[Exclusive] Local Government Support for Infertility Treatment Costs Surpasses 100 Billion Won... Which Local Government Ranks First? [Infertility SangGyeonggi]

⑧Data Collection and Analysis of Infertility Treatment Cost Support Projects in 17 Cities and Provinces Nationwide

Editor's NoteIn an era where the total fertility rate is 0.72, long queues form in front of well-known infertility clinics in Seoul. This unprecedented low birthrate trend throughout history seems almost unbelievable. Last year, there were 250,000 infertility patients nationwide. In a reality where all medical infrastructure is concentrated in Seoul, infertile couples from provincial areas who travel for 'expedition treatment' 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 expedition treatment for infertile couples from provincial areas full of determination to have children in South Korea, which is facing a low birthrate crisis.

The scale of infertility treatment cost support provided by 17 metropolitan cities and provinces nationwide exceeded 100 billion KRW last year. As the number of infertility patients rapidly increases, so does the number of infertile couples receiving assisted reproductive technologies such as artificial insemination and in vitro fertilization (IVF), leading to a sharp rise in infertility treatment cost support provided through local governments. However, the scale of support varied by more than 20 times depending on the local government, influenced by factors such as population size.

A pregnant couple who conceived through in vitro fertilization is visiting a women's specialty hospital for a medical consultation. Photo by Jo Yongjun

Infertility Treatment Cost Support by 17 Cities and Provinces Up 57% in Two Years

According to a request for information disclosure by Asia Economy on the number and amount of infertility treatment cost support projects conducted by 17 metropolitan cities and provinces over the past three years, the total infertility treatment cost support amount in these 17 regions last year was 105.88231 billion KRW. The infertility treatment cost support amount was 67.33196 billion KRW in 2021, increased to 89.3 billion KRW in 2022, and continued to rise last year. The number of infertility treatment cost support cases for infertile couples in these 17 regions rose steadily from 108,000 cases in 2021 to over 130,000 cases in 2022, reaching 153,531 cases last year.

The government began the infertility couple treatment cost support project in 2006. Following the application of health insurance coverage to infertility treatments in 2017, part of the treatment cost support project shifted from a national to a local government focus in 2022. The government-type and local government-type support programs, which cover non-reimbursable items not covered by health insurance and out-of-pocket medical expenses, allow local governments to directly decide the number of support instances and the scale of support.

Among the 17 metropolitan cities and provinces, Gyeonggi-do provided the highest number and amount of infertility treatment cost support. Last year, Gyeonggi-do supported 48,023 cases and 39.28 billion KRW in treatment costs for infertile couples. The scale of infertility treatment cost support in Gyeonggi-do, which was about 19.9 billion KRW in 2021, rapidly increased to 30 billion KRW in 2022 and reached 40 billion KRW last year. Jeju-do had the fewest support cases last year (1,949 cases), and Sejong-si had the smallest support amount (1.4 billion KRW). Among the 17 regions, Gyeonggi-do, with the largest population, showed a difference of 25 times in the number of support cases and 28 times in the amount of support compared to Jeju and Sejong, which have the smallest populations. In terms of the number of newlywed couples, Gyeonggi-do exceeded 300,000 couples in 2022, making it the region with the highest number nationwide, while Jeju-do and Sejong-si remained at around 10,000 couples.

The scale of infertility treatment cost support by local governments is expected to continue growing. Along with the increase in infertility patients, infertility treatment medical fees are also rising rapidly, prompting local governments to ease support criteria and expand the scale of support. According to the Health Insurance Review & Assessment Service, the average medical fee per person for infertility treatment increased by 42%, from 1,363,000 KRW in 2019 to 1,938,000 KRW in 2022. By gender, the average cost for women rose 41%, from 2,369,000 KRW to 3,351,000 KRW over five years, while for men it increased 21%, from 184,000 KRW to 222,000 KRW.

It is estimated that one out of every ten newborns each year is born through infertility treatment. The rate at which infertility treatment cost support from local governments leads to pregnancy varies between 10% and 30%, depending on the region and period. In Seoul, the rate changed from 27.8% in 2021 to 26.6% in 2022 and 19.7% in 2023. A Seoul city official explained, "As the number of support instances increased, the number of treatments for higher-order infertile couples also rose, resulting in a decrease in pregnancy rates."

"Transportation Cost Support" as Immediate Alternative to Attracting Infertility Hospitals

As the low birthrate problem worsens and the concerns of infertile couples deepen, local governments are introducing support policies beyond treatment cost support. One such support for couples traveling from provincial areas to other regions for infertility treatment is transportation cost support.

Traveling from provincial areas to Seoul for hospital visits incurs unexpected expenses. According to a survey conducted by the Jeju Women and Family Research Institute last year targeting about 500 Jeju citizens who received infertility treatment support, 30.7% responded that transportation and accommodation costs incurred during infertility treatment were "less than 1 million KRW," significantly lower than the national response rate of 57.4% (survey by the Korean Women's Development Institute). Conversely, the response rate for "between 1 million and less than 3 million KRW" was higher in Jeju (30.1%) than nationwide (25.7%). This adds considerable costs on top of infertility treatment expenses.

Local governments that find it difficult to immediately attract specialized infertility hospitals have started providing transportation cost support. Ulsan Ulju-gun was the first local government nationwide to implement a transportation cost support policy for infertility treatment in 2019. Over the past five years, it has provided 1,948 cases and 772.59 million KRW in transportation cost support to infertile couples. This year, from January to August, it supported 161 couples with 142.1 million KRW in transportation costs. Initially, Ulju-gun provided 50,000 KRW per treatment instance, up to 10 times (500,000 KRW total), but last year doubled the support to 100,000 KRW per instance, up to 10 times annually (1 million KRW total). An Ulju-gun official explained, "About 23% of infertility treatment patients use medical institutions in other cities such as Busan and Daegu, excluding infertility treatment medical institutions in Ulsan, reflecting opinions that transportation cost support is economically helpful."

Sangju-si in Gyeongbuk also introduced the same system in 2020 and has invested over 20 million KRW in its budget to date. Jindo-gun in Jeonnam and Pyeongchang-gun in Gangwon have also started providing transportation cost support to infertile couples this year. A Pyeongchang-gun official said, "Although there is an obstetrics and gynecology clinic in the area, infertility treatment is not provided. Among couples receiving infertility treatment in the area, about 30% undergo treatment within Gangwon Province, while about 70% go to Seoul and Gyeonggi-do." Additionally, support establishment procedures are underway in other areas such as Yeongwol in Gangwon, Gwangyang in Jeonnam, and Muan in Jeonnam.

However, there are criticisms that such transportation cost support is provided only in a very limited number of local governments by their own decisions and that the amounts are often insufficient, limiting its effectiveness. There is also criticism that multiple local governments responding by providing transportation cost support may actually exacerbate the concentration phenomenon.