, Beijing, November 11 (Shao Meng) A few days ago, the Guangxi Zhuang Autonomous Region Medical Security Bureau (hereinafter referred to as the "Guangxi Medical Insurance Bureau") issued a notice saying that from November 7, Guangxi will include some therapeutic assisted reproductive medical services into the scope of basic medical insurance and work-related injury insurance fund payment. Previously, many places have released news that they plan to explore the inclusion of assisted reproduction in medical insurance, and the topic of "test tube baby" cost inclusion in medical insurance has also attracted wide public attention.

The infertile group that is gradually being "seen".

When I saw the news that Guangxi would include some assisted reproductive projects in the medical insurance in the "Guan You" group, Yu Xuan (pseudonym), who lives in Guilin, was very happy. "When I saw the implementation in Beijing, I wondered when Guangxi could too? I didn't expect the policy to come. ”

In the posts published on her social platform, many users commented that they hope that more provinces and cities can also include such technology projects in medical insurance.

The Guangxi Medical Insurance Bureau issued a notice that from November 11, some therapeutic assisted reproductive medical services will be included in the medical insurance. Source: Guangxi Medical Insurance Bureau official website

In fact, the cost of assisted reproduction into medical insurance has been debated for a long time. Behind the call is the reality of the rising infertility rate and the low birth rate in China in recent years.

According to the results of a national reproductive health epidemiological survey conducted by the team of academician Qiao Jie of Peking University, between 2007 and 2020, the incidence of infertility in China has increased from 12% to 18%. This means that one in six couples of childbearing age faces fertility problems.

These people usually resort to assisted reproductive technologies, the most widely used of which are artificial insemination and IVF. The above survey results show that about 30,<> IVF babies are born in China every year.

The financial burden is an invisible threshold

Previously, Yu Xuan had done one ovulation induction and two embryo transfers in the local public hospital, although it was unsuccessful, but the cost was nearly 5,<> yuan, which is not a small amount for her family. However, Yu Xuan said that this is "lucky" compared to the "management friends" in other provinces and cities she knows. Due to the difficulty of treatment, different programs, and different regions, the cost of doing "IVF" can range from tens of thousands of yuan to hundreds of thousands of yuan, which also brings a certain economic burden to many families.

The price of a single cycle is already expensive for many families, and some patients need more cycles to conceive. The "Clinical Practice Guidelines for Assisted Reproduction in Elderly Infertile Women in China" formulated by the Reproductive Medicine Branch of the Chinese Medical Association mentions that women need an average of 35 IVF treatment cycles to successfully have a live birth when they are 3 years old and below, and when women are over 35 years old, the treatment cycles required will increase significantly.

In Yu Xuan's view, "doing IVF" is a long and difficult process, from ovulation induction to egg retrieval, sperm retrieval, in vitro fertilization, to embryo transfer, implantation and other links, it is like breaking through again and again, and the process is full of desire, tension and guilt. "I was planning to start the second time after the year, but this time I can catch up with the medical insurance, and I feel that the psychological burden is a little less."

Data map. Photo by Wei Liang noted that Guangxi's projects included in the medical insurance include egg retrieval, embryo culture, embryo transfer, etc., limited to outpatient clinics, with a maximum of 2 reimbursements per person, and when the insured enjoy the basic medical insurance treatment, there is no fund minimum payment standard, and the reimbursement ratio of basic medical insurance for employees and basic medical insurance for urban and rural residents is 70% and 50% respectively.

Jiang Quanbao, a professor at the Institute of Population and Development Research of Xi'an Jiaotong University, said in an interview with Chinanews that the inclusion of assisted reproductive technology projects in medical insurance is a specific measure to implement the active fertility policy and build a childbirth-friendly society. It has played a positive role in protecting women's reproductive rights and interests and reducing the economic burden of relevant families, reflecting social progress and humanistic care. It can also promote related industries and enterprises to further explore assisted reproductive technology and promote the development of related fields.

Gradually explore multiple places

In the past few years, there have been continuous calls for the inclusion of assisted reproductive technology in medical insurance, and many deputies to the National People's Congress have put forward relevant proposals. At the same time, there is also some controversy about whether consumer-level medical services such as assisted reproduction are in line with the principle of "guaranteeing the basics" of national medical insurance.

In August 2022, 8 departments, including the National Health Commission, issued the "Guiding Opinions on Further Improving and Implementing Positive Childbirth Support Measures", proposing to guide local governments to comprehensively consider factors such as the affordability of medical insurance (including maternity insurance) funds and relevant technical norms, and gradually include appropriate labor analgesia and assisted reproductive technology projects into the scope of fund payment.

Prior to this, some places have stated that they will explore assisted reproductive technology into medical insurance. The medical insurance departments in Hunan, Zhejiang and other places have mentioned that the next step will be to gradually explore the inclusion of common assisted reproductive technology projects in the scope of medical insurance reimbursement.

But there are still challenges to the real implementation. In February 2022, the Beijing Municipal Health Insurance Bureau issued a notice to include 2 assisted reproductive technology projects in the scope of reimbursement of medical insurance Class A, which was originally planned to be implemented on March 16 of that year, but announced the suspension of implementation in April.

However, since July 7 this year, 1 therapeutic assisted reproductive technology projects have been included in Beijing's basic medical insurance, and they have been included in outpatient reimbursement according to medical insurance category A. Beijing has also become the first city in China to include assisted reproductive technology in the scope of medical insurance.

Data map. Photo by Jian Wenyang

The Liaoning Provincial Medical Insurance Bureau issued a notice on May 5 stating that 5 assisted reproduction projects such as embryo culture will be included in the Liaoning Provincial Maternity Insurance Catalogue, which is planned to be implemented on July 18. However, on August 7, the Liaoning Provincial Medical Insurance Bureau said in its reply to the public message that the consideration of reproductive projects is relatively special, the situation is complex, and there is no mature experience in the formulation of treatment policies in China to learn from, so it is necessary to further study and demonstrate the supporting treatment policies. Chinanews noted that at present, Liaoning Province has not received further notice on this.

In Jiang Quanbao's view, it is worth considering how assisted reproductive technology is included in medical insurance. First of all, it is necessary to adjust the medical insurance policy. Secondly, we need to consider the ability to pay for the medical insurance fund, the basic medical insurance system is mainly based on providing basic medical security for the masses, under the premise of the limited medical insurance fund payment capacity, which projects can enter the medical insurance, all localities may have to do their best and do what they can. The third is the standard of payment, the proportion of reimbursement and the mechanism of sharing. Finally, there is the issue of cross-regional medical treatment.

Can we get through the "blockage" of childbirth?

Chinanews has noticed that the relevant departments have repeatedly stated their stance on the inclusion of assisted reproductive technology in medical insurance.

In August last year, 8 departments, including the National Health Commission and the National Health Insurance Administration, issued the "Guiding Opinions on Further Improving and Implementing Positive Fertility Support Measures", mentioning that it is necessary to guide local governments to gradually include appropriate labor analgesia and assisted reproductive technology projects into the scope of fund payment.

In May this year, Li Tao, deputy director of the National Health Insurance Administration, introduced at a press conference of the State Council Information Office that the National Health Insurance Administration has issued a document to guide local governments to gradually include appropriate labor analgesia and assisted reproductive technology projects into the scope of payment of the medical insurance fund according to regulations. We will continue to guide local governments to do a solid job in the work related to maternity insurance and basic medical insurance, consolidate and expand the coverage of maternity insurance, and strengthen the protection of maternity medical expenses.

Jiang Quanbao believes that judging from the relevant documents, assisted reproductive technology projects are expected to be gradually included in the scope of fund payment. However, it may be necessary to adopt measures tailored to local conditions and time conditions, depending on the capacity to pay.

In his view, the current low fertility rate is the result of social, economic, and cultural factors. On the one hand, women pursue their own education and career development, and do not want to have more children; On the other hand, the economic and employment environment, housing costs, children's education costs and educational anxiety, and the lack of inclusive and high-quality childcare institutions and high-quality educational resources are all factors affecting fertility.

"The more important and urgent issue of increasing fertility may be the reform of housing, education, etc. In addition, we will have to adapt to low fertility for a long time to come, and prepare for a long-term low fertility rate. Jiang Quanbao said. (ENDS)