부산대학교 도서관

We analyze public financing models of in vitro fertilization (IVF) in Japan, South Korea, and Taiwan. To build an analytical framework for policy evaluation, we present three ideal types, representing diverse values and evaluation criteria. The equal access model aims to narrow down the stratified use of IVF due to financial barriers. The risk prevention model tends to limit the number of embryos transferred during IVF by means of financial support so as to reduce the leading complication: multiple pregnancy/birth. The pronatalism model's main agenda is to increase the fertility rate by financially supporting the use of assisted reproductive technologies (ARTs). We take the approach of 'reproductive governance' to identify multiple actors and invention strategies to analyze the trajectory of subsidy policy-making in each country. The data to examine the public financing schemes in Japan, South Korea, and Taiwan, are based on archival data, fieldwork, and in-depth interviews of 47 stakeholders. We found that a low fertility rate served as an important motivation for all three governments to plan a subsidy program for IVF, but that their policy designs and impacts vary greatly. In Japan, the women's health movement criticized the health risk of IVF since 1990s gave important warning signs. The country's medical society took the opportunity of subsidy program to implement a single-embryo-transfer guideline, effectively reducing the health risks of IVF. The South Korean government redefined the demand for IVF from the pressure group of infertile couples, offering a generous subsidy program to boost the country's low fertility rate. ARTs have been covered by National Health Insurance in South Korea since 2017, which significantly increases equal access to IVF, but the risk of multiple pregnancy and birth also increases. Taiwan's subsidy program targets only low-income household, leading to a program with the lowest proportion of eligible users in the world. We propose adopting risk prevention as the core value in reforming the public financing of IVF in South Korea and Taiwan.