Impact of insurance coverage on access to assisted reproductive technology: A nationwide survey in Japan (the IZANAMI project)

IF 1.6 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of Obstetrics and Gynaecology Research Pub Date : 2025-04-14 DOI:10.1111/jog.16292

Aika Wada, Mitsutoshi Yamada, Hiromitsu Shirasawa, Seung Chik Jwa, Keiji Kuroda, Miyuki Harada, Yutaka Osuga

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引用次数: 0

Abstract

Aim

Assisted reproductive technology (ART) is a well-established infertility treatment. However, financial and geographical barriers can hinder patient access. The Japanese government implemented insurance coverage in April 2022 for specific ART treatments. This study assessed the effects of insurance coverage on ART utilization and accessibility.

Methods

An online survey was administered to 427 ART facilities that participated in a pre-policy assessment from December 1, 2023, to January 30, 2024.

Results

A total of 283 facilities responded (response rate: 66.3%). The number of ART patients increased by 4.0% (217 699–226 401) following the implementation of insurance coverage. The number of insured patients aged 25–43 years increased by 6.6%, with a notable increase of 22.9% (range: 44 144–54 253) in the 25- to 34-year age group. However, the number of uninsured patients aged ≥44 decreased by 16.3%; 172 facilities experienced an increased number of patients, whereas 111 facilities experienced no increase or decline. Patient growth rates were significantly higher in rural areas than in metropolitan regions (mean difference: 0.07; 95% confidence interval: 0.0–0.1; p = 0.03). Although there was a significant negative association between the proportion of out-of-pocket treatment and the rate of patient increase (p = 0.02), no such association was observed in rural areas (p = 0.68).

Conclusions

Insurance coverage improved patient access to ART services, especially for those in their 20s and early 30s. However, the number of patients in the uninsured group decreased significantly. Accessibility in rural areas also notably improved. These findings highlight the importance of economic support for enhancing ART accessibility.

Abstract Image

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保险对辅助生殖技术使用的影响：日本全国调查（IZANAMI 项目）

目的辅助生殖技术（ART）是一种成熟的不孕症治疗方法。然而，财政和地理障碍可能阻碍患者获得。日本政府于2022年4月实施了针对特定ART治疗的保险。本研究评估了保险覆盖率对抗逆转录病毒治疗的利用和可及性的影响。方法对2023年12月1日至2024年1月30日参与政策前评估的427家ART设施进行在线调查。结果共有283家机构回复，回复率为66.3%。实施保险后，ART患者人数增加4.0%（217 699-226 401）。25- 43岁参保人数增加6.6%，其中25- 34岁参保人数增加22.9%（范围：44 144-54 253）。≥44岁未参保患者数量下降16.3%；172家医院的病人数量有所增加，而111家医院的病人数量没有增加或减少。农村地区的患者增长率明显高于大城市地区(平均差异：0.07；95%置信区间：0.0-0.1；p = 0.03)。自费治疗比例与患者增加率之间存在显著负相关（p = 0.02），但在农村地区没有观察到这种关联（p = 0.68）。结论：保险覆盖改善了患者获得抗逆转录病毒治疗服务的机会，特别是对20多岁和30岁出头的患者。然而，未参保组的患者数量明显减少。农村地区无障碍条件明显改善。这些发现突出了经济支持对提高抗逆转录病毒治疗可及性的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Obstetrics and Gynaecology Research 医学-妇产科学

CiteScore

3.10

自引率

0.00%

发文量

376

审稿时长

3-6 weeks

期刊介绍： The Journal of Obstetrics and Gynaecology Research is the official Journal of the Asia and Oceania Federation of Obstetrics and Gynecology and of the Japan Society of Obstetrics and Gynecology, and aims to provide a medium for the publication of articles in the fields of obstetrics and gynecology. The Journal publishes original research articles, case reports, review articles and letters to the editor. The Journal will give publication priority to original research articles over case reports. Accepted papers become the exclusive licence of the Journal. Manuscripts are peer reviewed by at least two referees and/or Associate Editors expert in the field of the submitted paper.