Receiving any kind of medical treatment in a foreign country can be a daunting experience. And when one of the writers from Pouch gave birth to her second child in the United States, where she was living at the time, she was naturally expecting the procedures to be different from her native Japan. But there were a number of things that shocked, amazed and downright confused her about giving birth in the U.S. – not least the incredible cost incurred.
A little background info for you: Japan has a comprehensive national health system which is basically compulsory for all citizens, as well as people living in Japan for more than one year. Once enrolled in this program, you only pay 30 percent of the cost of any medical fees, which are in themselves fairly cheap compared to some countries. And when a woman in Japan gives birth, she receives a special childbirth allowance of 420,000 yen. If she’s lucky and has an uncomplicated birth, it’ll probably be covered by the allowance.
The United States, by contrast, has some of the highest childbirth costs in the world. A 2013 report by health analytics company Truven found that the price paid by insurers for childbirth costs in the US doubled between 2004 and 2010, and by 2012, the average amount paid was $10,000, rising to $15,000 for a caesarean.
In 2010, our Japanese writer Mrs A was pregnant and living with her husband and son in the United States, where she would give birth to their second child. The family had no significant medical history, so their health insurance costs in the U.S. had been relatively low – after employer contributions of 50 percent, the family was paying $400 a month. She was amazed, therefore, that after delivering her baby in hospital, her medical bills came to:
Laboratory services $67.90 Bed and meals $1,833.26 Perinatal services $4,420.35 Pharmacy $697.56 Supplies $771.32
Add in the $1,299.35 she paid for epidural anaesthesia, and that’s a grand total of just over $9,000 for one 24-hour stay in hospital.
It wasn’t just the cost that surprised our writer. In Japan, it’s common for new mothers to stay in the hospital for four to five days, resting and recuperating after the birth as well as receiving help and advice from staff on how to feed and care for their baby. Compared to her first pregnancy in Japan, therefore, the in-and-out approach at the American hospital was a shock to the system:
“Maybe it’s my age, but only staying in the hospital for 24 hours was tough. We were told it was possible to stay another night, but we have another young child, so decided to go home. But it was difficult for me even to walk to the car … When I saw the bill, though, I was glad I didn’t stay two days in the hospital!”
She felt that new mothers in the United States had to do more for themselves, rather than being looked after:
“I had to go and get my own medicine from the pharmacy. And for newborn screening (the baby’s routine check after three days), I had to choose a paediatrician and take the baby there myself. It was all very challenging.”
Thankfully, Mrs A’s medical insurance actually paid her costs, so she said she only ended up having to pay out about 50,000 yen (US$417). “I was lucky,” she acknowledges:
“The amount your insurance pays out depends on the individual. I heard of several Japanese women who were already pregnant when they moved to the US for their husband’s work – they had to pay the entire cost themselves. One woman was in hospital for four days – her medical costs, including a caesarean, came to 4 million yen ($33,500).”
Despite cultural differences and the money-related horror stories, Mrs A says she felt that overall, the experience of childbirth in the United States was actually a more positive one:
“I guess I felt more at ease in Japan, but as for the actual delivery of the child I think the United States was better. The treatment and service was just so good. The only problem was the bills – every time a new one came, I’d get super nervous.”
For some mothers, there is one other advantage to giving birth in the US that adds value to the equation: citizenship. “It’s difficult to get a green card these days. But if you pay 4 million yen, you at least get American citizenship for your child.”
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