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Public Financing of IVF: A Review of Policy Rationales

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Abstract

There is great diversity in in vitro fertilization (IVF) funding and reimbursement policies and practice throughout Europe and the rest of the world. While many existing reimbursement and regulatory frameworks address safety and legal concerns, economic factors also assume a central role. However, there are several problems with the evidence that is available on the economics of IVF. This suggests there is a need for more robust cost-effectiveness studies. It also indicates the need for alternative rationales to justify the reimbursement of IVF, which might more fully account for the social, political, ethical, and philosophical considerations embedded in notions of infertility and technology-driven reproductive treatments. The merits and limitations of five alternative rationales are discussed. The review suggests that while no existing single rationale provides a complete framework with which to support funding decisions, taken together they provide guideposts which signal important issues for consideration and highlight where further research, action, and debate are needed.

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Notes

  1. Other ART treatments include intra cyto-plasmic sperm injection (ICSI), frozen embryo replacement (FER), egg donation (ED), in vitro maturation (IVM), and preimplantation genetic diagnosis/screening (PGD/PGS).

  2. WTP places the relative benefits of a treatment in monetary, rather than health-related, terms.

  3. There may be other, ethical, reasons for excluding ‘socially infertile’ women from IVF treatment. For example, Sect. 13(5) of the UK Human Fertilization and Embryology Act 1990 states that: “a woman shall not be provided with treatment services unless account has been taken of the welfare of the child who may be born as a result of the treatment (including the need of that child for a father), and of any other child who may be affected by the birth”.

  4. It is not clear whether the survey distinguished between the cost of three successful cycles as compared to the cost of a successful hip replacement or simply the unit cost. If only the unit cost was used, the ‘real’ cost of IVF was probably seriously under-estimated as compared to the cost of a hip replacement.

  5. FINRRAGE is opposed to genetic research which, they argue, promotes the commodification of life and a ‘new’ eugenics seeking to create perfect ‘designer’ children. It is, however, beyond the scope of this article to discuss the arguments for and against genetic research.

  6. The main policies that have been employed by governments to address population ageing can be divided into two groups: 1) demographic policies, specifically immigration and family support measures aimed at increasing fertility and 2) welfare-related policies, such as increasing labour force participation, raising the age of retirement, and reducing public pension benefits [4].

  7. The low fertility trap entails a country’s TFR falling to less than 1.5, causing a relatively rapid decline in the birth rate, as the small cohorts born in many European countries since the mid 1980 s reach reproductive age.

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Acknowledgments

The authors are grateful to the anonymous referees for their helpful comments and suggestions and to Elias Mossialos and Harald Schmidt for their input into certain sections of the article. Part of this article is based on research undertaken for a project funded by the European Commission, DG Employment, Social Affairs and Equal Opportunities, on health status and living conditions in the EU, Contract No. VC/2005/0781. All the views expressed are the authors’ own.

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    Philipa Mladovsky & Corinna Sorenson

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Mladovsky, P., Sorenson, C. Public Financing of IVF: A Review of Policy Rationales. Health Care Anal 18, 113–128 (2010). https://doi.org/10.1007/s10728-009-0114-3

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