Recently, the Beijing Municipal Medical Insurance Bureau announced that 16 assisted reproductive technology projects such as intrauterine insemination, embryo transfer, and sperm optimization treatment will be included in the scope of medical insurance class A reimbursement. The new policy will come into effect on March 26, and Beijing has become the first city in China to include assisted reproductive technology in medical insurance.
As soon as the news was released, it attracted widespread attention.
"It's a good demonstration." Huang Kuangshi, a researcher at the Chinese and Development Research Center, said in an interview with China News Weekly that this will help the popularization and application and promotion of "artificial fertility" technology, reduce the cost of fertility for infertile people, and to a certain extent improve the fertility level and social recognition of "technical fertility".
Wang Guangzhou, a researcher at the Institute of Population and Labor Economics of the Chinese Academy of Social Sciences, predicts that it is only a matter of time before "auxiliary medical care is included in medical insurance" throughout the country, but it depends on the specific scope and intensity. He told China News Weekly that although this policy is a positive signal to encourage fertility, considering medical, socio-economic, legal and other factors, the effect on improving the local fertility rate in Beijing may be limited.
"This policy is equivalent to a kind of institutional construction and improvement. But we must also pay attention to which groups will have an impact on which groups and what kind of impact it will have, after all, it involves some legal boundaries. Wang Guangzhou said.
Whether medicare can be afforded for a long time
In recent years, although the state has introduced a number of policies to improve fertility, including opening up the second child, the third child, extending maternity leave, birth incentives... However, the fertility situation on the mainland is still not optimistic.
According to the National Bureau of Statistics, the proportion of women aged 35 and above who are not of optimal childbearing age is increasing year by year among the age groups of women who are registered for marriage in the mainland. The results of the investigation and analysis of the team of Academician Qiao Jie, president of Peking University Third Hospital, show that between 2007 and 2020, the incidence of infertility in mainland China has risen from 12% to 18%.
"In the case of Beijing, the average age of first marriage for women in Beijing is at least 3 years later than that of women in the country." Wang Guangzhou said that from the census point of view, the proportion of people who have been infertile for life in Beijing has grown rapidly in recent years, from less than 0.3% in the past to more than 3% today, an increase of more than 10 times.
The growth of the infertility population has made assisted reproductive technology the choice of more and more families. Assisted reproductive technology refers to the use of medical assistance to help infertile couples pregnancy technology, of which the most widely used is artificial insemination and IVF technology, the former through non-sexual intercourse to send sperm to the female reproductive tract to make women pregnant, the latter through artificial methods of sperm and eggs in vitro fertilization, and then transfer to the mother's uterus after the embryo matures to develop and give birth.
However, the expensive cost of assisted reproduction has made many infertile patients with the intention of "having a baby" retreat, and it has also brought economic pressure to many people on the road to treatment.
"Infertility treatment itself is a complex process that takes a long time and costs a lot." Li Junguo, deputy chief physician of the Reproductive Center of the Seventh Medical Center of the General Hospital of the Chinese People's Liberation Army, told China News Weekly that the new policy reduces the economic burden of patients on the one hand and improves the experience of medical treatment; on the other hand, doctors can also "let go" in treatment, which is more convenient for treatment.
Li Junguo explained that if it is just a test and a simple fertility, the cost is not expensive. However, if you need to do IVF, it will cost about 20,000-40,000 yuan at a time. Some women may not be successful in retrieving eggs at one time, and they need to do it twice or even three times, so that the overall cost will also rise and double. "Of the patients I received who eventually succeeded in assisting babies, some of them had been in the hospital many times without success. Now that the cost of treatment can be reduced, it is undoubtedly good news for them. ”
China News Weekly noted that the price of the 16 assisted reproductive technologies included in Beijing's Class A medical insurance ranged from 180 yuan to 5050 yuan, including 2 artificial insemination techniques and 3 third-generation IVF techniques. At present, there are 15 designated medical institutions with basic medical insurance qualifications in Beijing, including Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University, the Third Hospital of Peking University, and the First Hospital of Peking University.
Zhou Shaohu, vice chairman of the Reproductive Medicine Branch of the All-China Association of Traditional Chinese Medicine and director of the Reproductive Medicine Center of the First Affiliated Hospital of Guangzhou University of Chinese Medicine, said in an interview with the media that the average cost of the project is 7,000-8,000 yuan (the price of different reproductive centers is slightly different), of which the drug cost accounts for 20%, and the cost of technical operation projects accounts for 80%; Beijing includes the technical project in the scope of medical insurance Class A reimbursement (if the cost is reimbursed by 80%). , which means that the overall burden on patients will be reduced by 64%. Taking the first and second generations of IVF as an example, the average cost is 30,000-40,000 yuan, of which the drug cost accounts for 30% and the cost of the technical project accounts for 70%; if the technical project is included in the scope of medical insurance Class A reimbursement, it can reduce the overall burden of the patient by 56%.
Whether medical insurance can be afforded for a long time is a common concern of the outside world.
Some analysts believe that according to the calculation of 5 embryos produced in an egg retrieval cycle, each embryo needs to be tested or diagnosed above, plus each embryo also needs biopsy (the project is also included in the scope of Beijing medical insurance reimbursement this time, the price is 1560 yuan), so the cost is quite high.
Among the 16 assisted reproduction projects included in the medical insurance this time, the diagnosis of embryonic single gene diseases, preimplantation embryo genetics testing of chromosomal diseases, and the three three-generation IVF techniques of blastocyst/cleft bulb/polar body biopsy cost 5050 yuan (per embryo), 3750 yuan (per embryo), and 1560 yuan (per embryo/egg), totaling 10360 yuan.
A practitioner in the mother and baby industry told China News Weekly that the success rate of IVF is affected by a variety of factors, including egg and sperm quality, embryo quality, uterine conditions, doctor technology, treatment environment, patient mood and so on. Generally speaking, the hospital is billed according to the number of times and the number of eggs/embryos, if it is successful once, it is naturally cost-effective, but some women need to do several IVF to succeed, so the cost is naturally not low.
The practitioner said that the cost of ovulation-promoting drugs is also a big cost, and the total cost of a treatment cycle is normal between 15,000-20,000 yuan, and there is a certain gap between the prices of Chinese medicines and imported drugs. In addition, the cost of the upfront examination is not currently included in the medical insurance, which generally costs several thousand yuan.
Judging from the medical insurance information released by the Beijing Municipal Medical Insurance Bureau, IVF is not something that can be done if you want to do it, and some restrictions need to be met. Among them, the three generations of IVF need to meet the most restrictive conditions, including "one of the spouses is a single-gene disease patient or both husband and wife are carriers of the same single-gene disease, and there is a high risk of having or having a high risk of single-gene diseases with teratogenic, disabling, and death-causing children".
16 assisted reproductive technology projects included in Beijing Medical Insurance (Source: Beijing Municipal Medical Insurance Bureau)
Expert: It is expected to be rolled out nationwide
In fact, in recent years, the call for assisted reproduction to be included in medical insurance has not stopped. In the face of the call, the attitude of the National Medical Insurance Bureau is also gradually changing.
In October 2020, in response to Recommendation No. 2817 of the Third Session of the 13th National People's Congress, the National Medical Insurance Bureau said that it did not yet have the conditions to include assisted reproductive technology in the scope of payment for basic medical insurance. Some provinces, such as Zhejiang and Shaanxi, have set up public welfare funds and other means to provide appropriate subsidies to special groups such as "families who have lost their independence" to receive assisted reproductive technology services.
In September 2021, in response to Recommendation No. 5581 of the Fourth Session of the 13th National People's Congress "Suggestions for Integrating Infertility's Auxiliary Treatment into National Medical Insurance to Increase Population Growth", the National Medical Insurance Bureau said that the medical insurance department included eligible fertility support drugs such as bromocriptine, trippreeline, clomiphene and other ovulation-promoting drugs into the scope of payment, improving the level of medication security for infertility patients; in terms of diagnosis and treatment, on the basis of scientific calculations and full demonstration, the medical insurance can gradually undertake the mature, safe and reliable technology that medical insurance can afford. Therapeutic assisted reproductive technologies with controllable costs are included in Medicare payments on a procedural basis.
Such a shift is not out of thin air.
According to the National Bureau of Statistics, the net increase in population in 2021 hit a new low in nearly 60 years (since 1962), only 480,000 people, this figure is still 2.04 million in 2020, and 9.06 million in 2016. In six years, the net increase in population decreased by 8.58 million people.
According to the survey and analysis results of Academician Qiao Jie's team, in China, there are about 300,000 newborns added to the ivory infant every year, which accounts for more than 60% of the net increase in population (480,000) in 2021.
This time to include assisted reproduction in medical insurance, Beijing is in the first place, whether this can be carried out on a larger scale across the country has become a concern for everyone. Wang Guangzhou believes that it is only a matter of time before the "auxiliary medical treatment is included in medical insurance" to be rolled out throughout the country, but it only depends on the specific scope and strength.
In Wang Guangzhou's view, in recent years, although the state has introduced a series of policies to encourage fertility, the overall degree of improvement in fertility level is very limited. China's low fertility is mainly related to the decline in the number of marriages, the effect of adolescent reproductive health education and other factors, and some irregular or arbitrary abortions have increased the possibility of secondary infertility, which is also the main problem that needs to be solved urgently.
Before Beijing announced that medical insurance would be included in multiple assisted reproduction projects, the official website of the China Family Planning Association announced the key points of work in 2022, when it mentioned that it would "carry out special actions for artificial abortion intervention for unmarried people", which had caused discussion.
In 2018, the National Health Commission issued the "Specification for Contraceptive Services after Abortion (2018 Edition)", showing that the number of abortions in mainland China is about 9 million per year. This is only more than 1 million people born in 2021, which is only more than 1 million people. A number of surveys have shown that among women undergoing abortion, the proportion of young, unmarried and infertile women is increasing, and the proportion of multiple repeated abortions and high-risk abortions under the age of 20 years has increased significantly. The number of abortions among unmarried adolescents under the age of 24 each year accounts for more than 40% of the total number of abortions in mainland China, of which 19% have multiple abortions.
In an email reply to China News Weekly, the China Family Planning Association said that the China Family Planning Association plans to carry out reproductive health promotion actions, and the special action of artificial abortion intervention for unmarried people is one of the important contents. Based on the experience and foundation of youth health work carried out over the years, the emphasis is on prevention, the threshold is moved forward, and by improving the knowledge and skills of adolescent sexual and reproductive health, it helps adolescents avoid unintended pregnancy, thereby reducing the occurrence of induced abortion, especially high-risk abortion.
A medical source, who did not want to be named, said that secondary infertility is greatly affected by painless abortion, "Painless abortion seems to make 'abortion' costless, but also lose respect for life, making the process simple and painless, which stimulates the increase in the number of abortions to some extent." ”
Li Junguo also said, "The number of people flowing is more, which will cause blockage of women's fallopian tubes and uterine infections, so that women naturally cannot conceive naturally." As a result, assisted reproductive technologies are often required for fertility assistance. ”