公平近用、預防風險或增長人口？－助孕科技公費補助的日韓台比較

本文探討日韓台三國以公費補助人工協助生殖科技的政策。我們將國際上公費補助政策，依核心訴求分為公平近用、預防母嬰健康風險、增長人口三大類型，並以此作為政策評估架構。我們主張採用「生殖治理」的取向，看重多樣的行動者與介入策略，如何在特定歷史情境中結盟與解組，來解釋各國補助政策的歧異路徑。針對日韓台的比較部分，分析資料包括檔案文獻，參與觀察，以及深度訪談47位政策制定的相關行動者。我們發現，少子化是東亞三國施行公費補助助孕科技的重要推力，日韓台政府分別於2004、2006、2015年推出國家政策，但是政策設計與後果差異極大。日本的婦女健康運動早於1990年代即提出助孕科技造成的傷害，而高度反思的醫界善用政府補助政策的機會，建立單一胚胎植入的臨床指引，有效降低健康風險。韓國在不孕團體的推動，以及政府提高生育率的重視，逐步擴大補助，並於2017年將人工協助生殖科技納入健保，公平性最優，但也大幅增加了多胞胎孕產的風險。台灣補助方案最晚推出，僅以中低收入戶為對象，補助普及性為全球最低。本文提出，以降低風險作為公費介入目標，重新調整從助孕補助到母嬰健康的財務分配，是台韓值得推動的政策改革方向。

關鍵字

公費補助；人工協助生殖科技；生殖治理；健康風險；少子化

並列摘要

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.

並列關鍵字

public financing ； in vitro fertilization ； reproductive governance ； health risk ； pronatalism

參考文獻

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公平近用、預防風險或增長人口？－助孕科技公費補助的日韓台比較

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