I’ve come across a couple of new items that also address questions about the cost of IVF in particular, perhaps ART more generally. I thought I’d add them in to the conversation around this earlier post.
First, also thanks to The Spin Doctor, is this column from Canada. It’s actually a columnist’s opinion piece from The Globe and Mail, one of Canada’s national newspapers. It’s a consideration of the Quebec provincial policy of paying for IVF.
It seems the idea, at least in part, was that this might be a cost-effective move. Here’s how the theory would go. If people pay for their own IFV, they might transfer two or more embryos, hoping that at least one would take. This increases the likelihood a multiple–twins, triplets, etc. Once the children are born, the state is responsible for medical care. And medical care for multiples can be quite extensive.
If instead the state pays for IVF it can condition payment on transfer of a single embryo. While it is still possible that there will be twins, triplets, etc., it is far less likely. Hence, though the IVF is expensive, the overall cost of care may be lowered.
The columnist disputes this argument and you should read the piece to see how he makes his case. Part of his conclusion, though, is pertinent to the earlier discussion here.
As we undertake reforms of medicare to make it more cost-effective and fair, a distinction needs to be made between medically necessary services that should be covered by public insurance and other “frills” (for lack of a better word) that should be covered out-of-pocket, by private insurance or some other means.
Infertility can be a medical condition but helping women get pregnant with high-tech methods like IVF is not a medically necessary service that should be covered by medicare.
This is not to suggest that funding in vitro fertilization is not a legitimate social program that the state might choose to support for other reasons – compassion, a desire to increase the birth rate, an attempt to reduce multiple births, etc.
Let’s just be clear about the distinction between what is medically necessary and what is socially desirable.
Again the question of what medically necessary means and why it might matter. (I suppose I could note as an aside that much insurance pays for Viagra and I could make an argument that it isn’t medically necessary either.)
Closer to home, here’s a note from the ASRM. Legislation has been introduced that would allow a tax credit for certain types of fertility procedures. The credit would be available for procedures that allow a person to preserve fertility before other medical treatment. I think this probably means things like freezing eggs before chemotherapy and things like that.
The tax credit idea is modelled on the tax credit you get for adoption. But there may be an important distinction. We subsidize adoption because it is good for the kids who are adopted. These are already existing kids. Fertility procedures do something different.
This is not to say the legislation isn’t a good idea. But it should be considered as a government subsidy and the question is whether this is an activity the government ought to subsidize.
Once again, food for thought.