Wada Aika, Yamada Mitsutoshi, Shirasawa Hiromitsu, Jwa Seung Chik, Kuroda Keiji, Harada Miyuki, Osuga Yutaka
Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan.
Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, Akita, Japan.
J Obstet Gynaecol Res. 2025 Apr;51(4):e16292. doi: 10.1111/jog.16292.
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.
An online survey was administered to 427 ART facilities that participated in a pre-policy assessment from December 1, 2023, to January 30, 2024.
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).
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.
辅助生殖技术（ART）是一种成熟的不孕症治疗方法。然而，经济和地理障碍可能会阻碍患者获得治疗。日本政府于2022年4月对特定的ART治疗实施了保险覆盖。本研究评估了保险覆盖对ART利用率和可及性的影响。
于2023年12月1日至2024年1月30日对427家参与政策前评估的ART机构进行了在线调查。
共有283家机构做出回应（回应率：66.3%）。保险覆盖实施后，ART患者数量增加了4.0%（从217699例增至226401例）。25至43岁的参保患者数量增加了6.6%，其中25至34岁年龄组显著增加了22.9%（范围：从44144例增至54253例）。然而，44岁及以上未参保患者数量减少了16.3%；172家机构的患者数量增加，而111家机构的患者数量未增加或减少。农村地区的患者增长率显著高于大城市地区（平均差异：0.07；95%置信区间：0.0 - 0.1；p = 0.03）。虽然自付治疗比例与患者增加率之间存在显著负相关（p = 0.02），但在农村地区未观察到这种相关性（p = 0.68）。
保险覆盖改善了患者获得ART服务的机会，尤其是对20多岁和30岁出头的人群。然而，未参保组的患者数量显著减少。农村地区的可及性也显著提高。这些发现凸显了经济支持对提高ART可及性的重要性。
