Fertility and false economies

TheStar.com – Opinion

Published On Wed Feb 10 2010.   By Thomas Walkom, National Affairs Columnist

Sometimes, spending money saves money. This is one of the counterintuitive truths behind publicly funded programs like medicare. A small payment now may create great benefits later.

That’s the case with an increasingly popular fertility procedure. In vitro fertilization (literally, fertilization in a glass) lets some women who cannot otherwise bear children have kids.

In Ontario, most of the roughly 4,300 IVF procedures performed annually are not covered by medicare – the rationale being that they are both medically unnecessary (strictly speaking, no one needs to have a child) and – at about $10,000 a shot – too pricey.

But an advisory group set up by the provincial government has concluded that this is the falsest of false economies. The expert panel on infertility and adoption reported last summer that Queen’s Park could save more than $400 million over the next decade by having its Ontario Health Insurance Program fund IVF procedures, plus an addition $300 million to $460 million over a longer period

It also concluded that over 10 years this would prevent about 9,000 kids from dying at birth.

The reason has to do with human behaviour. Each IVF cycle (which typically involves egg removal, fertilization and implantation of the embryo) typically costs about $10,000. To increase their chances of success and avoid the need for another pricey cycle, virtually all would-be IVF parents in Ontario have their doctors implant more than one embryo. This, in turn, increases the chances of twins, triplets or other multiple births.

Not that there’s anything wrong with twins or triplets. But multiple births do, on average, create health problems for mother and child.

For mothers, according to the expert panel, they result in more miscarriages, more infections and more postnatal depression.

For the children, there is a greater risk of long-term disability. Multiple-birth children are 17 times more likely to be born prematurely and underweight which, in turn, increases the probability of physical or developmental disabilities later.

On average, the panel says, the lifetime health-care and education costs incurred by a single low-birth-weight baby exceed $1 million.

Multiple births also increase the chance of both mother and baby dying during childbirth.

The panel’s answer is to have OHIP fund up to three cycles of in vitro fertilization for women under 42 and for the government to partially cover the cost of necessary drugs. This, it points out, is similar to measures already in place in countries like Belgium, Sweden and Australia. Quebec is going in the same direction.

In Europe, published clinical evidence shows that public funding of IVF has reduced the number of multiple births, thereby saving both lives and money.

The expert panel report was handed in last year to Deb Matthews, then minister of children and youth services. It is currently in the hands of the provincial health minister who, by coincidence, is the same Deb Matthews.

So far, she and Premier Dalton McGuinty have maintained strict radio silence on the possibility of funding IVF. A health ministry spokesperson will say only that the government is conducting a review of the panel’s recommendations and hopes to respond soon.

Given that health-care costs already account for 40 per cent of provincial spending, it’s understandable that the government is wary of expanding OHIP.

But in this case, it’s also misguided. Spending more now promises to save both lives and money. Could matters be any clearer?

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