Japan enacts changes to make childbirth free, raise some patient drug costs

TOKYO — Japan's parliament on Friday enacted health legislation changes to make childbirth free in principle and to raise out-of-pocket costs for some prescription drugs, as the government seeks to ease the financial burden on working-age people.

Under the changes, patients prescribed drugs similar in ingredients and efficacy to over-the-counter medicines will pay a further 25 percent of medication costs. A system reflecting financial income, such as stock dividends, will also be implemented to decide the share of medical costs borne by people aged 75 or older.

The changes are designed to ease insurance premium burdens on the working generation amid demographic challenges from an aging population and declining birthrate. Some patients have expressed concern the increased out-of-pocket costs could discourage people from seeking care.

The revisions to laws including the health insurance act were approved in a House of Councillors vote.

Prior to the amendment, normal childbirth fell outside of the scope of the public health insurance coverage as it is not regarded as a medical condition like illness or injury, although cesarean sections were covered.

Under the enacted changes, the government will set a unified price nationwide for normal delivery and the standard amount will be fully covered under the public medical insurance system. It is expected to begin from around June 2028, with medical institutions making the shift once ready.

Childbirths through C-section will, as before, require out-of-pocket payment of in principle 30 percent of medical costs post-insurance.

Japan currently offers a 500,000-yen lump sum for each childbirth, but delivery costs have been on the rise and often exceed that amount.

Meanwhile, the new system for additional payments for OTC-like drugs projected to begin in March 2027 is expected to cover around 1,100 items with 77 ingredients, including tablets for pollen allergies and pain and fever.

The government intends to establish a system around 2030 for considering financial income in costs for patients aged 75 and over.

© KYODO