Carefully Design Health Insurance System for Fertility Treatment

Reducing the financial burden will be good news for couples hoping for fertility treatment. The government should carefully prepare for such treatments to be covered by the public health insurance system.

The government has set a timetable for supporting fertility treatment. On top of expanding the current financial support system, it plans to start having such treatment covered by health insurance in April 2022.

Along with the trend of people getting married later in life, an increasing number of couples are suffering from infertility. It is commendable that Prime Minister Yoshihide Suga has put forward a policy of active support for infertility as part of his efforts to tackle the declining birthrate.

Financial support has been provided for in vitro fertilization and micro-insemination, which are typical treatments for infertility, with ¥300,000 for the first treatment and ¥150,000 for the second and subsequent treatments. Starting this month, the government raised it to a uniform ¥300,000 for each treatment, and eliminated the requirement that a married couple’s annual earnings must be less than ¥7.3 million in total to be eligible for the support.

According to the Health, Labor and Welfare Ministry, treatments such as in vitro fertilization cost ¥370,000 to ¥580,000 per attempt, but pregnancy is often not achieved with one treatment, which is often repeated. In this regard, the review is appropriate based on the actual situation.

Also, many people opted to use their savings for treatment expenses because they are not eligible to receive financial support due to the income restriction. As the number of double-income households is increasing, expanding the scope of eligibility is a step forward.

The government plans to design by the end of this year the new coverage to start in 2022. The government will decide on standard treatment methods and medical fees based on the guidelines set by relevant academic societies this summer.

If the new insurance coverage is introduced, the financial burden on patients will be reduced. It is also expected that the new guidelines to be presented will help treatments with established efficacy and safety to be more widely used.

Currently, the methods and drugs used in fertility treatment differ among medical institutions. The revised system may make it easier for patients to select medical institutions as the treatment results are expected to become more transparent.

Under the health insurance system, so-called mixed medical care — that is, combining treatments covered by the health insurance system and treatments not covered — is prohibited in principle. However, the government plans to allow fertility treatments, which have long been excluded from the health insurance system, to be used in this way.

The focus of attention will now shift to the extent to which insurance coverage will be permitted. If the treatment methods covered are limited, patients’ options will be limited, too. On the other hand, if the scope of coverage is widened, the health insurance budget will possibly increase.

The government must carefully listen to the opinions of the parties concerned and experts, and build an appropriate system.

In supporting those who receive fertility treatment, in addition to the financial aspects, it is important to provide an environment in which they can balance work and treatment. Frequent outpatient visits reportedly resulted in 23% of women who underwent treatment having to quit their jobs.

It is important to expand such programs as staggered working hours and half-day paid vacations and to encourage employees to take advantage of such programs.

— The original Japanese article appeared in The Yomiuri Shimbun on Jan. 12, 2021.