**4.3 Examples of studies related to factors that form the parturition price**

The concept of factors that form the parturition price operated by the private medical care system (out-of-pocket) and the actual situation of the difference in price level due to regional characteristics [51] is introduced. This approach spans both "market-based" and "input-based" approaches, as discussed in Section 4.1. For the sustainable operation of the medical system, it is important to consider the stability of hospital management and the financial burden on citizens. In other words, it is presumed that discussions that consider the relationship between economic factors and medical treatment behavior are indispensable for the progress of UHC. This study has the advantage of developing purely causal inferences on that subject, considering the bias of other social support (subsidies). It is useful to indirectly re-recognize how the ratio of out-of-pocket expenses to the official price of public medical insurance affects the choice of consultation.

In Japan, parturition (normal childbirth), which differs from injury and illness, is not covered by the medical insurance system. This service is self-financed medical care. However, as financial support for childbirth expenditures, the Health Insurance Act provides a lump-sum childbirth and childcare allowance of JPY 420,000 per child (2021). As this system aims to reduce the financial burden of childbirth, it is also important from the perspective of measures against declining birth rates. However, the average price of childbirth is rising, and the actual cost of childbirth often exceeds JPY 420,000. Therefore, while an increase in the amount of lump-sum childbirth and childcare payments has been requested, the out-of-pocket price structure of childbirth is unclear; that is, actual costs have not been understood. Therefore, the government considers the appropriate amount of lump-sum childbirth and childcare payments to realistically grasp the situation of childbirth expenditures with services and prices.

Against the background of these trends, Japan's regional levels of parturition prices and the factors that helped inform them were analyzed. First, a hypothesis that market principles would have a greater effect on the level formation was proposed; then, the factors that affect childbirth expenditures were structured. Consequently, price formation was considered to involve delivery costs, outcomes, supply/demand, solvency, and official (public) prices. From the provider's perspective, "guarantee of provision cost (from a stable management viewpoint)," "overall market level and internal harmony (operation of facility)," "guarantee of quality (characteristics of the medical field)," and "competitiveness of regions (balance between supply and demand)" were selected. From the perspective of pregnant women, the elements of "interest in security (from the outcome perspective)," "interest in added value (from the amenity perspective)," "interest in the brand (from the perspective of other added values)," "restrictions on solvency (from an economic perspective)," and "access conditions (from the various types of burden)" were selected. Generally, childbirth expenditure is affected by various factors, including different factors related to facility type (e.g., general hospital, clinic, and maternity home), delivery method (e.g., natural childbirth, cesarean section, and painless delivery), timing (weekdays/daytime, night/holidays, year-end/new year), region (prefectures, cities/regions), and others (e.g., optional services such as attending a birth with family).

Consequently, the average parturition price by region in Japan was investigated. First, when the actual situation of childbirth expenditure by prefecture was analyzed using national birth-related statistical data (around 2016) [52, 53], the national average was 505,759 41,906 JPY/case. A difference of approximately 1.5 times was confirmed between the highest (Tokyo City: No.1 in **Figure 18**) and lowest (Tottori Prefecture: No.48 in **Figure 18**) areas. Subsequently, multivariate analysis (multiple regression analysis) was performed to analyze the factors that differed depending on regional characteristics. Based on the factor structure described above, the objective variable was the parturition price. The explanatory variables were citizen income (solvency), "public medical expense (hospitalization unit price)," "pregnant woman's

**Figure 18.**

*Distribution of parturition prices by region (prefecture). Note: The data source was "mean and median of childbirth costs by prefecture" (All-Japan Federation of National Health Insurance Organizations, announced in 2017).*

*Socio-Economic Considerations of Universal Health Coverage: Focus on the Concept… DOI: http://dx.doi.org/10.5772/intechopen.104798*


#### **Table 4.**

*Socio-economic factors are affecting parturition price levels (multiple regression analysis).*

age (risk factor)," "birth population (childbirth demand)," and "obstetric facility (supply capacity)," and "specialized equipment (maternal-fetal intensive care unit). The statistical software SPSS (IBM) was used for analysis, and the significance level was set at 5%. The results indicate that prefectural income, age at parturition, number of births, and density of equipment (facilities) affect parturition prices (**Table 4**). In particular, the citizen income (standard partial regression coefficient: 0.561, p < 0.001) tended to be highly related to parturition prices. The standard partial regression coefficient of birth population was negative (0.628, p = 0.014), but the simple regression coefficient was positive (0.721, p < 0.01).
