Yokohama and other municipalities have come under pressure to expand their subsidy programs to allow children of all ages and income brackets to receive free medical treatment.

Their residents are calling for wider health care coverage, while municipal officials themselves believe that easing the financial burden associated with child-rearing will attract young people to their areas and stem depopulation trends.

According to an April 2021 survey by the health ministry, only 220 cities, towns and villages across Japan imposed income ceilings for subsidy programs for children’s hospital visits as outpatients.

These municipalities include Yokohama, Sapporo and Osaka.

YOKOHAMA JUMPING ON BOARD

A woman in her 40s with two elementary school age children in Yokohama tweeted in July that “child care support in Yokohama is at the worst level.”

The tweet received more than 10,000 “likes.”

Only infants under 12 months are currently eligible for Yokohama city’s free medical framework.

Medical care subsidies are offered for children up to third-year junior high school age, but the amount provided depends on their guardians’ income levels.

Households with incomes lower than the municipality’s ceiling must still pay a maximum 500 yen ($3.30) per hospital visit of children of fourth-grade elementary school age or older.

The woman and her children suffer from chronic asthma and regularly visit a medical center.

Her family’s income exceeds Yokohama’s limit, so she must cover 30 percent of the treatment costs of her children as well as herself under the national health insurance.

She said she sometimes refrains from seeing a doctor herself to save on medical expenses.

Tokyo’s 23 wards and nearby Saitama city were among the 1,521 municipal governments in Japan that have eliminated income ceilings, according to the ministry survey. Their residents do not need to pay for their children’s care at medical centers.

“I wish Yokohama had a free medical system for young people like other local governments,” the mother lamented.

A group consisting of the 23 ward mayors in Tokyo in June announced plans to expand subsidies next fiscal year to include children up to high school age in their free medical care framework.

Inspired by the decision, Yokohama city assembly members, who had previously expressed concerns about municipal finances, said there is “no choice but to approve the expansion” of the city’s subsidy program for children’s medicine.

Yokohama Mayor Takeharu Yamanaka in August said the city’s income limit will be lifted by the end of next fiscal year, meaning that all children up to junior high school age will be able to visit hospitals for free.

This change is expected to require an extra 3.9 billion yen in Yokohama’s annual budget.

Behind the change was the shrinking of Yokohama’s population by more than 4,000 last year, the first decline since the end of World War II.

The ratio of people in the city under 15 hit a record low 11.8 percent this year.

Yokohama hopes its improved subsidy program will prevent families with children from leaving the city while encouraging new residents to move in, stemming a possible tax revenue decrease.

“Assistance for child-rearing is the most urgent problem to tackle right now,” Yamanaka said. “We will further commit ourselves to reducing financial burdens connected to the child care process.”

Seeing Yokohama’s move, neighboring Kawasaki quickly followed suit.

Kawasaki Mayor Norihiko Fukuda said in September that the city will remove the income ceiling and bolster its hospital visit subsidy program to cover children up to junior high school age.

REGIONAL APPROACHES

In Minami-Kyushu, Kagoshima Prefecture, and Nagoya, municipal subsidy systems were improved earlier this year to allow high school students to join younger children on the free medical care programs.

Kita-Kyushu has extended financial support to those up to high school age, but part of the medical costs must be paid by the patients.

Kaori Suetomi, a professor of educational administration studies at Nihon University, said the central government should have stepped in earlier to create a more favorable environment for families.

“Politicians or bureaucrats did not put priority on households with small children, and investments were not made for younger generations who are struggling the most,” Suetomi said. “This mistake is being rectified.”

The government plans to set up an agency next fiscal year to pour resources into policies concerning children and families.

But Suetomi said other measures are also needed.

“A revenue source for pressing ahead with policies to help raise children must be secured as soon as possible to make Japan a more sustainable nation,” she said.

(This article was written by Yushin Adachi and Naoko Kobayashi.)