目的: 分析浙江省辅助生殖技术纳入医保后的实施效果,比较不同辅助生殖技术患者的经济负担水平,为优化医保报销结构、完善生育支持政策提供参考依据。方法: 选取2023年6月—2025年5月在F市接受辅助生殖技术治疗的患者作为研究对象,收集诊疗量、不同医保类型患者结构及相关费用数据,对比医保纳入前后的费用变化及不同技术项目的经济负担差异。结果: 辅助生殖纳入医保后,参保患者门诊诊疗总人数小幅上升。新鲜胚胎移植项目总费用较之前下降,职工医保、城乡居民医保患者个人承担分别下降7623.2元、6160.1元。全流程首次常规胚胎移植阶段医保报销占比达65.2%。不同辅助生殖技术患者的自付比例均维持在30%~40%。结论: 辅助生殖技术纳入医保有效降低了患者经济负担,提升了不孕患者接受辅助生殖技术的意愿,但仍存在个人自付比例偏高、不同医保类型报销额度存在差异等问题。建议实行差异化补助机制,构建“基本医保+商业保险+财政补助+医疗贷款”的多元生育支持体系,完善异地医保直接结算机制,进一步减轻患者负担。

Objective: The paper attempts to analyze the implementation effect of including assisted reproductive technology in medical insurance in Zhejiang Province, compare the economic burden levels of patients undergoing different assisted reproductive technologies, and provide a reference basis for optimizing the medical insurance reimbursement structure and improving fertility support policies. Methods: Patients who underwent assisted reproductive technology treatment in F City from June 2023 to May 2025 were selected as the study subjects. Data on treatment volume, composition of patients with different medical insurance types, and medical expenses were collected. We further compared the changes in medical expenses before and after the inclusion of assisted reproductive technology in medical insurance and analyzed the differences in economic burden across different treatment items. Results: After the introduction of assisted reproduction into medical insurance, the total number of outpatient diagnosis and treatment of insured patients is on the slight rise. The total cost of the fresh embryo transfer project was lower than before, and the individual burden of employees' medical insurance and residents' medical insurance patients decreased by 7623.2 yuan and 6160.1 yuan respectively. The proportion of medical insurance reimbursement in the first routine embryo transfer stage of the whole process was 65.2 %. The proportion of patients with different assisted reproductive technologies at their own expense was maintained at 30% to 40%. Conclusion: The inclusion of assisted reproductive services in medical insurance has effectively reduced patients' financial burden and increased the willingness of infertile patients to undergo assisted reproductive technology treatment. However, several issues remain, including a higher out-of-pocket ratio, as well as disparities in reimbursement ratios across different types of medical insurance. It is recommended to implement a differentiated subsidy mechanism for diverse groups, establish a multi-dimensional fertility support system featuring basic medical insurance, commercial insurance, financial subsidies and medical loans, and improve the direct medical insurance settlement mechanism for cross-regional medical treatment, so as to further alleviate patients' financial pressure.