The health ministry has launched a full-scale study on providing insurance coverage for fertility treatment, a move proposed by Prime Minister Yoshihide Suga as one of his key policies.
The aim is to reduce the financial burden on couples suffering from infertility and address the chronically low birthrate, but there are many challenges ahead.
"I hope fewer people will give up on fertility treatment for financial reasons, like I did," said a woman in her 40s living in the Hokuriku region. She has high hopes for the new Cabinet regarding the policy.
The woman went through in vitro fertilization treatments eight times until she gave birth to her son, who is now 7 years old. Although she received government subsidies, she still had to pay nearly 3 million yen for the treatment and used her savings to cover the cost. She therefore had to give up on having a second child.
Aging and diseases of the uterus, ovaries and seminal ducts are among the causes of infertility. Health insurance only covers general infertility tests and treatment of disease, not artificial insemination or IVF.
Treatments not covered by health insurance pose a huge financial burden for couples, and IVF is particularly expensive, costing more than 500,000 yen per session. According to a 2018 survey by Fine, a Tokyo-based nonprofit organization supporting people with infertility, nearly 60% of the couples surveyed said they spent at least 1 million yen on fertility treatments, and 20% said they spent at least 3 million yen.
During the recent election for president of the Liberal Democratic Party, Suga announced for the first time that he would seek to have fertility treatment covered by insurance.
A senior member of the LDP parliamentary coalition that seeks to expand support for fertility treatment asked Suga his intentions via email, and Suga replied that he would "make it a top priority," the coalition member said.
The prime minister met Rikikazu Sugiyama, the chair of Sugiyama Clinic in Tokyo, on Sept. 21. According to Sugiyama, Suga actively took notes and seemed to understand the process of IVF treatments and technical terms.
--Concerns over uniformity
IVF is currently performed at about 600 medical institutions across the nation, with each institution deciding on its own treatment methods and prices. Even when medical institutions disclose their treatment records, it is difficult for patients to judge the quality, as there is no uniform standard.
When covered by health insurance, a standard treatment with proven safety and effectiveness is offered at the same price by different medical institutions. This makes it easier to compare the content of the treatment, giving people more information to use when choosing medical institutions.
Despite high hopes for the plan to support fertility treatments, some have expressed concern. Most infertility treatment is tailored to each patient -- treatments are chosen from a wide range of options, including the latest methods, based on the age and physical condition of each couple.
"Insurance coverage would lead to uniform treatment, which makes me worry that we might not be able to receive optimal medical care," a patient said.
Sugiyama also raised these concerns with the prime minister.
"I hope the government will design a system in which patients can receive the most desirable treatment," Sugiyama said.
--Cost effectiveness
The government subsidizes such procedures as IVF, which is not covered by health insurance. However, there is an upper limit of 150,000 yen per session (300,000 yen for the first session) for IVF, and there are conditions for receiving the subsidy related to such factors as age, income and frequency of treatment.
In response to the prime minister's directive, the Health, Labor and Welfare Ministry will work to reduce the burden on patients by expanding the current system for the time being. The ministry will devise specific measures, including increasing the subsidies, by the end of the year.
Insurance coverage is expected to be implemented in fiscal 2022 at the earliest. The content of treatment and prices will be decided following discussions at the Central Social Insurance Medical Council, an advisory panel to the health minister.
The focus will likely be on the requirements involved, such as age. The birthrate per IVF session is around 20% until a woman is 35 years old, but it is below 10% at age 40, according to statistics by the Japan Society of Obstetrics and Gynecology. As women age, they have a harder time getting pregnant and miscarriages increase.
"Cost effectiveness should be thoroughly reviewed based on data, to decide how much of the health insurance system's limited financial resources should be spent on fertility treatment," said Prof. Haruko Noguchi, who specializes in health economics at Waseda University and served as a committee member of the Central Social Insurance Medical Council.
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