly paid a total of 550,000 yen, including the 500,000 yen lump sum and an additional 50,000 yen out-of-pocket expense upon discharge.

Although the Japanese government has decided to consider applying health insurance to childbirth costs to resolve these issues, challenges remain before a final decision can be made. First, from a fundamental perspective, public health insurance traditionally covers only illnesses or injuries, so including natural childbirth as a covered service is being questioned as inappropriate.

Hospitals also express concerns and opposition, fearing that this could pose management risks. There are also criticisms that applying health insurance might actually increase out-of-pocket childbirth costs. Based on the average natural childbirth cost of 480,000 yen, if the government pays the 500,000 yen lump sum, the mother has no out-of-pocket expense; however, if insurance is applied with a 30% copayment, the mother would have to pay 140,000 yen directly.

Nevertheless, the Japanese government's goal is clear. According to Nihon Keizai Shimbun, the aim is to reduce the personal burden required for childbirth to strengthen low birthrate countermeasures and to increase transparency in childbirth costs.