How much does a Caesarean section cost? Introducing the knowledge of subsidies, insurance, and out-of-pocket costs that you should know!
Money related to childbirth that is of concern to pregnant moms and those who want to have a baby in the future. This time, I will explain in detail the cost of Caesarean section.
Birth is something you don’t know what will happen until your baby is born. Not only moms who have already decided to give birth by Caesarean section, but also moms who are planning to have a natural childbirth should be aware of the cost of Caesarean section.
This article will introduce you to the cost of Caesarean section, available subsidies, and examples of out-of-pocket costs, so please take a look.
What is a Caesarean section?
Caesarean section is a surgical procedure performed on moms and babies who have difficulty in spontaneous delivery. It is done when there is a risk of having a natural childbirth or when the baby needs to be picked up quickly due to trouble.
According to a survey conducted by the Japanese Nursing Association in 2020, the average cesarean section rate for hospitals that handle one or more deliveries is 27.5%. in short,1 in 5 moms give birth by caesarean sectionabout it.
In some cases, a mother who was supposed to have a natural childbirth suddenly had a Caesarean section due to a trouble.
Types of caesarean section
There are two types of Caesarean section: “planned Caesarean section” and “emergency Caesarean section”. Let’s take a look at the characteristics of each and in what cases it is done.
Scheduled Caesarean section
If vaginal delivery is difficult during pregnancy, plan delivery by Caesarean section. This is the planned Caesarean section.
The following causes can be cited as cases of scheduled Caesarean section.
- For breech births, multiple pregnancies, placenta previa, and other positions where vaginal delivery is difficult
- When it is judged that the burden on the baby is heavy for vaginal delivery due to growth retardation etc.
- When the baby’s head is larger than the mother’s pelvis and it is judged that vaginal delivery is difficult
- When there is a risk of mother-to-child transmission due to mama’s illness due to vaginal delivery
- If the last delivery was a Caesarean section
Emergency caesarean section
An emergency caesarean section is performed when an unexpected problem occurs even though a natural childbirth was planned.
This is done when the life of a mom or baby is at stake if the baby is not picked up quickly.
Cases of emergency Caesarean section include the following causes.
- When the baby needs to be delivered quickly due to fetal distress, umbilical cord ptosis, umbilical cord prolapse, prevascular rupture, placental abruption, etc.
- When it is judged that it is difficult to continue vaginal delivery such as labor suspension, prolonged delivery, uterine rupture, etc.
- When the mother’s life-threatening symptoms such as severe preeclampsia and cardiopulmonary arrest in pregnant women appear and delivery needs to be completed immediately.
What is the cost of a Caesarean section?
TypicallyChildbirth cost by Caesarean section is about 600 to 1 million yenIt is said that. On the other hand, the average cost of natural childbirth is about 500,000 yen. Many people may be worried that a high delivery cost will be required for a Caesarean section.
However, in reality, insurance is applied, so delivery costs can be reduced. In addition, by using the lump-sum birth allowance and the advanced medical treatment fee system,Out-of-pocket amount can be suppressed to about 100,000 to 200,000 yenThere will be many cases.
We will explain in detail later about the subsidy system that can be used for Caesarean section.
Insurance covers Caesarean section costs
Caesarean section is a medical procedure performed when a doctor deems it necessary. Therefore, health insurance is applied.
Moms who give birth by Caesarean section will bear and pay 30% of the medical expenses calculated from the medical fee points. The medical expenses for Caesarean section calculated from the number of medical treatment points in 2020 are as follows.
| Medical bills | Out-of-pocket amount | |
|---|---|---|
| Scheduled Caesarean section | 201,400 yen | 60,420 yen |
| Emergency caesarean section | 222,000 yen | 66,600 yen |
* Self-pay amount: 30% of medical expenses
Reference: ELSEVIER Reiwa 2nd year medical fee points
However, the cost of childbirth is not limited to the medical costs of a Caesarean section. And just because you gave birth by Caesarean section does not mean that all birth costs are covered by insurance.
It’s also a good idea to know more about the insurance coverage for Caesarean section costs.
Insurance applies only to insurance medical expenses
The costs associated with childbirth include:Hospitalization fee, room fee difference, delivery fee, newborn baby management fee, examination / drug fee, treatment / allowance fee, obstetric medical compensation system usage fee, etc.
this house,Insurance medical treatment includes delivery costs (caesarean section costs), examination costs required for delivery, treatment costs, drug costs, and hospitalization costs.Only.
Meals during hospitalization, difference bed fee if you wish to have a private room, newborn baby management and childcare fee, baby examination / drug fee, baby treatment / allowance fee, obstetrics medical compensation system usage fee, etc. are all borne by you. increase.
In the case of spontaneous delivery, the average length of hospital stay is 5 days. Caesarean delivery, on the other hand, requires an average of 7 days of hospitalization.
Due to prolonged hospitalization, even if insurance is applied to the delivery fee, hospitalization costs, meal costs during hospitalization, newborn management and storage costs, etc. are often high.
In some cases, private medical insurance can be applied.
If you have private medical insurance, you may be able to get insurance depending on the contract. It is recommended that moms who have a scheduled Caesarean section check with the insurance company in advance.
In many cases, you can receive insurance money for surgery and hospitalization, and it is not uncommon for people to end up with a positive balance when the insurance money goes down from private medical insurance.
Subsidy system available for Caesarean section
Various subsidies are available for childbirth to reduce the financial burden on moms and dads.
It is also important to have a firm grasp of the subsidy system that you can receive and to reduce the financial burden.
Subsidy system that can be used regardless of the birth method
First of all, I will introduce a subsidy system that pregnant moms can receive regardless of the delivery method such as natural childbirth and caesarean section.
| system | Grant amount | subject | Overview |
|---|---|---|---|
| Pregnant woman health checkup consultation slip | Depends on the municipality | All moms who issued the Mother and Child Handbook | A subsidy ticket for the cost of a pregnant woman examination. It will be issued when you apply when you issue the Mother and Child Handbook after you know that you are pregnant and submit a pregnancy report. |
| Childbirth and childcare lump sum | 420,000 yen (404,000 yen if you give birth at a hospital or midwifery hospital that does not have an obstetric medical compensation system) | Mom with health insurance | If you apply after giving birth, you will receive a grant. If you want to cover the cost of childbirth, you can apply for it before giving birth and the health insurance will pay you directly to the hospital. |
| Maternity allowance | 2/3 of the daily salary based on the standard monthly salary for 98 to 154 days | Moms who are working and have health insurance at work (limited to health insurance with maternity allowance system) | As a general rule, it is premised that you will continue to work after giving birth (depending on the conditions, moms who retire after giving birth may also receive it). |
| Medical expense deduction by final tax return | Income tax refund is available depending on the medical expenses you applied for | All dads and moms | Regardless of natural childbirth or caesarean section, the cost of childbirth will be deducted from medical expenses by filing a tax return. However, some expense items are deductible and others are not. |
In addition to these subsidies that can be used for childbirth, there are also childcare leave benefits and child allowances that reduce the financial burden during childcare.
If you would like to know more about childcare leave benefits, please refer to this article as well.When can I take maternity leave (prenatal and postnatal leave)? Introducing the difference from maternity allowance and childcare leave!While I am looking forward to the birth of a new family after understanding my pregnancy, I work such as “When can I take maternity leave and how long can I take maternity leave?” Mom and dad’s doubts and anxieties are exhausted …
Advanced medical expenses system
Health insurance has a system called “high-cost medical care system” that reduces high-cost medical expenses.
The high-cost medical treatment system is a system in which if a large amount of medical expenses are incurred, the expenses exceeding the self-pay limit can be refunded.is.
The out-of-pocket limit varies depending on age and income situation, and people under the age of 70 are divided into the following categories.
Reference: Ministry of Health, Labor and Welfare Insurance Bureau
Income category: Category a
| Estimated income | Annual income of about 11.6 million yen or moreHealth insurance: Standard monthly salary of 830,000 yen or moreNational Health Insurance: Old proviso income over 9.01 million yen |
| Out-of-pocket limit | 252,600 yen + (total medical expenses-842,000 yen) x 1% |
Income category: Category a
| Estimated income | Annual income of about 770 to about 11.6 million yenHealth Insurance: Standard monthly salary of 530,000 to 790,000 yenNational Health Insurance: Old proviso income 6 million to 9.01 million yen |
| Out-of-pocket limit | 167,400 yen + (total medical expenses-558,000 yen) x 1% |
Income category: Category C
| Estimated income | Annual income of about 3.7 to about 7.7 million yenHealth insurance: Standard monthly salary of 280,000 to 500,000 yenNational Health Insurance: Old proviso income 2.1 million to 6 million yen |
| Out-of-pocket limit | 80,100 yen + (total medical expenses-267,000 yen) x 1% |
Income category: Category D
| Estimated income | Annual income of about 3.7 million yen or lessHealth insurance: Standard monthly salary of 260,000 yen or lessNational Health Insurance: Old proviso income of 2.1 million yen or less |
| Out-of-pocket limit | 57,600 yen |
Income category: Category o
| Estimated income | Municipal tax exemption |
| Out-of-pocket limit | 35,400 yen |
Limit certificate
As a general rule, once you have paid the medical expenses, you will apply for the advanced medical expenses system and a part of the applicable medical expenses will be refunded.
However, it can be difficult to pay high medical costs, even if they are refunded later.
In such a case, apply for a limit certificate.
If you apply in advance and get a limit certificate, the amount paid at the counter will be the amount after using the advanced medical treatment fee system.
Especially for moms who have a scheduled Caesarean section, it is safe to have a limit certificate issued.
In the case of National Health Insurance, the limit certificate may be issued on the same day, but if you have social insurance, it may take up to a week.
If you are a mom who gave birth by an emergency Caesarean section and it is difficult to pay for medical expenses, ask your family to issue a limit certificate.
If you can prepare a limit certificate while you are in the hospital, you can only pay the amount after applying the advanced medical treatment fee system.
Examples of Caesarean section costs using various systems
Here, we will introduce an example of Caesarean section costs when actually using the subsidy system.
Let’s imagine the cost breakdown of a mom who had a Caesarean section (advanced medical expenses system category c) as follows.
- Insurance coverage costs 400,000
- Costs not covered by insurance 400,000
- Total childbirth cost before using the system 800,000 yen
Let’s use the advanced medical treatment fee system for the expenses covered by insurance.● Category C 80,100 yen + (400,000 yen-267,000 yen) x 1% = 81,430 yen
The out-of-pocket cost covered by insurance is 81,430 yen.
The total amount of money after using the insurance coverage / advanced medical expenses system and the expenses not covered by insurance is
81,430 yen + 400,000 yen = 481,430 yenIt will be.
Finally, if you apply the lump-sum birth allowance
481,430 yen-420,000 yen = 61,430 yen is the copaymentYou can see that.
In addition, if you have private insurance such as a flat hospitalization of 100,000 yen and a daily hospitalization fee of 5,000 yen, you will receive 135,000 yen of insurance money if you stay in the hospital for 7 days.
If a mom with private health gives birth by Caesarean section, the out-of-pocket cost may be virtually 0 yen.
If you have private insurance, it is recommended that you also check the conditions for receiving insurance.
If you are considering private insurance, it is recommended to take out before pregnancy
Some moms who are about to have a Caesarean section may still want to take out private insurance.
However, many private insurance companies have higher hurdles for pregnant women to take out insurance.
It is unlikely that you will be able to take out insurance before the scheduled Caesarean section, and even if you can get insurance, it is not uncommon for Caesarean sections to be excluded.
In addition to Caesarean section, various troubles such as severe morning sickness and illnesses associated with pregnancy may occur during pregnancy. Some moms need to be hospitalized.
If you want to have your baby in the future, it is recommended that you take out private insurance before you become pregnant.
summary
We have introduced the types of Caesarean section, costs, insurance coverage and available subsidies.
Many moms who give birth by Caesarean section may feel anxious before surgery. After surgery, the baby is cut off and the baby is taken out, so the burden on the body is heavier than that of natural childbirth.
It is important to know in advance about the money involved in a Caesarean section so that moms who have endured the fear and pain of surgery and have a baby can rest without any worries.
It is also important to let your partner and family know about the cost of a Caesarean section, not just your mom.
Especially in the case of an emergency Caesarean section, it can be difficult to prepare in advance.
Money is important. It’s also very important to learn about the cost of a Caesarean section with your partner and family so you don’t have to pay.