To boost its continually declining birth rate, China will soon offer couples free fertility treatment under the public medical insurance scheme.

In line with the recommendations of a previous proposal, the National Healthcare Security Administration Sunday said that the insurance fund will cover Assisted Reproductive Technology (ART) gradually to ease the financial burden of infertility treatment on families, which can cost several thousand yuan. It also announced that labor analgesia, an effective method of pain relief during childbirth, would also be covered by insurance.

Furthermore, the department also encouraged Chinese hospitals to open clinics to provide infertility treatment. The health care body, however, did not mention how or when the policy will be implemented.

The National Healthcare Security Administration’s response comes amid fewer births and a shrinking population in China. After scrapping the one-child policy in 2016, the government has since introduced several policies to encourage young people to have more children.

Promoting ART is essential at this point. Recent surveys show that, in China, over 10% of married couples have infertility problems. Among them, 20% require fertility treatment to have a child of their own. In the last decade, the percentage of people born with the help of ART across China has increased nearly fourfold — from 0.46% in 2009 to 2.37% in 2018.

During the 2021 Two Sessions — an annual meeting of the country’s top legislative and political advisory bodies — Gao Li, a representative from the eastern Anhui province, proposed for the first time that ART should be included in the national insurance scheme.

She argued that the technology was expensive, ranging from tens of thousands to hundreds of thousands of yuan, and inflicted great mental pressure on families that require it. Her proposal led to some medicines, including ovulation-promoting drugs such as bromocriptine, trampoline, and clomiphene, being covered by the state.

“The reimbursement is necessary for guaranteeing people’s reproductive rights and increasing their chances of having children,” Gao said in 2021.

In Shanghai, for example, the average cost of a fertility treatment session, which includes egg retrieval and transplant, is between 30,000 and 35,000 yuan ($4,500 to $5,000). Whether anesthetics are used during egg retrieval, the surgical method used, the sperm donor, and whether imported or domestic drugs are used all contribute to this cost.

What makes the treatment a tough pill to swallow is the low and unpromising success rate. The success rate of IVF for women under 35 is about 50%. For those over 40, it may be only 20%. That means the process may need to be repeated multiple times with the price increasing exponentially every time, making it unaffordable to many.

Last year, the National Health Committee, the All-China Women’s Federation, the Finance Ministry, and 14 other departments advised local governments to include ART and childbirth analgesia in local medical insurance schemes, including maternity insurance. It also recommended that the policy should be implemented step by step, while keeping the local financial burden in mind.

Over the past few years, several municipal governments, including Beijing and Hangzhou, have tried to implement the policy step by step. However, the central Henan province announced last February that it was not prepared to cover ART with insurance because “it is not affordable.”

“The difficulty of including ART in medical insurance lies mostly on the affordability of local funds, which is more tricky for the central and western parts of the country. It’s also noticeable that cities that have responded first are those with more generous medical insurance,” Zhao Heng, partner at Latitude Health, a Shanghai-based strategy consulting firm specializing in the healthcare industry, told financial media outlet Beijing Business Today.

“But since the cost of labor analgesia is not as high, it should soon be fully included in medical insurance,” Zhao added.

Editor: Apurva

(Header image: Nurses help a pregnant woman at a hospital in Shanghai, Feb. 4, 2019. Yin Liqin/CNS/VCG)