Assisted reproduction is included in medical insurance in four provinces. What signals does the national medical insurance director’s on-site investigation release?

　　China News Service, March 30 (Xinhua) According to the website of the National Medical Insurance Administration, for many ordinary families who are unable to have children naturally, assisted reproduction is the best way to realize their "childbirth dream", but its high cost prohibits many families. Since 2023, some provinces in my country have included assisted reproduction in medical insurance reimbursement to solve the problem of "cannot and dare not have children" among families who want to have children, and help promote long-term balanced development of the population.

　　"We will continue to guide relevant provinces to further improve policies and promote long-term balanced development of the population."

　　From "liberalizing three children" to this year's government work report, it is clearly stated that "improving fertility support policies...reduce family burdens on childbearing, parenting, and education." A number of fertility support policies have put forward new requirements for medical insurance.

　　The medical insurance department gives full play to the mutual aid function of medical insurance funds and actively responds to the people's livelihood issues that "the people need". Under the guidance of the National Medical Insurance Administration, the four provinces of Beijing, Guangxi, Inner Mongolia, and Gansu have successively included assisted reproduction in medical insurance reimbursement.

　　The policy continues to be effective. On February 29, Zhang Ke, director of the National Medical Insurance Administration, visited the Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University to learn more about the inclusion of assisted reproduction in medical insurance and pointed out that “we will continue to guide relevant provinces to further improve the establishment of assisted reproductive medical services and medical insurance payment.” management, and strengthen departmental coordination to promote the matching of basic medical insurance, maternity insurance and related economic and social policies, and jointly promote the long-term balanced development of the population." It releases an important policy signal to promote the establishment of a child-friendly society through medical insurance policies.

　"Do I only need to pay more than 3,000 yuan for the treatment fee of more than 1,000 yuan? That's great!"

　　On the first day of spring, at the settlement window of Guangxi Reproductive Hospital, Ms. Lu, a 35-year-old employee insured, jumped up in surprise when she saw the numbers in the overall fund payment column on the settlement form.

　　"Do I only need to pay more than 3,000 yuan for the treatment fee of more than 1,000 yuan? That's great!" She showed an incredulous expression when she saw more than 7,000 yuan in the column for payment from the overall fund. In order to realize her dream of becoming a mother, Ms. Lu spent 12 years on the test tube road and spent hundreds of thousands of yuan. It was the most relaxed she had felt at checkout in twelve years.

　　"In Guangxi, there are about 55,800 people like Ms. Lu who enjoy the reimbursement policy." The relevant person in charge of the Guangxi Medical Insurance Bureau said that since November 1 last year, Guangxi has included 9 categories of some therapeutic assisted reproductive medical services. The payment scope of basic medical insurance and work-related injury insurance funds, five months after the policy was implemented, the medical insurance fund expenditure was approximately 114 million yuan, and the reimbursement rate was 59.13%, which greatly reduced the medical expense burden of insured persons.

　　According to the person in charge, the inclusion of assisted reproduction in medical insurance reimbursement has greatly mobilized the enthusiasm of groups in need of fertility treatment. In the past few months, the number of outpatient visits to assisted reproduction institutions across the autonomous region has reached 607,700, a year-on-year increase of 35.64%.

　　“Now that there is a government price guide, I know how much it will cost, and I feel confident.”

　　In June 2023, the National Medical Insurance Administration issued the "Guidelines for the Establishment of Price Projects for Assisted Reproductive Medical Services (Trial)", which classified the originally diverse assisted reproductive projects in various places into 12 items. So far, 21 provinces have been guided to integrate assisted reproductive projects according to the project establishment guidelines, and 20 of them have changed the pricing method from market-regulated prices to government-guided prices to further standardize the prices of assisted reproductive medical services.

　　"We have integrated the original 37 assisted reproductive medical service items into 12 items, and the pricing model has been adjusted from independent pricing by medical institutions to government-guided prices. After the price adjustment, the average price reduction has reached 20%." Relevant person in charge of the Inner Mongolia Autonomous Region Medical Security Bureau According to the introduction, starting from February 1 this year, Inner Mongolia will include 8 assisted reproductive medical services such as egg retrieval and embryo culture, which are currently technologically mature, safe, reliable, and cost-controllable, into the scope of medical insurance reimbursement, and single outpatient payment will be implemented without setting a threshold. In terms of reimbursement, the basic medical insurance for employees and the basic medical insurance for urban and rural residents follow the system arrangement of "pay more, get more", and the reimbursement ratios are 70% and 50% respectively.

　　"Patients generally say that after assisted reproductive projects are standardized, they have expectations for treatment costs and feel much more at ease when seeking medical treatment." Ni Yali, director of the Reproductive Center of Gansu Maternal and Child Health Hospital, said that the introduction of this policy has effectively solved the problem in the past Due to the opaque and uneven problems caused by the independent pricing of each hospital, patients can expect to enjoy a reduction in out-of-pocket costs ranging from 7,000 yuan to 10,000 yuan in one assisted reproductive transplant cycle.

　　Ms. Liu from Gansu Province, who has experienced many treatments, said, “In the past, when choosing hospital treatment, I would be very hesitant about technology or price, and would not dare to try it easily. Now there are government guidance prices, and I know what treatment items need to be done and how much it will cost. When it comes to money, I have confidence in my heart.”

　　Ensure the safe operation of medical insurance funds

　　In addition to standardizing projects and implementing guide prices, Gansu, Guangxi, and Inner Mongolia have a limit of "twice" medical insurance reimbursement for each therapeutic assisted reproductive medical service project and related additional items for insured persons who meet the treatment conditions. .

　　In July 2022, the "Guidance on Further Improving and Implementing Active Fertility Support Measures" issued by 17 departments including the National Health Commission and the National Medical Insurance Administration proposed that factors such as the affordability of medical insurance (including maternity insurance) funds should be comprehensively considered. Gradually include appropriate labor analgesia and assisted reproductive technology projects into the scope of fund payment according to procedures.

　　Policies need to be long-term stable and implementable. When the medical insurance department makes long-term fund impact calculations, it needs to comprehensively consider factors such as population size, age structure, actual clinical needs, and amplification effects.

　　The "Lancet Special Invited Major Report on Female Reproduction, Maternal, Newborn, Child and Adolescent Health in China" released in 2021 shows that China's infertility rate increased from 12% in 2007 to 18% in 2020. After assisted reproduction is included in medical insurance, can the medical insurance fund afford it? This is an issue that the medical insurance department needs to consider. The operation status of Beijing’s medical insurance fund shows that the fund is operating smoothly within the estimated expenditure range.

　　"In the process of formulating policies, we have made precise calculations of the people in need and the affordability of funds, so as to do our best and within our capabilities." The relevant person in charge of the Beijing Municipal Medical Insurance Bureau said. As the capital and an international city, Beijing has a large population base, which places higher requirements on the evaluation of policy implementation and fund security. In the seven months since the policy was implemented, 27,000 employees in Beijing have received medical treatment, with a total cost of 220 million yuan, and the employee medical insurance fund has spent 150 million yuan, which is within the safe operation range of the annual estimated fund.