Starting from July, 16 assisted reproductive projects will be included in Beijing's medical insurance! Listen to what the Peking Union Medical College doctors say

Starting from July 1, 16 therapeutic assisted reproductive technology projects will be officially included in the scope of reimbursement of Beijing's basic medical insurance. This new policy will greatly reduce the medical burden on patients, but what practical problems will the new policy face in its specific implementation?

Written by reporter Wang Xueying New media editor: Lv Bingxin

According to the Beijing Municipal Medical Insurance Bureau, 16 therapeutic assisted reproductive technology projects will be officially included in the city's basic medical insurance reimbursement scope from July 1. In the future, insured persons who need assisted reproductive technology treatment services will have the opportunity to receive more "government support."

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16 assisted reproductive projects are included in basic medical insurance

In fact, as early as March this year, the Beijing Medical Insurance Bureau, the Municipal Health Commission and the Municipal Human Resources and Social Security Bureau issued the "Notice on Standardizing and Adjusting Some Medical Service Price Items" (hereinafter referred to as the "Notice"), planning to include 16 assisted reproductive technology projects including intrauterine insemination, embryo transfer, and sperm optimization processing into the Class A medical insurance reimbursement scope.

Relevant personnel from the Beijing Municipal Medical Insurance Bureau stated that the 16 assisted reproductive technology projects included in the Class A medical insurance reimbursement scope have a wider audience, are necessary for diagnosis and treatment and have more mature technology.

Among them, 2 items are intrauterine artificial insemination, 1 item is a second-generation test-tube baby item, 3 items are third-generation test-tube baby items, and the rest are in vitro fertilization-embryo items. In addition, the "Notice" also unified the pricing of 53 assisted reproductive technology items such as in vitro fertilization and embryo culture, which basically covers the common technologies used in assisted reproduction by public medical institutions in Beijing. At the same time, the "Notice" also combined the professional suggestions of medical institutions and industry associations to make regular adjustments to 10 current medical service price items such as subcutaneous injections.

▲The official website of Beijing Municipal Medical Security Bureau shows some price adjustments (Compiled by Wang Xueying)

In this reimbursement adjustment, the item with the highest unit price is the "embryo single gene disease diagnosis" in the third-generation technology, with a charging standard of 5,050 yuan per embryo. The total cost of all three third-generation technology-related technologies is 10,360 yuan. If calculated based on the Class A reimbursement rate of 70%, medical insurance will hopefully save patients 7,252 yuan.

In this regard, Lu Qun, chief physician of the Reproductive Medicine and Family Planning Department of Peking University People's Hospital, admitted in a previous interview that if this policy can really be officially implemented, "then, medical insurance can save about one-quarter to one-third of the treatment costs for infertile patients."

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Technology saves the future: Assisted reproductive technology

For families who want to have children but cannot, assisted reproductive technology is undoubtedly a life-saving straw. The so-called human assisted reproductive technology (ART) refers to the use of medical technology and methods to artificially operate gametes (sperm and eggs), zygotes (fertilized eggs), and embryos to achieve the purpose of conception, including artificial insemination, gamete transfer, in vitro fertilization-embryo transfer technology and various other derivative technologies.

At present, in vitro fertilization-embryo transfer is the most common assisted reproductive technology. This technology removes sperm and eggs from the patient's body, fertilizes them in vitro, and then transplants them into the female uterus after they develop into embryos to develop into real fetuses.

Since the embryo needs to develop in a test tube in the first two days, it is also called in vitro fertilization technology. In terms of scope of use, this technology is mainly suitable for women with gamete transport disorders, ovulation disorders or male families with oligospermia and weak sperm.

Since the birth of the world's first test-tube baby in the UK in July 1978, humans have been exploring how to use technology to assist reproduction. In the past 40 years, test-tube baby technology has generally undergone three important changes: the first generation of test-tube babies, namely conventional in vitro fertilization (IVF), is to solve the problem of female infertility from the egg; the second generation of test-tube babies, namely intracytoplasmic sperm injection (ICSI), is mainly used to solve male infertility problems by embryologists manually selecting sperm for fertilization; the third generation of test-tube babies refers to preimplantation genetic diagnosis (PGS+PGD), which is based on the first and second generation technologies and can help patients truly achieve optimal breeding by screening embryos without chromosomal diseases or genetic diseases for implantation.

According to Frost & Sullivan statistics, the global assisted reproductive market has grown from US$18.7 billion in 2013 to US$27.8 billion in 2020. Considering the huge market gap, experts predict that the global assisted reproductive service market will continue to grow at an average annual growth rate of 5% in the future, eventually reaching US$35.5 billion in 2025.

▲Infertility treatment plan (from Jinxin Reproductive IPO prospectus, Pacific Securities, etc.)

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Although the new policy is good, it is still mixed

In theory, the new policy will greatly reduce the medical burden on patients, but what practical problems will the new policy face in its implementation? "In fact, the proportion of infertile patients who really need IVF is not high, only a small part," said Yu Qi, director of the Endocrinology and Reproductive Gynecology Center and deputy director of the Department of Obstetrics and Gynecology at Peking Union Medical College Hospital. Although many patients hope to do the third-generation test tube directly when seeking medical treatment, most people do not meet the relevant regulations of the National Health Commission on indications.

▲Insured persons should confirm whether the corresponding medical institution supports reimbursement before seeking medical treatment (Chart/Wang Xueying)

"The proportion of patients who need third-generation test tubes is very small, 20%-30% is already the highest." Yu Qi said, "A large number of patients actually do not need to do test-tube babies. From this perspective, if we start from the perspective of universal benefits, I personally think that if infertility treatment can be included in medical insurance, the effect may be better."

In addition, there are many details that need to be clarified in the implementation of the "Notice". At the beginning of the policy announcement, the relevant person in charge of the Municipal Medical Insurance Bureau reminded that the policy does not mean that patients can be reimbursed for related treatments in any hospital in Beijing, and "insured persons can only be included in medical insurance reimbursement when they receive treatment for 16 assisted reproductive projects in designated institutions." As for how the major medical institutions will operate at the implementation level, and how many infertile families can benefit from medical insurance, these are issues that Beijing, the "first person to try it out", still needs to explore and solve.