Japan to cover childbirth costs under public insurance amid falling birthrate

JAPAN: Japan’s Health Ministry is expected to eliminate out-of-pocket payments for childbirth, potentially starting from April next year, in an effort to tackle the country’s persistently declining birthrate.

A panel of experts approved a policy proposal on Wednesday (14 May) that includes fully covering the cost of normal deliveries under the public medical insurance system.

At present, such deliveries are not insured, as they are not categorised as medical treatments in the same way as illnesses or injuries. Caesarean sections, however, are covered as exceptions.

Epidurals—which help relieve labour pain—are expected to remain outside the scope of insurance under the proposed policy.

Currently, medical institutions are free to set their own prices for childbirth, resulting in significant regional disparities.

Although the government provides a lump-sum payment of 500,000 yen (approximately S$4,400) per birth, delivery costs have continued to rise and often exceed this amount.

According to the Ministry of Health, Labour and Welfare, the average cost for a normal delivery in the first half of fiscal 2024 was around 518,000 yen (S$4,600).

If the reform is implemented, a standardised nationwide fee would be introduced.

However, some obstetricians have raised concerns that the change could place financial pressure on medical institutions due to a potential drop in revenue.

The urgency behind the policy shift is underscored by troubling demographic data.

The Ministry reported a preliminary birth count of around 720,988 in 2024—the lowest since records began—representing a 5 per cent decline compared to 2023.

Japan’s total fertility rate (TFR) fell to a record low of 1.20 in 2023, down 0.06 points from the previous year.

It marks the eighth consecutive annual decline in the TFR, which represents the average number of children a woman is expected to have in her lifetime.

In Singapore, childbirth costs vary significantly depending on the type of hospital and ward class, particularly for inpatient procedures.

According to the Ministry of Health, the bill for “Uterus, Pregnancy, Complicated Vaginal Delivery” can range from S$1,491 in Ward C to S$6,795 in Ward A at public hospitals.

In private hospitals, the average cost is about S$11,129, with some cases going up to S$13,262.

These figures include charges for hospital wards, doctors’ daily attendance, medication, consultations, tests, and emergency care.

Caesarean deliveries are generally more expensive due to their surgical nature and the longer recovery period required.

Patients typically remain in hospital for three to four days following the procedure.

A Caesarean delivery in a public hospital Ward A starts at approximately S$8,700, while private hospitals with two-bedded rooms charge from around S$12,000.

Meanwhile, Singapore’s total fertility rate stood at 0.97 in 2024—the same record low recorded in 2023.

This marks the second consecutive year that the TFR has fallen below 1.

Preliminary data showed a slight increase in resident births, with 30,800 babies born in 2024, up from 30,500 the previous year.

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