In the UK, with the multiple-birth rate soaring in the 1980s, concerns about maternal and infant health, along with rising public health expenditure, came to the forefront, prompting the government to implement various policy initiatives by the early 2000s to manage multifetal pregnancies. The National Institute for Clinical Excellence (NICE) adopted the Twin and Triplet Pregnancy Guideline and later introduced quality standards for pre- and postnatal care for multifetal pregnancies. Through its single-embryo transfer policy, the Human Fertilisation and Embryology Authority (HFEA) helped reduce the post-IVF multifetal pregnancy rate from 28.5 percent in 1991 to 3.4 percent in 2023. The National Health Service (NHS) implemented the Multiple Births Midwife program, which over the years has brought improvements to maternal and child health service delivery. Non-profit organizations, such as Twins Trust, have worked in collaboration with the NHS to enhance the management of maternal and child health through improved guidelines, education, and awareness campaigns. These efforts have enabled the UK to reduce multifetal pregnancies while maintaining an appropriate total fertility rate, making them a valuable source of insights and implications for Korea as it grapples with a high rate of multiple births.
The Netherlands’ policies on assisted reproductive technology are quite distinct from those of other European countries. Following the birth of its first IVF baby in 1983, the Netherlands officially introduced ART in 1985. IVF Planning Decree was enacted to regulate the establishment of IVF centers, laying the foundation for ensuring that related medical practices and procedures remained lawful. Subsequent measures include guidelines, quality assurance indicators, and accreditation programs, all aimed at enhancing safety and quality in the operation of embryo laboratories. The Dutch approach to promoting user safety and service quality in IVF procedures, with ART policies designed to strengthen procedural regulation while keeping the medical profession autonomous, offers valuable insights for policymaking in Korea.
The US approach to managing the quality of public medical institutions that practice assisted reproductive technology (ART) relies not on direct government assessment but on a national surveillance system that, by making ART outcomes publicly available, prompts providers to improve their services voluntarily. The system also discloses whether each institution holds laboratory accreditation from a private professional association, creating further incentives for quality improvement. Intended to enhance social trust and encourage provider cooperation through data disclosure, the US quality management system differs significantly from Korea’s centralized approach. The US system, which respects clinical autonomy while providing users with transparent information, offers a meaningful model for Korea, where information available to users when choosing providers is limited and where cooperation from the medical field is greatly needed. In light of these considerations, Korea should actively consider expanding the scope of standardized data collection, disclosure, and utilization at the level of individual fertility treatment institutions.
This article examines the UK quality management system for medical institutions practicing assisted reproductive technology (ART) procedures and discusses its implications for policymaking in Korea. The survey of the system centers around the Human Fertilisation and Embryology Authority (HFEA), an independent entity responsible for managing the quality of procedures and treatments involving ART. Anchored in the Human Fertilisation and Embryology Act, the HFEA was established to regulate the full gamut of fertility treatment, gamete donation, and embryo research. Complementing the HFEA are the National Institute for Health and Care Excellence (NICE) and the Medicines and Healthcare Products Regulatory Agency (MHRA), responsible for clinical guidelines and the safety of medicines and medical devices, respectively, to form an integrated quality management system. The HFEA specifies statutory provisions, licensing conditions, and mandatory requirements through its Code of Practice, and enhances transparency and accountability by collecting and publishing treatment, outcome, and safety data through its register. This UK model, which links legal and regulatory structures with practical guidance and a registry, offers a useful reference framework for developing Korea’s quality management system for ART.
Meals on Wheels (MoW) in the United States is a leading home-delivered meal program that supports homebound older adults by providing nutritious meals and regular safety check-ins. Although MoW originally centered on meal delivery and basic wellbeing monitoring, it has expanded into an integrated service model that includes wellness activities, home repair and modification, pet assistance, and technology-based supports. MoW is seeing rising waitlists nationwide, and Meals on Wheels America highlights increased funding, provider capacity, and stronger public-private partnerships as key solutions. These shifts show that MoW is evolving beyond meal delivery into a broader community-based aging support system that enhances safety, social connection, housing stability, and digital access. This paper examines MoW’s structure, services, recent program expansions, and policy developments to highlight its role in community-based care.
This article examines how the U.S. Medicaid program, expanded under the Affordable Care Act (ACA), is being restructured through the Trump administration’s second-term budget legislation (the One Big, Beautiful Bill Act (OBBBA)). While large literature reports that ACA Medicaid expansion significantly improved access to care and health outcomes, OBBBA introduces stricter work requirements and eligibility rules that are expected to reduce coverage. As a result, the number of uninsured individuals is projected to increase substantially, alongside rising uncompensated care and greater strain on local health systems. This article reviews these developments to outline recent shifts in U.S. Medicaid policy.
Old-age income protection systems constitute the foundation of the welfare state, of which the quintessential component is the public pension system. However, amid shifts in the economic structure coupled with population aging, traditional pension policies have proven insufficient to achieve the goal of old-age income protection. In this context, public pension reform has been a staple of the US political agenda for well over a decade. In the process, the US has developed a wide variety of old-age income security programs, including private pension plans and tax-based welfare programs. This article discusses in depth the three pillars of the US old-age income protection system―Social Security, occupational pensions, and individual pension plans. Exploring at length the dynamics between these pillars and tax programs, this article examines old-age income security programs in the US and their characteristics that define the American welfare state as it is today, and draws implications for policymaking in Korea.
In the UK, with the multiple-birth rate soaring in the 1980s, concerns about maternal and infant health, along with rising public health expenditure, came to the forefront, prompting the government to implement various policy initiatives by the early 2000s to manage multifetal pregnancies. The National Institute for Clinical Excellence (NICE) adopted the Twin and Triplet Pregnancy Guideline and later introduced quality standards for pre- and postnatal care for multifetal pregnancies. Through its single-embryo transfer policy, the Human Fertilisation and Embryology Authority (HFEA) helped reduce the post-IVF multifetal pregnancy rate from 28.5 percent in 1991 to 3.4 percent in 2023. The National Health Service (NHS) implemented the Multiple Births Midwife program, which over the years has brought improvements to maternal and child health service delivery. Non-profit organizations, such as Twins Trust, have worked in collaboration with the NHS to enhance the management of maternal and child health through improved guidelines, education, and awareness campaigns. These efforts have enabled the UK to reduce multifetal pregnancies while maintaining an appropriate total fertility rate, making them a valuable source of insights and implications for Korea as it grapples with a high rate of multiple births.
