Faced with a serious low birth rate, the Japanese government is pursuing a “free maternity fee” policy where all maternity expenses are covered by public health insurance. The idea is to reduce the burden on mothers by standardizing labor costs, which are fluctuating in each region.
According to the Yomiuri Shimbun and Asahi Shimbun on the 3rd, the Japanese government is discussing how to apply health insurance to natural delivery expenses with the goal of implementing it in April 2027.
Currently, natural births are not covered by health insurance in Japan, and instead, the government is paying a “lump-sum payment of 500,000 yen (approximately 4.71 million won)” for childbirth and childcare. However, due to differences between regions and hospitals, Tokyo reached 640,000 yen (about 6.03 million won), and the national average reached about 520,000 yen, so it has been consistently pointed out that grants alone are not enough.
As a result, the government covers the full cost of delivery with insurance, and is considering standardizing the delivery fee itself instead of abolishing the current lump-sum payment system. However, the policy is to maintain a 30% out-of-pocket rate for medical practices that are already covered by insurance, such as caesarean section, and to exclude non-medical items such as food to celebrate childbirth or beauty services.
However, the backlash from the medical community is also overwhelming. This is due to concerns that profitability may deteriorate if the number of insurances for delivery expenses is bundled into a system in a situation where obstetrics and gynecology management difficulties have worsened due to low birthrate. The Asahi Shimbun said, “Obstetricians' and gynecologists groups are strongly opposed.”
In fact, according to a survey by the Japan Obstetrics and Gynecology Association, 7.6% of all birthing facilities said they would not treat natural births if they were covered by insurance. In the medical field, “The cost of childbirth varies depending on the mother's condition and hospital environment. It is pointed out that “standardization of a single standard does not reflect reality.”
The expert meeting also suggested that it is necessary to design a system that takes into account the management burden of medical institutions, and analyzed that time may be delayed until implementation. Asahi reported that even within the Japanese government, there is an opinion that “complete exemption may be difficult within March 2027.”
In fact, the number of children born in Japan in the first half of this year was 319,000, more than 10,000 fewer than the previous year, and the number of children born each year is expected to fall below 700,000 for 2 consecutive years. Japan's total fertility rate also reached an all-time low of 1.15 last year.
South Korea is still unable to break out of the bottom of the fertility rate. According to the Bureau of Statistics, as of May 2025, the total fertility rate of the Republic of Korea was 0.75, which is the lowest level among the 38 OECD member countries. This is 0.76 lower than the OECD average fertility rate of 1.51.
The Japanese government plans to submit relevant legislation to the regular assembly next year after full-scale discussions at the Social Security Council meeting to be held on the 4th. The Yomiuri Shimbun assessed that “free delivery costs are a measure to reduce economic anxiety about childbirth,” but the debate over actual effects and acceptance in the medical field is expected to continue for the foreseeable future.
