Beijing’s ART insurance coverage: enhancing outpatient visit frequency and reducing out-of-pocket costs

The incorporation of assisted reproductive technology (ART) into Beijing’s medical insurance (MI) represents a significant policy change aimed at alleviating the declining fertility rates, with unknown effects on outpatient demographics and associated out-of-pocket cost (OOP), which refers to the medical expenses occurred since ART such that patients must cover themselves - within the parameters of the medical insurance catalog-without reimbursement. This study investigates and compares the changes in the demographic characteristics and OOP of outpatient visits before and after the integration of MI for ART. We conducted a single-center, retrospective quality improvement study analyzing outpatient medical record data from two 12-month periods: the pre-integration period (July 1, 2022, to June 30, 2023) and the post-integration period (July 1, 2023, to June 30, 2024). Primary outcomes included changes in outpatient visits, insurance coverage distribution, and OOP expenses. Descriptive and comparative analyses were conducted, with potential contributing factors to observed variations briefly explored. After including ART in MI, both outpatient visits and the number of patients significantly increased. The number of patients elevated across all age groups, with the proportion of patients aged 41–42 rising notably, while the proportion of patients under 30 slightly decreased. Urban Employee Basic Medical Insurance (UEBMI) is the predominant insurance type, and the number of patients covered by it increased from 75.22% to 77.59% following the implementation of insurance coverage. The proportion of cross-regional patients surged, with Cross-Region Urban-Rural Resident Basic Medical Insurance (CR-URRBMI) and Cross-Region Urban Employee Basic Medical Insurance (CR-UEBMI) patient proportions increasing to 4.32% and 7.81%, respectively. Although the proportion of infertility patients exhibited a slight decrease, there was an increase in the proportion of patients undergoing intrauterine insemination (AIH). Conversely, the proportion of patients receiving in vitro fertilization/intracytoplamic sperm injection-embryo transfer (IVF/ICSI-ET) treatment saw a decline. Additionally, the OOP associated with outpatient visits experienced a significant drop. Medical mandates for ART coverage were associated with an increase in outpatient visits, particularly drawing in more advanced-age patients and Cross-Region individuals, while simultaneously contributing to a reduction in OOP.