A reduction in public funding for fertility treatment - an econometric analysis of access to treatment and savings to government

Abstract

BackgroundAlmost all assisted reproductive technology (ART) and intrauterine insemination (IUI) treatments performed in Australia are subsidized through the Australian Government’s universal insurance scheme, Medicare. In 2010 restrictions on the amount Medicare paid in benefits for these treatments were introduced, increasing patient out-of-pocket payments for fresh and frozen embryo ART cycles and IUI. The aim of this study was to evaluate the impact of the policy on access to treatment, savings in Medicare benefits and the number of ART conceived children not born.MethodsPooled quarterly cross-sectional Medicare data from 2007 and 2011 where used to construct a series of Ordinary Least Squares (OLS) regression models to evaluate the impact of the policy on access to treatment by women of different ages. Government savings in the 12 months after the policy was calculated as the difference between the predicted and observed Medicare benefits paid.ResultsAfter controlling for underlying time trends and unobserved factors the policy change reduced the number of fresh embryo cycles by almost 8600 cycles over 12 months (a 16% reduction in cycles, p < 0.001). The policy effect was greatest on women aged 40 years and older (38% reduction in cycles, p < 0.001). Younger women engaged in relatively more anticipatory behaviour by bringing forward their fresh cycles to 2009. Frozen embryo cycles, which are approximately one quarter of the cost of a fresh cycle, were only marginally impacted by the policy. Utilisation of IUI cycles were not impacted by the policy. After adjusting for anticipatory behaviour, $76 million in Medicare benefits was saved in the 12 months after the policy change (0.47% of annual Medicare benefits). Between 1200 and 1500 ART conceived children were not born in 2010 as a consequence of the policy.ConclusionsThe introduction of the policy resulted in a significant reduction in fresh ART cycles in the first 15 months after its introduction. Further evaluation on the long term impact of the policy with regard access to treatment and on clinical practice, particularly the number of embryos transferred, is crucial to ensuring equitable access to fertility treatment and the health and welfare of ART children.

Assisted reproductive technology in Australia and New Zealand: cumulative live birth rates as measures of success

“…Almost all ART treatment is eligible for partial re‐imbursement by Medicare, without limitations on the number of cycles or the woman's age. The cost of fresh stimulated ART cycles is estimated to be about $10 000, of which $6000–7000 is reimbursed by Medicare 18 . Several studies have found that the out‐of‐pocket cost of ART treatment for patients influences the number of embryos transferred: higher out‐of‐pockets costs encourage multiple embryo transfers to maximise pregnancy rates with fewer funded cycles 19 , 20 .…”

Who Pays? Mandated Insurance Coverage for Assisted Reproductive Technology

“…There are large numbers of children without homes, children whose adoption would, in most cases, improve their lives [11]. In addition to being more accessible and affordable than ART, adoption brings with it the social good of giving a child who is without parents a chance to grow up in a loving home and reduces governmental expenditures for that child's support [8].…”

“…A number of scholars have also argued that mandating insurance coverage reduces the risks associated with ART and, in the long run, cuts costs that arise from the incentive infertility clinics have to increase the live-birth rate by implanting large numbers of embryos per IVF cycle [8,15,20]. Successful implantation of multiple embryos means the woman requires more monitoring during pregnancy and is more likely to have a preterm delivery, while the infants are at increased risk for complications ranging from cerebral palsy to neurological problems [21].…”

Expectations and experiences of midlife intending mothers engaging with Assisted Reproductive Technology

“…The EMSN benefit was intended to be a patient benefit; it was not intended to be a mechanism for doctors to increase their fees (Australian . Following the introduction of the EMSN, infertility clinics increased fees for a stimulated cycle from $3269 to $4089 per cycle (Metherell, 2005 (Chambers et al, 2012a;Chambers, Van Phong, Zhu, & Illingworth, 2012b;Robotham, 2010). The changes resulted in a significant decline in the number of women having IVF cycles in particular among women 40 years or older (Chambers et al, 2012a).…”

“…Following the introduction of the EMSN, infertility clinics increased fees for a stimulated cycle from $3269 to $4089 per cycle (Metherell, 2005 (Chambers et al, 2012a;Chambers, Van Phong, Zhu, & Illingworth, 2012b;Robotham, 2010). The changes resulted in a significant decline in the number of women having IVF cycles in particular among women 40 years or older (Chambers et al, 2012a). The 21-25% decrease in the number of women of all ages accessing IVF suggests that the additional out-of-pocket expense of approximately $2500 was financially prohibitive for many couples (Chambers, Hoang, & Illingworth, 2013b).…”