Impact of insurance coverage on access to assisted reproductive technology: A nationwide survey in Japan (the IZANAMI project).

Objective: Assisted reproductive technology (ART) is a well-established infertility treatment. However, financial and geographical barriers can hinder patient access. The Japanese government implemented insurance coverage in April 2022 for specific ART treatments. This study assessed the effects of insurance coverage on ART utilization and accessibility.

Methods: An online survey was administered to 427 ART facilities that participated in a pre-policy assessment from December 1, 2023, to January 30, 2024.

Results: A total of 283 facilities responded (response rate: 66.3%). The number of ART patients increased by 4.0% (217 699-226 401) following the implementation of insurance coverage. The number of insured patients aged 25-43 years increased by 6.6%, with a notable increase of 22.9% (range: 44 144-54 253) in the 25- to 34-year age group. However, the number of uninsured patients aged ≥44 decreased by 16.3%; 172 facilities experienced an increased number of patients, whereas 111 facilities experienced no increase or decline. Patient growth rates were significantly higher in rural areas than in metropolitan regions (mean difference: 0.07; 95% confidence interval: 0.0-0.1; p = 0.03). Although there was a significant negative association between the proportion of out-of-pocket treatment and the rate of patient increase (p = 0.02), no such association was observed in rural areas (p = 0.68).

Conclusions: Insurance coverage improved patient access to ART services, especially for those in their 20s and early 30s. However, the number of patients in the uninsured group decreased significantly. Accessibility in rural areas also notably improved. These findings highlight the importance of economic support for enhancing ART accessibility.