Local Governments' Infertility Treatment Support Exceeds 100 Billion Won... Gyeonggi Ranks First

Editor's NoteThe era of a total fertility rate of 0.72 children. In front of famous infertility clinics in Seoul, long lines of people are waiting. The unprecedented trend of low birth rates in both the East and West seems irrelevant here. Last year, there were 250,000 infertility patients nationwide. In a reality where all medical infrastructure is concentrated in Seoul, infertile couples from the provinces who travel for "treatment expeditions" to have children continue to suffer. Receiving treatment alone is difficult, but regional medical inequality blocks the path of infertile couples who desperately wish for pregnancy and childbirth. In South Korea, which faces a low birth rate crisis, we look into the reality of provincial infertile couples who are determined to have children and their treatment expeditions.

The total amount of financial support for infertility procedures provided by the 17 metropolitan cities and provinces in South Korea exceeded 100 billion won last year. As the number of infertility patients increases, the number of couples receiving assisted reproductive technology procedures such as artificial insemination and in vitro fertilization (IVF) is rapidly rising, and the financial support provided by local governments is also surging. However, depending on the population and other factors, the scale of support differed by more than 20 times between local governments.

Local Governments' Infertility Treatment Support Exceeds 100 Billion Won... Gyeonggi Ranks First

Procedure Support by 17 Cities and Provinces Up 57% in 2 Years

According to data obtained by Asia Economy through an information disclosure request to the 17 metropolitan cities and provinces regarding the number of cases and amount of infertility procedure support over the past three years, the total amount of infertility procedure support provided by these regions last year was 105.88 billion won. The amount of support, which was 67.33 billion won in 2021, increased to 89.3 billion won in 2022 and continued to rise last year. The number of cases supported also increased steadily, from 108,000 in 2021 to over 130,000 in 2022, and reached 153,531 last year.

The government started providing financial support for infertility procedures in 2006. In 2017, with the inclusion of infertility procedures under the national health insurance, part of the financial support program was transferred from the central government to local governments in 2022. For government and local government support that covers non-insured items and out-of-pocket medical expenses, the number of supported procedures and the scale of support are determined directly by each local government.

Among the 17 metropolitan cities and provinces, Gyeonggi Province provided the largest number of cases and amount of support for infertility procedures. Gyeonggi Province supported 48,023 cases and 39.2 billion won last year. The amount of support in Gyeonggi, which was about 19.9 billion won in 2021, rapidly increased to 30 billion won in 2022 and 40 billion won last year. The region with the lowest number of supported cases last year was Jeju (1,949 cases), and the region with the lowest amount was Sejong (1.4 billion won). The number of cases and the amount of support in Gyeonggi, which has the largest population, were 25 and 28 times higher, respectively, than those of Jeju and Sejong, which have the smallest populations. In terms of the number of newlywed couples in 2022, Gyeonggi had over 300,000, the highest in the country, while Jeju and Sejong remained in the 10,000 range.

The scale of local government support for infertility procedures is expected to continue growing. As the number of infertility patients and the cost of infertility procedures rapidly increase, local governments are easing support criteria and expanding the scale of support. According to the Health Insurance Review and Assessment Service, the average medical cost per person for infertility procedures rose by 42%, from 1.36 million won in 2019 to 1.94 million won in 2022. By gender, the average cost per woman increased by 41% over five years, from 2.37 million won to 3.35 million won, while for men it increased by 21%, from 184,000 won to 222,000 won.

It is estimated that 1 in 10 newborns each year is born through infertility procedures. The pregnancy rate resulting from local government support for infertility procedures varies by region and period, ranging from 10% to 30%. In Seoul, for example, the rate changed from 27.8% in 2021 to 26.6% in 2022 and 19.7% in 2023. A Seoul official explained, "As the number of supported procedures increases, the number of high-order infertility treatments rises, resulting in a decrease in the pregnancy rate."

A counseling and information center for various supports such as infertility, pregnancy, childbirth, and postpartum care operated by the Seoul Metropolitan Government is established at the Dongdaemun-gu Public Health Center. Photo by Jo Yongjun

A package containing a guidebook for pregnant women and badges, which are distributed upon registration of pregnancy in Seoul, is available at the Dongdaemun District Public Health Center. Photo by Jo Yongjun

Difficult to Attract Infertility Clinics Immediately, So "Transportation Support"

As the low birth rate problem worsens and infertile couples' concerns deepen, local governments are introducing support policies beyond just procedure subsidies. One such policy is transportation cost support for couples who travel from provincial areas to other regions for infertility treatment.

Traveling from provincial areas to Seoul for medical treatment often leads to unexpected expenses. According to a survey conducted last year by the Jeju Women's and Family Research Institute on about 500 Jeju citizens who received infertility procedure support, only 30.7% said their transportation and accommodation costs during treatment were "under 1 million won," far below the national response rate (57.4%, Korea Women's Policy Institute survey). On the other hand, the response rate for "between 1 million and 3 million won" was higher in Jeju (30.1%) than nationwide (25.7%). This means additional costs are incurred on top of infertility procedure expenses.

Local governments that find it difficult to attract specialized infertility clinics immediately have started to provide transportation support. Ulju County in Ulsan, which was the first local government nationwide to introduce a transportation support policy for infertility treatment in 2019, has provided transportation support for 1,948 cases, totaling 772.59 million won over the past five years. This year alone, from January to August, 142.1 million won was provided to 161 couples. Initially, Ulju County provided 50,000 won per procedure, up to 10 times (500,000 won), but last year doubled the support to 100,000 won per procedure, up to 10 times per year (1 million won). An Ulju County official explained, "About 23% of patients use medical institutions outside of Ulsan, such as Busan and Daegu, and many have said that transportation support is a significant economic help."

Sangju in North Gyeongsang Province also adopted the same policy in 2020 and has invested over 20 million won to date. Jindo in South Jeolla Province and Pyeongchang in Gangwon Province also began supporting transportation costs for infertile couples this year. A Pyeongchang official said, "Although there is an obstetrics and gynecology clinic in the area, infertility treatment is not available," and "Among couples undergoing infertility treatment, about 30% go to clinics within Gangwon Province, while about 70% go to Seoul or Gyeonggi Province." In addition, new support programs are being prepared in Yeongwol in Gangwon, Gwangyang and Muan in South Jeolla, and other regions.

Support from local governments for infertility is expanding, but it is still insufficient.

However, there are concerns that such transportation support is only provided in a few areas at the discretion of local governments, and the amount is often insufficient, limiting its effectiveness. There is also criticism that responding with transportation support in various regions may actually encourage further concentration of patients in certain areas.