{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T04:43:06Z","timestamp":1791434586283,"version":"4.3.3"},"reference-count":21,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:00:00Z","timestamp":1744588800000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Obstet and Gynaecol"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Assisted reproductive technology (ART) is a well\u2010established 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An online survey was administered to 427 ART facilities that participated in a pre\u2010policy assessment from December 1, 2023, to January 30, 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 283 facilities responded (response rate: 66.3%). The number of ART patients increased by 4.0% (217\u2009699\u2013226\u2009401) following the implementation of insurance coverage. The number of insured patients aged 25\u201343\u2009years increased by 6.6%, with a notable increase of 22.9% (range: 44\u2009144\u201354\u2009253) in the 25\u2010 to 34\u2010year age group. However, the number of uninsured patients aged \u226544 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\u20130.1;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03). Although there was a significant negative association between the proportion of out\u2010of\u2010pocket treatment and the rate of patient increase (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02), no such association was observed in rural areas (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.68).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jog.16292","type":"journal-article","created":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T23:44:47Z","timestamp":1744674287000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Impact of insurance coverage on access to assisted reproductive technology: A nationwide survey in Japan (the\n                    <scp>IZANAMI<\/scp>\n                    project)"],"prefix":"10.1111","volume":"51","author":[{"given":"Aika","family":"Wada","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Keio University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7560-316X","authenticated-orcid":false,"given":"Mitsutoshi","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Keio University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5300-0037","authenticated-orcid":false,"given":"Hiromitsu","family":"Shirasawa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Akita University Graduate School of Medicine  Akita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8815-5714","authenticated-orcid":false,"given":"Seung Chik","family":"Jwa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Jichi Medical University  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2759-9159","authenticated-orcid":false,"given":"Keiji","family":"Kuroda","sequence":"additional","affiliation":[{"name":"Center for Reproductive Medicine and Endoscopy Sugiyama Clinic Marunouchi  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miyuki","family":"Harada","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Graduate School of Medicine The University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaka","family":"Osuga","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Graduate School of Medicine The University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,14]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/rmb2.12620"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.10.046"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2009.04.029"},{"key":"e_1_2_10_5_1","volume-title":"Survey research on the reality of infertility treatment, final report","author":"FY2020 Research Project for the Promotion of Support for Children and Childbearing","year":"2021"},{"key":"e_1_2_10_6_1","unstructured":"Ministry of Health Labour and Welfare (MHLW).Comprehensive survey of living conditions.https:\/\/www.mhlw.go.jp\/toukei\/saikin\/hw\/k-tyosa\/k-tyosa23\/index.html(2023). Accessed 28 Mar 2025."},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2015.10.009"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa013491"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.15780"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.16051"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.16022"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1404601"},{"key":"e_1_2_10_13_1","unstructured":"Statistics Bureau of Japan.Population of estimates on 1st Oct 2023.https:\/\/www.stat.go.jp\/data\/jinsui\/2023np\/index.html(2023). Accessed 28 Mar 2025."},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.16234"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2009.07.1665"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/rmb2.12552"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.03.003"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0803072"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1110238"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.17296"},{"key":"e_1_2_10_21_1","unstructured":"National Institute for Health and Care Excellence.Quality statement 6: IVF for women aged 40 to 42\u2009years.https:\/\/www.nice.org.uk\/guidance\/qs73\/chapter\/Quality\u2010statement\u20106\u2010IVF\u2010for\u2010women\u2010aged\u201040\u2010to\u201042\u2010years(2014). 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