**5.3 2022 Overhaul**

With the system being run carrying out the revised eligibility criteria, the Steering Committee meeting held on July 20, 2018, found that such issues had arisen as "more than 50% of the patients on case-by-case review were not covered by the system", "a sense of unfairness is spreading because some patients were covered and others were not despite of suffering commonly from CP with similar clinical course," and "the revised criteria has already been inconsistent with the latest knowledge from scientific viewpoint." Therefore, it was concluded that the system needed to be revised as soon as possible. In July of the same year, the Steering Committee submitted a request to the MHLW that the committee commenced the review of the system to overhaul because the MHLW is authorized to fix the price of childbirth lumpsum payment under the government regulation that substantially gives rise to financial source of compensation. Later in the year, the MHLW responded to the JQ claiming that the JQ listens to the voices of relevant parties such as healthcare-related entities, patient groups, and insurers, proposes the blueprint to reform the system, and reports the conclusion to the MHLW so that the MHLW would take necessary action for the reform.

With those dialogs between the JQ and the MHLW, the first round of the Committee on the Review of the Japan Obstetric Compensation System for Cerebral Palsy was held on September 2020. At the meeting, the items to be examined and reviewed were presented to the committee members such as "Efficiency in running the system," "Latest estimates of the number of eligible patients," "Price of insurance premium," "Eligibility criteria for compensation," "Financial resource for compensation," and "Price of compensation." The JQ engaged in Q&A session in the committee in exploring the expansion of the system, which was in line with the views of the most committee members who engaged in perinatal care. In addition to the agreement with members with healthcare background, it was necessary to make efforts to reach a unanimous agreement of the stakeholders including public health insurers involved in the meeting. Therefore, the JQ requested committee members and all those involved in perinatal care across the country for attention and support for the direction, i.e., expansion of the system that JQ proposed in response to the difficult reality in perinatal care delivery system.

The Committee compiled a report on the blueprint of the revision to submit to the MHLW subcommittee on healthcare insurance that works under the MHLW Social Security Panel. The subcommittee includes members such as healthcare insurers, academic experts, and representatives of healthcare professionals, industries, and labor unions. It endorsed the report in December 2020 that led to the launch of the revised system in January 2022 (**Table 2**).

#### **5.4 Future implication of the no-fault compensation system**

The Japan Obstetrics Compensation System for Cerebral Palsy, which was launched in 2009, celebrated its tenth anniversary in 2019. During this period, the *The Japan Obstetric Compensation System for Cerebral Palsy: Novel System to Improve Quality… DOI: http://dx.doi.org/10.5772/intechopen.106760*

system has made enormous achievements such as delivery of no-fault compensation for profound CPs, provision of investigative report to share both with families and childbirth facilities, prevention activities through collective analysis of aggregated investigative reports, and sharing plenty of scientific data on CPs gained through the system on a national scale. The system was reviewed 5 years after it was launched on a planned timetable produced initially. The review concluded that the system was run appropriately in line with the original objectives, such as provision of monetary compensation on no-fault basis, early resolution of disputes, and quality improvement of perinatal care through investigation and prevention. Then, the revised system was partly initiated in January 2014 on such details as procedure of investigation and adjustment of monetary compensation and damage payment, and in January 2015 on the rest of the details such as scope of eligibility to cover more CPs and other issues relevant to insurance. The JQ completed another review of the system to explore further expansion to cover more cerebral palsy cases in January 2022 and later. As seen above, the JQ believes that it is vital to improve the system in continued fashion through periodical review in cooperation with stakeholders.
