"Top-tier hospitals exist, but"… Even with government evaluations of infertility hospitals, desired information is 'missing' [Nanimsang Gyeonggi]

⑥ Lack of Information and Data Submission, Government Evaluation Fails to Support Patient Choice

Editor's NoteIn an era where the total fertility rate is 0.72, long queues have formed in front of well-known infertility clinics in Seoul. This unprecedented low birthrate trend throughout history seems almost ironic. Last year, there were 250,000 infertility patients nationwide. In a reality where all medical infrastructure is concentrated in Seoul, infertile couples from provinces who travel for 'medical tourism' to have children continue to suffer today. Just receiving treatment is difficult enough, but medical inequality between regions blocks the path of infertile couples who desperately wish to conceive and give birth. We take a closer look at the reality of medical tourism for infertile couples from provinces full of determination to have children in South Korea, which is facing a low birthrate crisis.

"To induce autonomous quality improvement of infertility treatment medical institutions through evaluation of whether they meet the designation criteria and by treatment type, and to guarantee a safe treatment environment and choice for the public."

The government conducted two nationwide evaluations of infertility treatment medical institutions in 2020 and 2023 and announced the results. As infertility patients rapidly increased due to delayed marriage and aging childbirth age, the government began providing information and managing medical institutions performing treatments. The core is to check whether infertility treatment specialized medical institutions ▲are well equipped with professional personnel, facilities, and equipment, and ▲whether artificial insemination and in vitro fertilization (IVF) treatments are properly performed. This evaluation, conducted every three years, is scheduled to be held for the third time next year. The evaluation results can be checked on the Health Insurance Review & Assessment Service (HIRA) website and others.

Although one of the government's intentions in conducting the evaluation is to guarantee infertile couples' right to choose medical institutions, infertile couples from provinces whom the reporter met directly responded that they "did not even know such an evaluation system existed." Some also said, "I saw a banner saying 'Grade 1' at the hospital, but I questioned the evaluation criteria." Even if hospitals are concentrated in the metropolitan area, if there is information that there are appropriate infertility hospitals near their residence, infertile couples are more likely to consider local hospitals instead of traveling to Seoul. The problem is that the government's evaluation system is practically not utilized in the hospital selection process of infertile couples.

Patients 'Ignore' Results Without Desired Information

The reason infertile couples do not closely examine the government evaluation when choosing hospitals after much consideration is that they do not even know whether the evaluation is conducted and judge that the disclosed information is not very helpful. Since the evaluation is conducted every three years and the evaluation period itself lasts two years, there are criticisms that it is difficult to consider the information up-to-date. The 2021 treatment data of infertility treatment medical institutions were evaluated over one year in 2022 and only disclosed to the public in July last year. This means they have to decide on their current treatment hospital based on results from two years ago.

The reasons why target hospitals are excluded from evaluation are also not easy to understand at a glance. Reasons for exclusion include ▲non-submission of data ▲failure to meet a certain number of treatments (at least 10 artificial inseminations per year, at least 30 IVF treatments per year), but only "excluded from evaluation" is indicated without specifying the exact reason. Regarding this, HIRA told Asia Economy, "The infertility treatment medical institution evaluation committee decides on disclosure methods and plans to review disclosing the reasons for exclusion by institution in the third evaluation results."

Above all, it is not easy to confirm the information infertile couples are most curious about, such as pregnancy success rates, from the disclosed data alone. According to a 2021 survey by the Korean Women's Development Institute targeting about 600 women undergoing infertility treatments, the top consideration when choosing an infertility treatment medical institution was "pregnancy success rate" (41.7%). However, unless individual hospitals disclose this, infertile couples as medical consumers cannot verify it from the government evaluation. The detailed evaluation criteria reflect average pregnancy rates for artificial insemination and standardized pregnancy rates (overall pregnancy rates) for IVF, but these are not publicly disclosed.

Based on the two previous evaluations, the government is working on supplementing the third evaluation to be conducted next year by adding some evaluation indicators. A HIRA official stated, "We plan to strengthen evaluation criteria for appropriate treatment numbers and multiple pregnancy rates, and introduce evaluation of embryo culture room infection control and embryo production personnel expertise."

More Than Half of 'Grade 1' Hospitals Concentrated in the Metropolitan Area

The government is cautious about disclosing hospital information. There are concerns that disclosing some information such as pregnancy success rates could worsen the concentration in the metropolitan area and intensify competition among hospitals. Lee Su-hyung, a research fellow at the Korea Institute for Health and Social Affairs who published a report last year titled "Research for Improving the Quality Management Evaluation System of Infertility Treatment Medical Institutions," said, "If results by institution were exposed, there is a high possibility of side effects such as misuse of data, limitations in interpretation, and concentration of patients in certain medical institutions," and added, "It is premature to disclose statistical indicators to the public by region or by medical institution."

Even from the evaluation results already released by the government, the concentration of infertility hospitals in the metropolitan area can be sufficiently confirmed. The government announced through the second evaluation that as of 2021, 45% (97 institutions) of the target institutions were located in the metropolitan area including Seoul, Gyeonggi, and Incheon, and 68.5% of the total 189,373 treatments were performed in the metropolitan area. By individual cities, 40.4% (76,585 treatments) of all treatments were performed in Seoul, and 28.1% (53,236 treatments) in Gyeonggi and Incheon.

Asia Economy’s detailed review of the second evaluation results of infertility treatment medical institutions found that among the 233 evaluated institutions, those receiving the highest grade, Grade 1, were concentrated in Seoul, Gyeonggi, and Incheon. For artificial insemination, 52% (60 institutions) received Grade 1, and for IVF, 54% (56 institutions) received Grade 1. Artificial insemination is divided into two grades, and IVF into four grades, with 115 and 104 institutions respectively receiving Grade 1. Of course, since there are many medical institutions in the metropolitan area, there were also a considerable number of so-called 'excluded from evaluation' institutions that did not submit data or performed treatments below a certain level: 40 for artificial insemination and 49 for IVF.

Hospitals with extensive infertility treatment experience are also concentrated in the metropolitan area. The average annual number of treatments per infertility hospital was 165.12 for artificial insemination and 1,063.46 for IVF. Among hospitals performing more than 100 artificial inseminations annually, 38 out of 67 were located in Seoul, Gyeonggi, and Incheon, and among those performing IVF, 30 out of 53 were in the metropolitan area. Although a high number of treatments does not directly translate to pregnancy success, based on experts’ opinions that "experience cannot be ignored," infertile couples’ travel to Seoul is understandable.

44% of Infertility Hospitals 'Did Not Submit Data'... "Mandatory Submission Needed"

Another reason infertile couples find it difficult to refer to government evaluations when choosing hospitals is that many institutions are excluded from evaluation due to non-submission of data. The government evaluates the standards and performance of infertility hospitals every three years based on the Maternal and Child Health Act and the Act on Designation of Infertility Treatment Medical Institutions, and can cancel designation based on evaluation results. It also collects, analyzes, manages related statistical data, and discloses evaluation results. So far, no infertility treatment medical institution has had its designation canceled by the government.

In the second evaluation conducted in 2022, out of 283 target institutions, 68 did not submit data such as institutional survey forms and infertility treatment records. Considering 56 institutions were excluded due to insufficient treatment numbers (less than 10 artificial inseminations or less than 30 IVF treatments annually), 44% of all designated infertility treatment medical institutions were excluded from evaluation. In the first evaluation conducted in 2019, 70 out of 377 institutions did not submit data. At that time, when the government requested data for evaluation, 90 hospitals voluntarily decided to cancel their designation.

Ultimately, the response rate of infertility treatment medical institutions increased from 40.3% in the first evaluation to 56.2% in the second, but the proportion of institutions receiving evaluation grades remained in the 50% range, still low. A Ministry of Health and Welfare official explained, "During the evaluation process, we encourage non-submitting institutions to submit data and request corrective measures. In that process, some hospitals return their designation, and various issues arise."

Since the government manages quality and provides information by designating and evaluating infertility treatment medical institutions, there are calls to make data submission mandatory. The research fellow emphasized, "Data submission is essential to designate and manage infertility treatment medical institutions. Separate measures are needed for non-submitting institutions," stressing the need for mandatory submission through legal amendments.