Is there any light for fertility treatment? November 26, 14:11
Infertility treatment experienced by 1 in 5.5 couples.
Suga, who took office as Prime Minister, has announced the expansion of insurance coverage.
We explored the issues and circumstances of what is currently required for infertility treatment.
(Political Department Reporter Kei Yamamasu)
"In the limelight" for fertility treatment
Support to reduce the burden on fertility treatment people.
It has been discussed so far, but it has attracted attention because Prime Minister Suga has listed "expansion of infertility treatment insurance coverage" as one of the signboard policies.
According to a survey by the Japan Society of Obstetrics and Gynecology, the number of children born by "in vitro fertilization", in which an egg taken out of the body as one of fertility treatments is fertilized with sperm outside the body, reached a record high of 56,979 in 2018. did.
One in fifteen children born this year.
Due to the late marriage, the number of treatments has reached a record high of 454,893.
Artificial insemination is not covered by insurance now
The content of fertility treatment is unexpectedly unknown.
As a result of examinations at medical institutions, infertility treatment is generally classified into (1) "male infertility" (2) "female infertility" (3) "functional infertility of unknown cause", and the treatment content is different for each.
There are about 600 specialized medical institutions in the country, and in many cases, treatment begins with examining the cause of infertility by blood or ultrasonography for both men and women.
Insurance is available for treatment of sperm that cannot pass through the vas deferens or for endometriosis.
In addition, treatment that predicts the day of ovulation and guides the timing of sexual intercourse is also covered by insurance.
On the other hand, insurance is not applied to treatments that are performed when pregnancy does not occur even after these treatments, such as "artificial insemination" in which semen is directly injected into the uterus or in vitro fertilization of sperms and eggs to return them to the uterus. For example, "in vitro fertilization".
The current situation is that it costs more than 3 million yen
Treatments that are not covered by insurance are called "free medical treatment," and treatment techniques and treatment costs differ from one medical institution to another.
In principle, it is often more expensive than "insurance medical treatment", which is based on 30% self-pay.
According to a survey conducted by a research group of the Ministry of Health, Labor and Welfare in 2017, the average cost per infertility treatment is 380,000 yen for in vitro fertilization and 430,000 yen for microinsemination.
According to a survey conducted in 2018 by NPO "Fine", which works to support patients, 27% of the respondents answered that the total treatment cost was "1 million yen to less than 2 million yen", and "3 million yen or more". There are also 17% of the answers.
In addition to insurance coverage, the government also subsidizes part of the cost of infertility treatment, but the target is limited to in vitro fertilization and microinsemination.
The reason for this is that the Ministry of Health, Labor and Welfare states that "whether or not the treatment is covered by insurance depends on the question of whether infertility is a disease and whether the treatment is safe or effective."
In addition, certain conditions are imposed, such as an income limit of less than 7.3 million yen per year for a married couple and a wife's age of less than 43 at the start of treatment.
The income limit is set as an amount that can cover 90% of household income in Japan, and the age limit is set for medical reasons such as the pregnancy rate, but couples who do not meet these conditions also complain.
Behind the growing political attention to increased insurance coverage for infertility treatment is the presence of many who have suffered from the financial burden of treatment or have been left out of support.
Just make it cheaper ...
Tomoki Ishikawa, CEO of "Reproduction Clinic", which operates specialized medical institutions in Tokyo and Osaka as a doctor, hopes that growing interest will help patients suffering from infertility.
"I take it very favorably. I think the psychological hurdles for patients have become considerably lower. The number of initial consultations has increased since Prime Minister Suga announced (expansion of insurance treatment coverage). I think there are a lot of things that have been pushed. ”
On the other hand, Akiko Matsumoto, the president of NPO Fine, which works to support patients, points out anxiety about the current situation where the specific content of the discussion cannot be seen.
Matsumoto is also an experienced infertility treatment.
"I'm grateful to have you put fertility treatment on the discussion table, but I can't help but feel that the word" expansion of insurance coverage "is walking alone without seeing the details. The quality of medical care is guaranteed. Being treated is of utmost importance to the patient, and no matter how cheap the treatment is, if the quality of the treatment deteriorates, it will be overwhelming. "
Quality of treatment questioned
In general, if insurance is applied, the patient's out-of-pocket cost will be reduced, leading to a reduction in the financial burden.
In insurance, prices (medical fees) are set for medical treatment for each illness, so how to expand the scope of application is a major issue.
On the other hand, it is said that infertility treatment in Japan has developed centering on "free medical care" by introducing cutting-edge overseas treatment technologies and drugs that have not been approved in Japan.
For this reason, Ishikawa points out the issue of setting uniform medical fees for infertility treatment, for which many treatment methods have not been standardized.
"In fertility treatment in Japan, tailor-made treatments have been performed for each couple, centering on free medical treatment. The strength of free medical treatment was the ability to quickly introduce new medical equipment and technology, but insurance coverage was unnecessarily applied. It may not be beneficial to patients if the number of patients is expanded and uniform treatment is provided in a uniform manner with other medical institutions. ”
Matsumoto also
says that
the quality of treatment varies greatly from medical institution to medical institution. He pointed out that he is concerned about whether the quality of medical care will be maintained even if the insurance coverage is expanded.
"If the number of treatments that cannot be done increases due to the expansion of insurance coverage, pregnancy may be far away. For those who only need insurance medical treatment, that is fine, but for those who say that they have no time in terms of age, or for the body. I want people who want to be treated to avoid miscarriage from the burden of medical treatment to have more freedom of treatment. ”
Amid concerns about the deterioration of medical quality due to the expansion of insurance coverage, the medical community There are also calls for the lifting of the ban on "mixed medical care".
"Mixed medical treatment" is a combination of "insurance medical treatment" and "free medical treatment", and if this is approved, the cost will be covered by insurance for the treatment covered by the insurance, and the patient will pay for the treatment not covered by the insurance. Become.
Currently, the state does not allow "mixed care" as the medical care provided by the patient's ability to pay should not make a difference.
However, an executive of the Ministry of Health, Labor and Welfare makes a certain evaluation, saying, "There is exceptional room for consideration in the area of fertility treatment."
Ishikawa, on the other hand, takes a different perspective.
In the Japanese medical community, there is a deep-rooted cautious theory about "mixed medical care."
Under these circumstances, he points out that it is more realistic to expand the subsidy while maintaining free medical care in order to reduce the financial burden of infertility treatment and achieve both the quality of treatment.
“Applicable to treatments with no difference in technology”
What kind of treatment could be covered by expanded insurance coverage?
The Ministry of Health, Labor and Welfare is considering adding in vitro fertilization and microinsemination, which have been confirmed to be effective and safe, to new targets.
In the future, the policy is to formulate guidelines based on the opinions of specialists, and after deliberation by the Chuikyo = Central Social Insurance Medical Council, aim to expand the application from the 4th year of Reiwa.
On the other hand, Ishikawa points out that if the treatment technology is the same for each medical facility from the standpoint of a specialist, it may be covered by insurance.
"For male patients with azoospermia, surgery to remove sperm from the testes called'TESE'can be covered by insurance. Also, regarding female infertility, artificial fertilization is a step because there is little difference in level between facilities. It is conceivable to step in and expand insurance coverage. "
Are you taking a break from work for treatment?
Many couples undergoing fertility treatment have a keen desire to increase their chances of becoming pregnant.
On the other hand, the environment surrounding treatment is extremely harsh, and balancing treatment and work is a major issue.
Matsumoto points out the actual situation as follows.
"Infertility treatment has four issues: physical, mental, financial, and time burden. Expanding insurance coverage is only an economic aspect, and solving it alone is an overall solution. If you can't balance work and treatment, you will not be able to go to treatment even if you expand your insurance coverage. You need a leave system that matches the actual situation of treatment. ”
Ministry of Health, Labor and Welfare in 2017 According to the survey, the turnover rate of those who have undergone treatment is as high as 16%.
There are a number of cases in which employees are forced to take frequent leave or take leave for medical treatment, and there are calls for the establishment of a leave system to stabilize employment.
On the other hand, Ishikawa suggests that the balance between treatment and work can be improved by the efforts of medical institutions.
"There is also a way to give medical institutions a policy incentive to provide medical care on weekday nights and Saturdays and Sundays instead of telling patients to take a rest. If patients take a rest, the productivity of the company will decrease and women's career development It will also affect the situation, so changing the medical institution side may be less socially costly than establishing a vacation system. "
Do you rely on "word-of-mouth" for fertility treatment?
As a further issue, there are opinions that demand transparency and objectivity on the part of medical institutions.
According to a survey by the NPO "Fine", 49% of the respondents answered that "because of their good reputation (word of mouth)" regarding the points that patients emphasized when choosing a hospital.
The fact that many patients have no choice but to rely on word-of-mouth information on the Internet when choosing a medical institution for treatment clearly shows that there is a lack of data that can be used as a reference when receiving treatment.
Similarly, it has been pointed out that the standards for published treatment results differ depending on the medical institution.
Ishikawa points out the need for a "third-party institution" that provides appropriate information to patients.
"It is said that'fertility treatment is a black box', but in fact, we are not trying to hide it, and each facility sells differently. However, various clinics provide information on the homepage, and patients are worried. However, patients have difficulty in choosing a clinic because the criteria such as pregnancy rate are not transparent. It is important to establish a third-party institution and ensure transparency. "
Matsumoto also a same opinion.
"It is possible to disclose objective data for each medical institution right now, and it should be done regardless of the expansion of insurance coverage. The government should create a third-party institution and show the treatment results of each clinic. , A third party should check the results published by the clinic. "
The circumstances of Japan such as late marriage and late birth
The government plans to expand the current subsidy system until the insurance coverage is expanded, and plans to lift the income limit and raise the subsidy amount by the end of this year.
There is some data to be worried about in the examination.
In Japan, the percentage of infertility patients aged 40 and over with low treatment results exceeds 40%, which is the highest in the world, and as a result, the treatment results are below the world average.
How to deal with the social issues of late marriage and late childbirth and how to tackle them are also indispensable viewpoints for advancing the environment for infertility treatment.
(Titles omitted)
Political
editor Kei Yamamasu
Joined the
station in
2009.
After working at the Aomori Bureau, became a political department.
After interviewing the Ministry of Education, Culture, Sports, Science and Technology, the opposition party, and the Ministry of Defense, he has been in charge of the Ministry of Health, Labor and Welfare since September.