On February 21, 2022, the Beijing Municipal Medical Security Bureau, together with the Municipal Health Commission and the Municipal Human Resources and Social Security Bureau, issued the Notice on Regulating and Adjusting the Price Items of Some Medical Services, which for the first time incorporated assisted reproductive technology into medical insurance, and the new policy will be implemented on March 26. The notice includes 16 assisted reproductive technology projects in the scope of medical insurance Class A reimbursement, which basically covers the commonly used technologies used by public medical institutions in Beijing to carry out assisted reproduction.
What is assisted reproductive technology?
Assisted reproductive technology, full name "human assisted reproductive technology", refers to the use of medical technology and methods of gametes (sperm and eggs), zygotes (fertilized eggs), embryos for artificial operation, in order to achieve the purpose of conception of the technology, divided into artificial insemination and in vitro fertilization - embryo transfer technology and its various derivation techniques.
(1) Artificial insemination
Artificial insemination is a method of artificially injecting semen into a woman's body in place of the sexual intercourse route to make them pregnant. According to the source of semen, it is divided into husband semen artificial insemination (AIH) and donor sperm artificial insemination (AID).
(2) In vitro fertilization - embryo transfer technology and its various derivation techniques
In vitro fertilization - embryo transfer technology, commonly known as IVF, refers to the technology of taking eggs from a woman's body, cultivating them in a dish, adding technically treated sperm, and after the eggs are fertilized, continue to cultivate, and then transfer to implantation in the womb when an early embryo is formed, and then develop into a fetus until delivery.
In vitro fertilization - embryo transfer and its derivation techniques currently mainly include in vitro fertilization - embryo transfer (IVF-ET), gamete or zygote intrasalping transfer (GIFT or ZIFT), intracytoplasmic sperm microinjection (ICSI), embryo freeze-thaw (CET/FET), preimplantation embryo genetic diagnosis (PGD) and so on.
Of the 16 projects included in medical insurance in Beijing, two are artificial insemination, one is second-generation IVF, three are third-generation IVF, and the rest are embryo storage and other projects.
Figure 1 16 assisted reproductive technologies in Beijing will be included in medical insurance reimbursement
Source: Beijing Municipal Medical Insurance Bureau, Huachuang Securities
Low penetration and high cost of assisted reproduction
Domestic assisted reproductive technology penetration is low. Relevant data show that at present, the number of patients undergoing assisted reproduction in China is about 1 million per year, while the actual number of infertility in China is more than 40 million, and the penetration rate of assisted reproductive technology in the infertility population is less than 3%. IVF technology is widely used in assisted reproduction, as of 2019, the penetration rate of IVF technology in mainland China is only 7.1%, and the penetration rate of the United States is about 30% in the same period.
There are two main reasons for the low penetration rate, on the one hand, infertile couples lack sufficient knowledge and education on assisted reproductive services, on the other hand, it is also an important reason, infertile people pay for treatment at their own expense, the economic burden is heavy, and the field of assisted reproduction has long been constrained by the ability to pay.
Specific to the price, the cost of domestic artificial insemination is generally 5,000 yuan / cycle, and the cost of IVF technology is generally 25,000-40,000 yuan / cycle. The above is only the cost of single-cycle treatment, and the lower success rate of assisted reproduction multiplies the total cost of treatment.
Clinically, a standard population will be defined, that is, women who are less than 35 years old and have normal ovarian function. Such a couple to do test tubes, the success rate should be about 70%, but in fact, the average is only 30%. And some ovarian function is not good, or the man's problem is serious, the age is large, such a person's success rate is even 20%, 10%, after the age of 45 is less than 5%. Unsuccessful need to be done repeatedly, so the total cost of assisted reproduction is high and difficult for ordinary families to bear.
The significance of the inclusion of assisted reproduction in health insurance
The inclusion of assisted reproduction in medical insurance has three important significance:
(1) Reduce the burden on infertile couples and increase the penetration rate of assisted reproduction
After the implementation of the Beijing medical insurance adjustment policy, IVF technology can cover laboratory technology of 8,000 yuan to 11,000 yuan, that is to say, a maximum of 11,000 yuan can be reimbursed for an IVF, and a minimum of 8,000 yuan can be reimbursed. To a certain extent, it can reduce the burden on the people, increase their willingness and opportunity to try assisted reproduction, and increase the success rate.
Pacific Securities also pointed out that with reference to overseas experience, the subsidy policy will significantly accelerate the penetration rate of assisted reproductive technologies.
In Australia, the Australian government implemented two adjustments to the IVF technology subsidy policy in 2004 and 2010, with 80 per cent of IVF treatment reimbursement for patients who met the reimbursement threshold in 2004 and the government lowering the reimbursement rate in 2009. Taking 2003 and 2009 as the boundary, the compound growth rate of australian IVF cycles in 2000-2003 was 6.77%, the compound growth rate rose to 9.92% in 2004-2009, and the compound growth rate fell back to 4.87% in 2010-2020.
The inclusion of some assisted reproductive technologies in medical insurance in Beijing shows the importance that the government attaches to fertility support, and in the future, assisted reproductive technologies are expected to receive support from the payment side on a larger scale, and the industry penetration rate is expected to increase rapidly.
(2) The industry has accelerated its development, and the competitive landscape has become clearer
Due to the high barriers in the assisted reproduction industry and the strict supervision and supervision of the state, there have always been few qualified assisted reproduction medical institutions.
According to the List of Medical Institutions Approved to Carry Out Human Assisted Reproductive Technology and Set Up Human Sperm Banks released in 2021, by the end of 2020, there were 536 medical institutions in China that had been approved to carry out human assisted reproductive technology, of which 411 medical institutions were approved to carry out first- and second-generation technologies (367 public and 44 private+ private in total), and 78 medical institutions were approved to carry out three-generation technologies (76 public and 2 private+ private).
After the policy of the Beijing Municipal Medical Insurance Bureau was announced, the assisted reproduction sector ushered in an uptick. On the same day, Daga Vikon (301126. SZ), Kangzhi Pharmaceutical (300086. SZ), Yuexin Health (002162. SZ), Hanshang Group (600774. SH), Maddy Technology (603990. SH) and other successively up and down. It is foreseeable that with the increase in national attention, the increase in penetration rate and the increase in market demand, the assisted reproduction industry is expected to usher in rapid development. As a scarce resource, assisted reproduction has greater market certainty and will nurture more opportunities in the future.
(3) Raise the fertility rate and fertility health rate of the mainland population
The key points of work in 2022 released by the China Family Planning Association recently emphasized that this year it is necessary to implement reproductive health promotion actions, carry out special actions for artificial abortion intervention for unmarried people, reduce unintended pregnancies and abortions among adolescents, and comprehensively and effectively protect female fertility under the reality of declining population fertility rate year by year, so as to improve China's population fertility rate and fertility health rate.
Assisted reproductive technology is mainly aimed at infertile families who are willing to have children, and the inclusion of assisted reproduction in medical insurance reduces the fertility burden of such families and increases their chances of trying assisted reproductive technology, which can effectively improve the fertility rate of infertile families.
On the other hand, genetic testing programs in assisted reproductive technologies are available to all families. In September last year, the Beijing Municipal Medical Insurance Bureau for the first time included non-invasive prenatal genetic testing into the category of Class A medical insurance payment, the test is mainly for women over the age of 35, by drawing peripheral blood to detect whether the fetus's 21-trisomy, 18-trisomy and 13-trisomy are abnormal, if abnormal, the fetus will have Down syndrome, Edward's syndrome, Pattaw's syndrome, respectively. By incorporating programs such as genetic testing into medical insurance, the accessibility of genetic testing will be improved and the fertility health rate on the mainland will be improved.
The inclusion of assisted reproductive technology in medical insurance is another policy in the mainland to promote population growth after the "second child" and "third child". The difference is that the policy is mainly aimed at infertile families, which have a strong desire to have children, but are subject to physical and economic reasons. After the inclusion of assisted reproduction in medical insurance, on the one hand, it can realistically solve the reproductive needs of this part of the population, on the other hand, it will gradually improve the degree of knowledge and acceptance of assisted reproduction by the public, thereby promoting the development and penetration of the assisted reproduction industry, and ultimately improving the fertility rate and reproductive health rate of the mainland population. Beijing's inclusion of assisted reproduction in medical insurance is a major breakthrough, and it is expected that more provinces will introduce relevant policies in the future to further clarify the relevant details and meet the basic needs of the people on the basis of not bringing a large burden to the medical insurance fund.