China’s population growth trend
In recent years, China has fallen into a “low birthrate trap.” From 1990 to 2021, China’s birth rate decreased from 21.06 percent to 7.52 percent, and the population growth rate decreased from 14.39 percent to 0.34 percent. At the same time, the aging rate for people aged 65 and over rose from 5.6% to 14.2%. Recognizing the seriousness of the problem, the Chinese government has made several policy adjustments over the past decade to encourage births. However, the effectiveness of these policies appears to be limited. In 2021, there were 10.62 million births and a birth rate of 7.52 percent, both the lowest since 1978. The population crisis has become one of the hottest topics. The National People’s Congress (NPC) and the Chinese People’s Political Consultative Conference (CPPCC) in 2022 will include a total of nine proposals aimed at improving the birth rate, the most ever.
Infertility rate and number of infertile people in China
At present, there is no consensus on the definition of infertility.Different studies also disagree on the denominator of infertility ratesFive. It has been difficult to accurately estimate the number of infertile couples in China. Therefore, we attempted to resolve this issue through meta-analysis. Infertility rates for all couples ranged from 0.015 to 0.042, and infertility rates for at-risk couples ranged from 0.089 to 0.153. One study reported that the annual infertility rate for married and willing women aged 20 to 44 is approximately 9% worldwide.20, this seemed consistent with our conclusions. During the 1970s and 1980s, the two-year infertility rate among newly married women in China was 6.89%.twenty one, lower than the current 8.9%. We also found that the visit rate of infertile couples was approximately 40%, of which approximately 20% received her ART, which is consistent with previous literature reports.2,10. Our results indicate that infertility is primarily due to female factors. However, male patients are less likely to be detected. Due to conventional wisdom and expectations of women’s childbearing, in most cases, only the woman’s infertility is evaluated, and the male partner is not evaluated.twenty two.
Based on the prevalence, it was estimated that there were 4.102 million to 11.792 million infertile couples in China, with an annual increase of 1.189 million to 1.867 million couples.This was much lower than the 50 million people previously reported in some studies.10, 23, 24This is a gross overestimation of the number of people experiencing infertility because it incorrectly multiplied the infertility rate among at-risk couples by the number of total couples. People who have given birth and do not want to give birth again should not be counted in the infertile population, even if they have lost their reproductive abilities. According to a study by the Population Development Research Center of Renmin University of China, the lifetime infertility rate for women over 40 years of age was 0.27-1.00%, which was close to our results.twenty four.
chinese art
Since the first baby was born as a result of in vitro fertilization in China in 1988, a growing number of infertile couples have benefited from ART.twenty three. According to information released by the National Health Commission, there are 536 ART facilities in China, of which 411 can perform IVF and ICSI, and 78 can perform PGD/PGS. .Over 1 million ART cycles and over 300,000 babies born each year8. The average LBR per transplant in China is 40.5%, similar to 43% in the United States.twenty five. However, China’s ART multiple birth rate is 25.4%, much higher than the US rate of 13.1%.twenty five 0.65% of natural pregnancies in China26.
ART is a time-consuming and expensive process. In China, the cost of ART must be borne by the patient. Economic research on ART is mainly concentrated in Europe and America, accounting for 88% of studies.27. Until now, there have been no multicenter studies, reviews, or meta-analyses on the cost of ART in China. According to our results, the cost per birth was 67,002 Yuan and the cost per cycle was 23,901 Yuan. Age structure was an important factor influencing costs. Of those we included, 27.6% were women over the age of 35, which matched the actual proportion of her 30%.13, 14, 15, indicating that the costs are unfair. Dr. Zheng studied the economic burden of infertility in China in 2008 based on clinical data from the Reproductive Medicine Center of Peking University People’s Hospital.Ten. He estimated the direct medical cost per patient to be 62,150 yuan, which was close to our results. Compared to the average hospitalization costs for 30 serious diseases published in the 2020 China Health Statistics Yearbook (published by the Chinese Union Medical University Press in 2021), the cost of coronary artery bypass surgery for myocardial infarction (74,942 yuan) ) was higher than direct hospitalization costs. Medical expenses for infertility. Compared to other countries around the world, China’s disease burden is high.And high-income groups are much more likely to receive ART treatment than low-income groups.28. Currently, 44 countries, mainly in the Americas and Western Europe, cover all or part of the cost of ART in MI. Covered costs include medications, ART procedures and hospitalization, management of complications, and pregnancy diagnosis.29.In the United States, IVF use is 277% higher in fully insured states than in uninsured states.30.
Financial costs and cost-effectiveness after incorporating ART in MI
To test the stability of our results, we calculated the cost of ART for all infertile couples using the average cost per complete cycle and per birth. The results were very close. The average of the two was taken as the estimate. Ultimately, it was found that the fund would have to pay 72.313 billion to 207.878 billion yuan, and subsequent annual payments would be 20.961 billion to 32.913 billion yuan. Her LEV per complete cycle was 3.174 million yuan. The financial input-output ratio was 13.022.
Of course, it is not possible for 100% of infertile couples to choose to undergo ART.Currently this percentage is 38%9, may increase with the inclusion of ART in MI. Other treatments include artificial insemination, clomiphene, surgery, and observation, which together account for 62% of all treatments.9but it only accounts for 10-20% of the total treatment costTen. This means that a 10% reduction in ART rates reduces total costs by 8-9%. ART currently covers approximately 40% of infertile couples, and the actual financial burden may be less than half of previous estimates.
If MI does not cover ART, the total population of mainland China is expected to reach 1.413 billion in 2050, which is consistent with Yi Zeng’s prediction of 1.42 billion.31. If ART is included in MI, the total population in 2050 is expected to be between 1.45 billion and 1.478 billion. This means that by 2050, 37 to 65 million people will be born due to the inclusion of ART in MI.
Feasibility of MI including ART
Whether ART should be incorporated into MI is debatable. In March 2021, members of the National People’s Congress proposed including infertility treatment in MI to improve population growth. NHSA supported the inclusion of ART in commercial MI, responding that ovulation-stimulating drugs such as bromocriptine, triptorelin and clomiphene were included in MI. However, in practice, payment for these drugs can only be made by MI in some specialties, and patients receiving ART must pay for these drugs themselves. Furthermore, less than 15% of families residing in China currently purchase commercial MI.32, and the majority of infertile couples cannot benefit from commercial MI. With the implementation of China’s three-child policy, support for the introduction of ART in MI is increasing. At least five NPC MPs proposed incorporating ART into MI in 2022. From July 1, 2023, Beijing City has included her ART in medical insurance.
Incorporating ART in MI is very important33. First, the right to have children is considered a fundamental human right.34, and governments have a responsibility and obligation to provide support to infertile couples. Second, the inclusion of ART in MI can certainly help alleviate the decline in fertility.Third, infertility increases depression and anxiety in patients35 Leads to social problems such as divorce and domestic violence36. Fourth, twins cost 4 times as much as her as a singleton, but triplets cost 10 times as much as her as a singleton.37and including ART in MI can effectively reduce the incidence of multiple births.30,38.
China’s MI Fund’s income exceeds its expenditures every year. In 2021, the fund’s income was 2,871.03 billion yuan, the expenditure was 2,401.11 billion yuan, and the cumulative balance was 3,612.15 billion yuan. The cost of integrating ART into MI accounted for only 2-6% of the current fund balance. Subsequent annual expenditures were only 4 to 7 percent of the annual fund balance. This assumes that all infertile couples receive her ART, and the actual cost may be lower than this. At least from a data perspective, including ART in MI appeared to be feasible and the benefits were clear. Please note that approximately 30% of the MI fund surplus is deposited into the insured’s personal account. However, according to the above calculation, there should also be enough funds after deducting the surplus from the personal account. Mr. Lin Wang also believed that selective reimbursement and subsidies could be made available to those in particular need. 12.
How to incorporate ART into MI is also a topic worth considering.See US Affordable Care Act39, we need to have three goals: to provide ART care to all patients, to control healthcare costs, and to improve the quality of healthcare. Expanded funding sources, physician training, professional regulatory bodies, opposition to wasteful spending, rational payment systems, and reward and penalty measures are considered positive experiences.39.It is also important to adopt low-cost ART treatment strategies40 Implement strict admission policies12. Additionally, government coverage of ART for MI could first begin by reimbursing a portion of ART treatment costs for special groups, such as low- and middle-income patients and elderly patients. . Finally, you can also determine the payment ratio based on the number of children. The payment rate is highest for those who have never given birth, and the payment rate gradually decreases as the number of children increases.
