**2.3 Registration of childbirth facility**

The system was launched and being hailed by professional societies such as the Japan Association of Obstetricians and Gynecologists (JAOG) and Japanese Midwife Association (JMA). They, therefore, helped the JQ to involve childbirth facilities across Japan for registration in the system. Although there is no legislation that mandates them participate in the system, the JQ successfully observed extremely high registration rate in the system as high as 99.9% achieved in close cooperation with the societies and relevant stakeholders [7] (**Table 1**).


#### **Table 1.**

*Registration rate by type of facility. As of November 30, 2021.*

#### **2.4 Review and compensation**

The scope of those eligible for compensation must meet the general criteria, which consists of birth weight and weeks of pregnancy, or the individual criteria when the weeks of pregnancy are less than the general criteria : 28 weeks or more of pregnancy, case-by-case criteria: umbilical artery blood pH less than 7.1, meeting one of the prescribed patterns in the fetal heart rate labor diagram (CTG) that indicate hypoxia in the fetus, etc., meets severity criteria: degree equivalent to level 1 or 2 of the physical disability grade defined in the Welfare for the Disabled Act, and does not meet the exclusion criteria such as cerebral palsy obviously caused by congenital factors or factors taking place in neonatal period and later [8]. Even if congenital factors (brain malformation, genetic abnormality, chromosomal abnormality, etc.) exist, patients are not necessarily excluded because the factors may not be the obvious cause of profound CP. Decision for approval is made based on medical examination as to what caused profound CP that applicant suffers. The general criteria and caseby-case criteria were revised in reference to aggregated data and scientific progress on cerebral palsy. The latest criteria that applied to cerebral palsy who were born in 2022 or later does not include case-by-case criteria due to expansion of general criteria so that more cerebral palsy would be covered (**Table 2**). The revision of the criteria is described later.

As of June 2021, 3374 cases have been approved for compensation, and payment for the cases have been swiftly made or in progress. The annual number of persons eligible for compensation to such criteria as 2009 and 2015 criteria that have been confirmed so far is 419 in 2009, 382 in 2010, 355 in 2011, 362 in 2012, 351 in 2013, 326 in 2014, and 376 in 2015. For children born in later years, the application is still allowed until they are 5 years old (**Table 3**). It should be noted that the number of approved patients rose to a certain extent in 2015 because new criteria that could cover more cerebral palsy were applied. In addition, applicants of uncompensated cases may apply to the Appeal Committee if they are not convinced on the results of the review.

A uniform compensation of 30 million yen is paid for each case once approved by the Review Committee. There are two different ways applied to the payment such as lumpsum payment and annual installment that continue 20 times (**Figure 2**). If childbirth facility is liable for the development of cerebral palsy, the compensation and the damage payment are adjusted to eliminate duplicative payments. In other words, the child and the family cannot receive both the compensation and the damage payment in the system [9].
