[Exclusive] Statistics on Infertility Treatment Support Program for Couples Unknown to the Government [Nanimsang Gyeonggi]

⑦ Ministry of Health, Unaware of How and How Much Support Was Provided
No Central Control Tower, No Statistics on Infertility Treatment Support
"Since 2022 Decentralization, Managed Separately by Local Governments"

Editor's NoteThe era of a total fertility rate of 0.72. Long queues have formed in front of famous 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 actual conditions of medical tourism for infertile couples from provinces full of determination to have children in South Korea, which is facing a low birthrate crisis.

The representative infertility policy, the infertility couple procedure cost support project, is being promoted differently in each region due to the absence of a control tower, and it has been confirmed that the central government cannot even compile the contents. Despite being a policy with a large-scale budget of several hundred billion won, information about the different implementation details by region is scattered, and even the statistical standards vary, raising concerns that this will negatively impact the establishment of national infertility policies in the future. Considering the increasing importance of infertility policies amid the worsening low birthrate problem, voices are growing for the government to take overall control and manage them integrally.

A counseling and information center for support related to infertility, pregnancy, and childbirth operated by the Seoul Metropolitan Government is established at the Dongdaemun-gu Public Health Center. Photo by Jo Yongjun

Infertility Policy Data Varies... Statistical Management Is Lax

When the Ministry of Health and Welfare was requested last month by Asia Economy through an information disclosure request for data related to infertility couple procedure cost support projects by 17 metropolitan cities and provinces, it responded that "since 2022, this information has been transferred to local governments and is not held or managed by the agency," indicating 'information non-existence.' Since the national infertility procedure cost support policy is currently implemented simultaneously by the government and local governments, the central ministry, the Ministry of Health and Welfare, answered that it does not oversee the implementation details of local governments.

At the same time, the data items related to procedure cost support managed by the 17 metropolitan cities and provinces also differed depending on the local government. According to the investigation, the detailed data held regarding infertility procedure support, such as the number of supported procedures, detailed procedure classifications like artificial insemination and in vitro fertilization, number of supported individuals, and number of pregnancies through infertility procedures, varied individually. If statistical management, which forms the basis for policy decisions, is not properly conducted because the support contents differ by local government, it will inevitably be difficult to utilize the effects of existing policies when establishing future policies.

Kim Myung-hee, president of the Korea Infertility Family Association, pointed out, "In the United States, the infertility market relies on private insurance or a free market where medical insurance does not apply, but statistical management is legally conducted by the state," adding, "Statistics must be accurate so that management can be properly carried out regarding how efficiently the budget is being used and how medical institutions are operating."

"Discrimination Despite Being the Same Citizens"... Infertility Policies Issued Separately by Local Governments

"They say low birthrate is a national issue. Even if we live in different regions, we are all part of the same Republic of Korea. Isn't it a problem if people feel discriminated against just because they live in different places despite being the same citizens?" - Infertility patient A, who travels from the provinces to Seoul

A pamphlet containing information on infertility, pregnancy, childbirth, and postpartum care support provided by the Seoul Metropolitan Government is available at the Dongdaemun-gu Public Health Center. Photo by Jo Yongjun

The absence of integrated management statistics for infertility procedure cost support is a representative example showing that the current domestic infertility policy faces the limitation of lacking a control tower. In fact, infertile couples from provinces complain that the gap between infertility policies supported by the government and local governments acts as a discouraging factor during treatment. Although infertility treatment is effectively conducted nationwide, the representative infertility policy, the procedure cost support project, was transferred to local governments in 2022, resulting in different policies being issued by each local government.

The national infertility couple procedure cost support project began in 2006. Initially, it supported up to 1.5 million won per procedure twice for in vitro fertilization for infertile couples with an average monthly urban worker income of 130% or less. Over the years, the number of eligible recipients and payment frequency steadily expanded, and in 2017, health insurance coverage was applied to infertility procedures. With the application of health insurance, the procedure cost support project was partially transferred from the national government to local governments in 2022, allowing local governments to autonomously decide support criteria and scale. Currently, the government and local governments provide infertility procedure costs divided into three types: ▲Health Insurance ▲Government Type ▲Local Government Type.

Controversy over regional disparities related to infertility policies arose immediately after the transfer to local governments. Differences began to appear in support eligibility criteria and support scale by local government. Except for health insurance, which applies equally to all infertile couples, government-type and local government-type supports, which cover non-insured items and out-of-pocket medical expenses, differ by local government. As the controversy over regional disparities in government-type support grew, the Ministry of Health and Welfare intervened last year to negotiate with the 17 metropolitan cities and provinces nationwide and adjusted the policy to abolish income criteria starting this year.

Different Support Amounts by Local Governments... "Infertility Is a National Issue"

However, regional disparities remain in both government-type and local government-type supports. According to Asia Economy's confirmation through information disclosure responses from 17 metropolitan cities and provinces and publicly available information on their websites, only 7 out of the 17 cities and provinces have removed all age and income restrictions and procedural barriers in government-type procedure cost support for infertile couples. The other 10 maintain age criteria based on 45 years old or impose limits on the number of supports depending on the procedure type, such as artificial insemination and in vitro fertilization (fresh and frozen embryo transfer).

Five cities and provinces, including Gyeongbuk, Gwangju, Daegu, Jeonnam, and Jeonbuk, provide additional procedure cost support by securing their own funds beyond health insurance and government-type support. They either add extra amounts to government-type support or provide additional support to residents whose health insurance coverage has ended. In Daegu, for example, women under 44 years old who have resided in the city for more than six months and undergo fresh embryo in vitro fertilization receive up to 1.7 million won per procedure (up to 16 procedures). This adds 600,000 won per procedure to the amount received under government-type support under the same conditions.

The newly established Korean Medicine infertility support project, introduced through the Maternal and Child Health Act amendment earlier this year, also shows significant differences in support availability, scale, frequency, and eligibility by local government. Before the law was amended, policies were promoted by establishing separate ordinances by region. Currently, 10 metropolitan cities and provinces, including Gyeonggi, operate Korean Medicine infertility support projects, and Gangwon and Chungbuk provide Korean Medicine infertility treatment support in some cities within their jurisdictions.

There is a procedure in place to discuss the process of transferring some infertility support policies to local governments. When a local government changes or expands infertility support systems, it requests social security system consultations with the Ministry of Health and Welfare, which then finalizes and proceeds with the changes. According to data on social security system consultation requests related to infertility received by Rep. Kim Mi-ae of the ruling People Power Party from the Ministry of Health and Welfare, from January 1 to September 10 this year, local governments requested 37 consultations with the Ministry of Health and Welfare and completed 17. Most involved adjustments to changes in the infertility procedure cost support project, and discussions included male infertility procedure cost support, transportation cost support, and the establishment of Korean Medicine infertility support projects.

However, criticism continues that these procedures alone are insufficient to resolve disparities between local governments. Since financial conditions differ by local government, the degree of policy benefits for infertile couples is expected to vary accordingly. The National Assembly Budget Office evaluated in last year's report on fiscal decentralization policies and local government transfer projects that "As the infertility couple procedure cost support project was transferred to local governments, disparities in support benefits have occurred by region depending on financial burdens and local government preferences," adding, "It is necessary to consider that infertility is not a regional issue but a national issue."

Efforts are underway to resolve policy inefficiencies caused by the government and local governments each introducing infertility support systems. The Anti-Corruption and Civil Rights Commission requested data submission from local governments nationwide earlier this month to conduct a survey on the current status of related infertility support system operations for system improvement. It is also conducting a survey on the National Sinmungo platform asking questions such as "Do you think there is a difference in accessibility to infertility medical institutions depending on the region you live in, such as the metropolitan area?" A commission official explained, "We aim to promote system improvements to address administrative inefficiencies and inconvenient procedures, such as unnecessarily submitting many documents during the use of infertility support systems."