How can medical treatment provided to pregnant women be enhanced while reducing their financial burden? It is impossible to erase the sense that a conclusion was hastily reached without any fundamental discussions being held.
The Central Social Insurance Medical Council has agreed that freezing the extra fee added to the medical bills of pregnant women when they see a doctor at a medical institution from the start of next year is "unavoidable." The fee is expected to be abolished when the next medical payment system review is conducted for fiscal 2020.
The extra fee for pregnant women was introduced in fiscal 2018. The fee's main purpose was to recognize the "extra-careful medical examinations," including checkups and administering medicine, that give special consideration to the impact on expecting mothers and their unborn babies. The ruling parties had been demanding the fee be reviewed in the face of mounting criticism that it increased the financial burden of pregnant women and "runs counter to government measures to combat the nation's chronically low birthrate."
The fee came as a result of the reality that medical departments other than obstetrics departments tend to avoid treating pregnant women. Many medical institutions refuse to check pregnant women or prescribe medicine to them even for common ailments such as colds, due to fears that problems could occur, and instruct these women to consult a doctor in an obstetrics department.
Obstetrical care suffers from an especially severe doctor shortage, and some areas are being stretched close to the breaking point. By adding the extra fee, the government wanted to encourage other medical departments to become aware of the special conditions of pregnant women and treat them more willingly. There is nothing wrong with that aim.
The problem was that because the fee could be added to outpatient medical care covered by insurance except for dental care, medical facilities could charge it even in cases that did not require the administration of medicine, such as getting a prescription for contact lenses. There were not even standards stipulating what sort of special consideration should be offered. In some cases, medical facilities reportedly added the fee after providing treatment and later learning the patient was pregnant.
Alternatives needed
Under the system, the amount paid by women who are pregnant and who pay 30 percent of their medical fees under insurance increased by about 230 yen for their first examination and about 110 yen for each subsequent visit. After-hours medical care required payment of an even higher fee.
It also is understandable that expectant mothers bristled at a system that required them to pay more money despite receiving the same treatment as they did before becoming pregnant. The system's design was undeniably flawed. Reviewing the inappropriate imposition of this extra fee is a natural step.
A lack of knowledge about the system also compounded these problems. The fee is compensation for medical services that give special consideration to pregnant women; its objective was not to increase the financial burden shouldered by patients. Criticism that this was a "tax on pregnant women" is wide of the mark. There are various additional fees within medical service payments, and these also are a method to urge medical institutions to act in line with government policies.
The Health, Labor and Welfare Ministry presented a proposal that would tighten the conditions for imposing the extra fee on pregnant women, but the Liberal Democratic Party and its coalition partner Komeito both strongly demanded any increase in the burden shouldered by the women be abolished. There are doubts over the ruling parties' assertion that focused only on the expenses covered by the women.
Medical treatment pertaining to pregnancy and childbirth is, in principle, not covered by insurance. A one-off payment is made after a baby is born, but this usually is not enough to cover all the costs related to childbirth. If the LDP and Komeito are serious about reducing the financial burden on pregnant women and steps to address the low birthrate, they should consider the issue from a comprehensive perspective, including boosting the one-off payment and whether the costs of pregnancy and childbirth could be covered by insurance.
Improving medical treatment that is considerate of expectant mothers' needs is vital. If the extra fee added to their medical bills is to be axed, effective alternative policies will be needed.
(From The Yomiuri Shimbun, Dec. 20, 2018)
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