After getting the documents, Xie Dan, director of the medical insurance office of Beijing Obstetrics and Gynecology Hospital, immediately synchronized the news with the director of the outpatient department and the reproductive department. After 10 days, ovulation induction tests, blastocyst culture, embryo transfer... 16 assisted reproductive technologies will be included in Beijing Medical Insurance.
At that time, the number of hospital visits and workload will usher in an increase.
Since July 1, 16 assisted reproduction projects have been included in medical insurance, and Beijing Obstetrics and Gynecology Hospital is one of the 16 hospitals designated in the document.
Compared with February 2022, the Beijing Medical Insurance Bureau issued a hasty document, and since then the landing has been suspended and shelved for a year. "This year has smoothed out some of the project price and policy implementation procedures." Senior medical investor Lin Treasurer revealed.
The policy is favorable, quickly transmitted to the secondary market, and the assisted reproduction sector stock market is bullish.
But the benefits are very short-lived, in the reality of low fertility, institutions, hospitals, and companies related to assisted reproduction are almost tacit: the 16 assisted reproduction projects implemented in Beijing into medical insurance cannot pull back the fertility rate and cannot pull up the high business volume.
A professional said that only about 20% of infertile people choose assisted reproduction. There are only about 1 million cases of assisted reproduction in China every year, and the success rate is only 30%~35%; Some people also bluntly said that women who do not have the desire to have children are precisely women who do not need assisted reproductive services, and "these two groups of people just diverge."
Not only that, "where medical insurance is tight, the willingness to give birth is high, but assisted reproduction is not in medical insurance; Where medical insurance is relatively abundant, the willingness to give birth is low, but assisted reproduction is included in medical insurance. An industry insider bluntly said that this contradiction is difficult to reconcile.
In order to increase the fertility rate, in 2016, the second child was liberalized, and policies such as childcare, maternity allowance, and maternity leave were introduced. In the context of the low fertility era, assisted reproduction into medical insurance is also interpreted by the industry as one of the measures to increase fertility.
However, the haze of obstetric winter is better than the year.
District and county maternal and child health hospitals that used to be "big birthers" have reduced salaries, transferred posts internally, issued notices for several years not to recruit obstetricians, and even merged into one department by the local county people's hospital as a whole; A private maternity hospital in Beijing, when it opened, the fountain and lighting in front of the door, now in order to save electricity, the layer is dark...
Back to reality, we are still not struggling to emerge from the vortex of low fertility.
Assisted reproduction, stumbling into health insurance
The industry has said that on June 15, they learned the news of assisted reproduction entering Beijing medical insurance. From the announcement to the landing, the new policy left only half a month for the preparation of Beijing's 16 hospitals.
Hospitals are in full swing for the long-awaited New Deal.
Sheedan was excited, happy for the women he often met in the hospital. This time, Beijing included assisted reproduction in medical insurance, "which is actually very good." ”
"It will probably be reimbursed for more than 10,000 yuan." Li Yang, head of the Department of Reproductive Health of the United States, Zhongyi, told Eight Points that in female assisted reproduction, drugs are the bulk of the cost, and the items included in medical insurance are biased towards operational projects, accounting for one-third of the overall cost.
This is not the first time Beijing has reported that assisted reproduction will be included in medical insurance.
As early as February 2022, Beijing announced that 16 assisted reproductive technology projects would be included in the scope of medical insurance category A reimbursement, and officially landed on March 26 of that year.
According to the original plan, Beijing will become the first provincial region in the country to include assisted reproductive technology in medical insurance, but the progress has not been smooth.
On March 26, 2022, patients who were expecting the implementation of the policy went to the designated hospital for consultation, but only got the result of the suspension of implementation.
From the reply of the Xinjiang Medical Insurance Bureau's NPC deputies, it seems that the reason for the suspension can be seen: Beijing included 16 assisted reproductive technologies such as intrauterine insemination and embryo transfer into the scope of medical insurance payment on March 26, 2022, but the state has not yet formulated a new policy, so the National Health Insurance Administration asked Beijing to suspend the implementation of the policy.
Among them, there are also reasons why the National Health Insurance Administration has previously issued a document requiring that the "small list of medical insurance benefits" be gradually cleaned up and standardized in various places.
"A year ago it was too hasty, and the pause was because the price system was not fully straightened out at that time. Considering the pressure on the medical insurance fund, the National Health Insurance Administration must put pressure on it. Senior medical investor Lin said.
Regarding whether assisted reproduction is included in medical insurance, the attitude of the Medical Insurance Bureau has also changed in the past three years.
On October 10, 2020, the National Health Insurance Administration stated that "there are currently no conditions for including assisted reproductive technology in the payment scope of basic medical insurance." However, by August 2022, 17 departments jointly issued the Guiding Opinions on Further Improving and Implementing Active Fertility Support Measures, proposing to gradually include appropriate childbirth analgesia and assisted reproductive technology projects into the scope of fund payment according to procedures; In May 2023, at the press conference of the State Council's new office, the National Health Insurance Administration said that assisted reproductive technology projects would be gradually included in the payment scope of the medical insurance fund.
The industry predicts that after the caliber of the National Medical Insurance Administration is relaxed, assisted reproduction into medical insurance may be successively landed in various places. "The general trend is that developed regions will implement first, and Jiangsu, Zhejiang, Shanghai and even Tianjin and Guangdong are all possible." Lin said.
Obstetric winter that is difficult to disperse
Assisted reproduction into medical insurance did not dispel the haze of obstetric winter.
Han Ying, head of information data analysis at a maternity hospital in Chaoyang District, Beijing, observed that in the past 10 years, after the birth population peaked in 2017, the birth rate fell sharply.
Over the years, Han Ying has observed and counted the changes in the birth population of Beijing Chaoyang Maternity Hospital. "The effect of fertility policy adjustment reached its maximum in 2017 and began to decline at an annual rate of 20%." The first quarter of 2023 is only an increase of 3% compared to the same period in 2022, and Han Ying roughly predicts that the number of newborns born in 2023 is estimated to increase by only 5% compared to 2022, "that is, the difference between 30,000 and 30,000, with no substantial increase."
Under the background of low fertility rate, even the Beijing Maternity Hospital, which was included in the list of designated hospitals for assisted reproduction, dropped from nearly 19,000 births a year before, a contraction of nearly 50%, which is the largest hospital in Beijing for the number of births.
In Hubei Provincial Maternal and Child Health Care Hospital, the annual number of births has also dropped by about 10% in recent years; Due to the decrease in fertility rate in a county-level hospital in Yunnan, the annual birth volume shrank from more than 1,000 to 500~600 people; A maternal and child health care hospital in Hebei was bankrupt and liquidated, with foreign debts of more than 50 million yuan, salary arrears for a year, and is looking for a successor...
In the early years, as a "big birthing household", the county maternal and child health care hospital could survive well by obstetric delivery, and "the treatment ability was relatively weak".
In order to improve the rescue capacity of the county maternal and child health care hospital, the county people's hospital dispatched doctors to the county maternal and child health care hospital. At present, many directors of maternal and child health hospitals are also sent by general hospitals.
"The decline in obstetric deliveries and the reduction in the occupancy of obstetric beds in general hospitals have forced us to reduce the number of beds and the size of medical staff. Some hospital obstetrics departments have not recruited doctors and nurses in recent years, and some have been diverted to gynecology or other departments. ”
A private maternity hospital in Beijing also dropped from nearly 3,000 births a year to 3400, a shrinkage of nearly 1/10. "The fountain in front of the hospital and the goldfish were now turned on in order to save electricity." Han Ying said.
Zhou Sheng (pseudonym), a senior investor in the obstetrics and gynecology track, deeply felt the withering of the obstetrics and gynecology industry in recent years.
"The money invested is lost." Zhou Sheng (pseudonym) participated in the restructuring of two county-level maternal and child health care hospitals, renovated and built buildings, and invested a total of more than 700 million yuan.
At one point, county-level maternal and child health hospitals became a "hot potato" that local finances wanted to throw off, and Zhou Sheng recalled that it was in this context that local finances and private hospitals hit it off and reached a lot of cooperation.
After 2014, the PPP model of public-private-partnership between the government and social medical services has been quite hot. However, the hot cooperation in the early stage could not escape the fate of "the government defaulted halfway and did not fulfill its promises", and the project fell into premature use, and the project in which Zhou Sheng participated was lost.
A number of industry insiders said that under the influence of low fertility rate under the influence of obstetrics winter, the "damage value" from high to low, followed by obstetrics departments of general hospitals, specialized maternal and child health hospitals, and head maternity private hospitals.
Once considered a high-end private hospital squeezed by public hospitals, in the same battlefield, the lowest damage value. For example, when the volume of obstetric services in Chaoyang District fell by 50%, the decline in the head private hospitals that do high-end obstetrics and gynecology may only be about 20%.
Whether private or public, as long as the hospital is stained with the word "maternity and gynecology", they are looking for a way out.
In order to survive, some maternal and child health hospitals have begun to undertake some government projects, such as screening for two cancers and newborn diseases, etc.
However, these measures to deal with the decline in hospital revenue caused by low fertility can only be "small repairs", and more hospitals have begun to open nine-valent vaccine clinics, develop adult departments, and move from specialties to comprehensive and self-help.
Declining fertility rates
Obstetric winter is the epitome of China's low fertility rate, standing in this context, how should we understand the signal of assisted reproduction into medical insurance?
Most practitioners believe that this move can bring more patients to medical institutions. Lin Treasurer regards it as a "collective procurement" operation, the price drops, and the exchange of quantity for price is the underlying logic.
Some people also believe that the impact of assisted reproduction into medical insurance will not be large, "entering medical insurance may not bring many customers, which can only show that the country has a high degree of recognition of this technology." Li Yang said that 10,000 or 20,000 in front of childbirth is not much money.
Entering medical insurance can help women who need assisted reproduction to complete childbirth and reduce the burden. But now, assisted reproduction is more like a "regret drug", which cannot save China's declining fertility rate.
"When I was in my 20s, I didn't want to have children, and when I was 35 years old, I wanted to give birth and found that the conditions were indeed not allowed, and the 'regret medicine' could also be taken, at least there was technology to solve this problem." Li Yang said that it solves medical problems.
However, the decline in the birth population is a complex social problem, and behind it is an almost unshakable and low willingness to have children.
At present, the main force of fertility is the post-90s generation, but in comparison, the post-80s generation has a higher willingness to give birth. But the group with relatively high fertility intentions of this generation also generally hovers over 35 years old.
When the childbearing age is under 30 years old, the success rate of assisted reproduction can reach up to five or six percent, and by the age of 35, there is only three or four percent of the success rate. If you are old, you can be considered lucky if you can succeed in three or four cycles. It is worth noting that the "success rate" here refers to the fertilization success rate, and the final delivery success rate will be discounted by another 8%.
At present, the total number of assisted reproduction cycles exceeds one million, and it is growing at a rate of more than 100,000 per year. On average, China has more than 300,000 babies born through assisted reproduction each year, but this is not a large proportion compared to the tens of millions of births in recent years, let alone reverse the decline in the birth population.
When there was a high success rate after the 80s, assisted reproduction was not included in medical insurance. Nowadays, even if the post-80s group has the intention to regenerate, the extremely low success rate will only lead to half the effort. On the issue of fertility, one step is slow, one step is slow.
Moreover, raising the birth rate requires a "package" of support programs, of which medical care is only one part, followed by the upbringing of children after birth and education after they grow up, and even related to the pressures of work and life of the family who have children.
Fertility policy needs to be three-dimensional. In promoting fertility, assisted reproduction into medical insurance is only an auxiliary item, one of the many obstacles to cleaning.
But to save China's declining fertility rate, the "regret medicine" of assisted reproduction into medical insurance is not enough.
(Tian Wei also contributed to this article.) ）
Written by Song Xinze and Luo Chunhao
Li Lin丨Responsible editor
This article was first published on the WeChat public account "Eight Points Jianwen" and may not be reproduced without authorization