近年来,我国的生育率持续走低,为顺应积极的生育政策、减轻不孕不育人群接受医疗服务的经济负担,全国范围内正在加速推进辅助生殖技术纳入医保。本研究参考典型国家将辅助生殖技术纳入医保的政策实践,分析了我国辅助生殖技术纳入医保政策的实施现状,发现我国政策运行已取得显著进展,但医保政策支持辅助生殖的有效性和可持续性尚存在一定挑战。在政策设计和执行过程中,还需动态优化辅助生殖的医保制度设计、逐步扩展辅助生殖领域的医保支付范围、加强宏观规划和管理,以促进辅助生殖技术公平可及,从而进一步提高辅助生殖技术纳入医保政策的有效性和可持续性。
Abstract
In recent years, China's fertility rate has remained at a low level. In order to comply with the positive fertility policy and reduce the economic burden of infertile individuals receiving medical services, the inclusion of assisted reproductive technology (ART) in medical insurance is accelerating countrywide. This study learns from the policy and practice of typical countries including ART in medical insurance abroad, analyzes the implementation status of including ART in medical insurance, and finds that China has made significant progress in incorporating ART into medical insurance. However, there are challenges to the effectiveness and sustainability of medical insurance policies supporting assisted reproduction. In the process of policy design and implementation, it is necessary to dynamically optimize the medical insurance system design of ART, gradually expand the scope of medical insurance coverage for ART, and strengthen macro-level planning and management to promote equitable access to ART, in order to further improve the effectiveness and sustainability of including ART in medical insurance policies.
关键词
辅助生殖技术 /
生育支持政策 /
医疗保险 /
卫生政策
Key words
assisted reproductive technology /
fertility support policies /
medical insurance /
health policy
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参考文献
[1] 国家统计局.年度人口数据[EB/OL].[2025-03-13].https://data.stats.gov.cn/easyquery.htm?cn=C01.
[2] World Bank Group.World Bank open data: population growth[EB/OL].[2025-03-13].https://data.worldbank.org.
[3] QIAO J, WANG Y, LI X, et al.A Lancet Commission on 70 years of women’s reproductive, maternal, newborn, child, and adolescent health in China[J].Lancet, 2021, 397(10293): 2497-2536.
[4] FENG R, CHEN B.Environmental risks and infertility in China[J].Science, 2024, 383(6680): 267-268.
[5] HUANG R, YU J Y, HE W C, et al.Feasibility analysis of China’s medical insurance coverage of assisted reproductive technology[J].Scientific reports, 2024, 14(1): 7998.
[6] MACKAY A, TAYLOR S, GLASS B.Inequity of access: scoping the barriers to assisted reproductive technologies[J].Pharmacy, 2023, 11(1): 17.
[7] FERRARETTI A P, NYGREN K, ANDERSEN A N, et al.Trends over 15 years in ART in Europe: an analysis of 6 million cycles[J].Human reproduction open, 2017, 2017(2): hox012.
[8] BERG BRIGHAM K, CADIER B, CHEVREUL K.The diversity of regulation and public financing of IVF in Europe and its impact on utilization[J].Human reproduction, 2013, 28(3): 666-675.
[9] IFFS Surveillance.International Federation of Fertility Societies[EB/OL].[2025-03-13].https://www.iffsreproduction.org/our-journal/iffs-surveillance/.
[10] Federal Ministry of Health[EB/OL].[2025-03-13].https://www.bundesgesund heitsministerium.de/en/index.html.
[11] RAUPRICH O, BERNS E, VOLLMANN J.Who should pay for assisted reproductive techniques? answers from patients, professionals and the general public in Germany[J].Human reproduction, 2010, 25(5): 1225-1233.
[12] DUNN A L, STAFINSKI T, MENON D.An international survey of assisted reproductive technologies (ARTs) policies and the effects of these policies on costs, utilization, and health outcomes[J].Health policy, 2014, 116(2-3): 238-263.
[13] Procréation médicalement assistée (PMA)[EB/OL].[2025-03-13].https://www.service-public.fr/particuliers/vosdroits/F31462.
[14] MAEDA E.Health insurance coverage of infertility treatment - its impact and challenges[J].Journal of social security research, 2024, 8(4): 464-478.
[15] 郑思越,李欣雨,廖云鹏,等.辅助生殖技术治疗费用分担机制研究[J].卫生经济研究,2024,41(11):62-66,70.
[16] CHA W, YUN I, NAM C M, et al.Evaluation of assisted reproductive technology health insurance coverage for multiple pregnancies and births in Korea[J].JAMA network open, 2023, 6(6): e2316696.
[17] 北京市人力资源和社会保障局.关于将16项治疗性辅助生殖技术项目纳入医保、工伤保险支付范围的通知[EB/OL].(2023-06-15)[2025-03-13].https://ybj.beijing.gov.cn/zwgk/2024zcwj/202406/t20240619_3721533.html.
[18] 古丽丹娜·吐尔逊,睢素利.我国超高龄妇女借助辅助生殖技术生育所引发的相关问题及其应对之策[J].医学与法学,2025,17(1):80-85.
[19] 乔静静,王玉,张琼,等.基于174例体外受精-胚胎移植助孕患者前瞻性队列的经济负担分析[J].中国妇幼保健,2022,37(10):1845-1848.
[20] 国家卫生健康委员会妇幼保健司.更新《经批准开展人类辅助生殖技术和设置人类精子库的医疗机构名单》[EB/OL].(2024-11-19)[2025-03-13].http://www.nhc.gov.cn/fys/s3582/202404/6b619a6193324b5ba69c0e5bd7189289.shtml.
[21] 许中缘.人工辅助生殖技术法律规制立法价值、原则与规则[J].中国政法大学学报,2023(3):76-93.
[22] 杨帆.辅助生殖技术对生育权的冲击及立法调整[J].法学杂志,2010,31(4):93-96.
[23] 高德胜,季岩.总体国家安全观视域下人类辅助生殖技术规制研究[J].求是学刊,2023,50(4):112-121.
基金
中国医学科学院医学与健康科技创新工程“基于卫生健康体系学的健康中国建设战略研究”(2021-I2M-1-046)