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

Japan’s parliament has enacted significant changes to health legislation aimed at restructuring medical costs. These revisions seek to alleviate the financial pressure on the working-age population while addressing the challenges of a declining birthrate and an aging society.

Expanding Coverage for Childbirth

Under the new laws, normal childbirth will, in principle, become free. Previously, normal delivery was not categorized as a medical condition like an injury or illness and therefore fell outside the scope of public health insurance coverage.

The government plans to establish a unified nationwide price for normal delivery, with the standard amount fully covered by the public medical insurance system . This transition is expected to begin around June 2028 as medical institutions prepare for the shift.

childbirths via C-section will continue to require an out-of-pocket payment, which remains at 30 percent of medical costs post-insurance. While Japan currently provides a 500,000-yen lump sum for each birth, actual delivery costs have risen and often exceed this amount.

Did You Know? Prior to these legislative changes, normal childbirth was not regarded as a medical condition, which is why it was not covered by public health insurance.

Adjustments to Prescription Drug Costs

To balance the insurance premium burden on the working generation, the government is raising out-of-pocket costs for certain medications. Patients prescribed drugs with ingredients and efficacy similar to over-the-counter (OTC) medicines will pay an additional 25 percent of the costs.

This system is projected to begin in March 2027. It is expected to cover approximately 1,100 items across 77 ingredients, including tablets used for pain, fever and pollen allergies.

Expert Insight: Samantha Carter notes that these revisions represent a strategic demographic pivot. By removing financial barriers to childbirth and shifting costs for non-critical medications, the government is attempting to sustain the health insurance system’s viability amid a shrinking workforce. However, the trade-off may be a potential decrease in medication adherence if costs become prohibitive for some.

Income-Based Costs for Seniors

The legislation also introduces changes for citizens aged 75 and older. A new system will be implemented to determine the share of medical costs borne by this group based on their financial income, which includes assets such as stock dividends.

The government intends to have this income-based system established around 2030. These revisions were approved via a vote in the House of Councillors and include changes to the health insurance act .

Future Implications and Potential Challenges

The shift toward free childbirth may encourage more families to have children by removing a significant financial hurdle. However, the implementation depends on the readiness of medical institutions by 2028.

life insurance costs in Japan

We find also concerns regarding the increased costs for OTC-like drugs. Some patients have expressed that higher out-of-pocket expenses could potentially discourage individuals from seeking necessary medical care.

Frequently Asked Questions

When will normal childbirth become free in Japan?

The system is expected to begin around June 2028, as medical institutions make the necessary shifts.

Which medications will see a price increase?

Prescription drugs similar in ingredients and efficacy to over-the-counter medicines, including tablets for pain, fever, and pollen allergies, will see a 25 percent increase in out-of-pocket costs starting in March 2027.

How will medical costs be decided for people aged 75 or older?

The government intends to establish a system by 2030 that considers financial income, such as stock dividends, to determine the share of medical costs these individuals will pay.

Do you believe adjusting medical costs based on income and drug type is an effective way to manage an aging population?