On Wednesday, July 17, 2024, Health and Global Policy Institute held an expert meeting titled “Establishing a Sustainable Perinatal Medical Care System in the Era of Declining Birth Rates.”

In Japan, the number of births in 2023 was approximately 750,000, marking a continuation of record lows since data collection began. Addressing the urgent issue of halting the declining birth rate is critical. In response, the Japanese government has implemented various measures, such as increasing the “Childbirth and Childcare Lump-Sum Grant,” establishing a system to transparently disclose childbirth expenses, and debates on the potential inclusion of childbirth costs in insurance coverage by 2026.

Moreover, while there are calls to reduce the burden of childbirth costs, the management environment surrounding obstetric medical institutions has become increasingly challenging due to the decline in births and rising costs. There is concern that sudden systemic changes could lead to the destabilization of the safe and secure perinatal medical care system.

At this meeting, we engaged in further enriched active discussions with experts on how to maintain a safe perinatal medical care system in the era of declining birth rates.
In the first half of the session, representatives from related organizations presented on current challenges in the perinatal medical care system, including the potential inclusion of childbirth in insurance coverage. The second half featured a round-table discussion, where perspectives were shared on these key areas: 1) Financial and economic aspects, 2) Issues within the medical care system, and 3) The quality and safety of medical care.
*Details will be published later as a summary of discussion points.

1. The perinatal medical care system is already struggling to maintain its current state due to various social conditions, including the impact of declining birth rates, a shortage of obstetricians (particularly in rural areas and acute care facilities), rising costs, and reforms in doctors’ work styles. While much attention is given to whether childbirth costs should be included in insurance coverage, maintaining the current care system in its existing form has been pointed out to be challenging. Rather than limiting the discussion to insurance coverage, it is necessary to consider a broader range of perspectives on how to sustain or reform the future of the system.
2. From a financial perspective, two major issues need to be addressed: 1) reducing the financial burden of childbirth costs on pregnant women and their families, especially in urban areas, and 2) sustaining the functions and standards of regional perinatal medical institutions.
3. Regarding the insurance coverage of childbirth, the discussion involves shifting from the current cash benefits for childbirth to physical benefits. This potential transition raises the contentious issue of the scope of coverage. Specifically, it is necessary to consider tiered financial support measures that differentiate what is covered by insurance and what requires out-of-pocket expenses.
4. The shortage of personnel in perinatal medical care and the impact of reforms in doctors’ work styles present severe challenges. To address issues such as the reduction in delivery facilities and staff shortages, it is necessary to consider the most effective support and systems for both obstetrics and pediatrics, including the consolidation of medical institutions tailored to the local context. It needs to include the support for patient transportation, as the burden of travel on patients increases with consolidation.
5. Childcare extends beyond the moment of development. To establish a seamless support system from pregnancy to child-rearing, it is also necessary to consider the functional differentiation and clarification of roles among various facilities and other medical departments such as pediatrics.

The above discussion points do not represent the views of any specific organization or institution. Health and Global Policy Institute will continue to contribute to productive discussions aimed at establishing a sustainable perinatal medical care system.

[Event Overview]

• Date & Time: Wednesday, July 17, 2024, 16:30-18:10 JST
• Format: In-person (on-site only)
  This meeting was held under the Chatham House Rule and was not open to the public.
• Venue: Otemachi Financial City Grand Cube 3rd Floor, Global Business Hub Tokyo Field
• Language: Japanese
• Host: Health and Global Policy Institute

[Program] (Titles omitted, listed in alphabetical order)

16:30-16:35 Opening Remarks and Explanation of Recommendations

Haruka Sakamoto (Senior Manager, Health and Global Policy Institute)

16:35-17:05 Presentations

Yoshimasa Kamei (Executive Board Members, Japan Society of Obstetrics and Gynecology)
Isamu Ishiwata (President, Japan Association of Obstetricians and Gynecologists)
Shigeharu Hosono (Director, Japan Society of Perinatal and Neonatal Medicine / Executive Director, Japan Pediatric Society)
Gaku Hashimoto (Member of the House of Representatives)

17:05-18:05 Roundtable Discussion

Isamu Ishiwata (President, Japan Association of Obstetricians and Gynecologists)
Yoshimasa Kamei (Executive Director, Japan Society of Obstetrics and Gynecology)
Yasuhiro Sato (Director of the Employees’ Health Insurance Division, Health Insurance Bureau, Ministry of Health, Labour and Welfare)
Gaku Hashimoto (Member of the House of Representatives)
Kinya Hamaguchi (Executive Board Member, Japan Medical Association)
Shigeharu Hosono (Director, Japan Society of Perinatal and Neonatal Medicine / Executive Director, Japan Pediatric Society)
Ryuichi Ito (President, Japan Pediatric Association)
Megumi Mori (Head of the Emergency Healthcare Office, Regional Medical Care Planning Division, Health Policy Breau, Ministry of Health, Labour and Welfare )
Eri Yoshimura (Senior Manager, Health and Global Policy Institute)

Moderator:
Haruka Sakamoto (Senior Manager, Health and Global Policy Institute)

18:10 Closing