Social Policy in Ontario

Ontario to cover in-vitro fertilization treatments

Posted on October 2, 2015 in Health Policy Context

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TheStar.com – News/Queen’s Park – Health Minister Eric Hoskins’ announcement Thursday makes Ontario the second province to cover costly programs for what is increasingly seen as an important medical issue.
Oct 01 2015.   By: Rob Ferguson, Queen’s Park Bureau

After years of pressure, Ontario has agreed to help infertile women under 43 get pregnant by paying for in vitro fertilization — but patients will still have to cover the cost of expensive drugs.

The new coverage will take effect in December at a cost of $50 million a year to taxpayers, providing one cycle of IVF to about 4,000 women annually regardless of sexual and gender orientation or family status.  That means singles, surrogates and same-sex couples will be eligible.

“Infertility is a serious medical issue,” Health Minister Eric Hoskins, a physician and father, said at an east-end child care centre Thursday, noting that families now come in many forms.  “It’s impossible to describe the joy that having a child brings to your life.”

Until now, Ontario has helped fund IVF only for women with blocked fallopian tubes.

Advocates said the new policy, which makes Ontario the only province outside Quebec to cover IVF treatments, will save many parents from deeper debt.

“There is an incredible cost,” said Sandra Alsaffawi-David of the IVF advocacy group Conceivable Dreams, who spoke of parents raiding RRSPs and running up credit cards to pay for treatments and medications to make the mother’s body receptive to the eggs.

About half of fertility problems involve men who have difficulties such as low sperm motility, she added.

One cycle of IVF costs about $10,000, with drugs adding thousands of dollars to the tab and sometimes hitting 40 per cent of the total cost, although the medicines are covered by some employer drug plans. One woman told the Star the bill for her first child was $30,000.

“IVF will remain a dream for some people because they can’t afford it,” said New Democrat MPP France Gélinas (Nickel Belt), her party’s health critic.  Nevertheless, she and others hailed the provincial coverage for IVF as a step forward despite concerns in some circles about the age limit and lack of restrictions.

“It’s the right thing to do, it’s good public health,” said Kerry Bowman of Mount Sinai Hospital and a bioethicist at the University of Toronto’s Dalla Lana School of Public Health.  “There are so many people out there having fertility trouble,” added Jeff Yurek, a Progressive Conservative MPP (Elgin-Middlesex-London).

Hoskins said the age limit was set following recommendations from an expert advisory panel.  “Once you pass the age of 43 the likelihood of success drops significantly,” he told reporters, defending the new spending at a time when opposition parties are criticizing the government for cuts to doctors’ pay and hospital nursing layoffs.  “The justification is to my right,” Hoskins said, pointing to toddlers playing on rocking horses and tiny slides.

Bowman warned the government could face a court challenge on the age limit, predicting “people are going to push back.”

Amir Attaran, a University of Ottawa scientist and law professor who was on the advisory panel, said the age limit could have been set lower to improve conception rates and provide better value for tax dollars.  “Would it be smarter to lower the age and give more people the opportunity? There really isn’t a right choice. This is a judgment call,” said Attaran, who also called on the government to pressure fertility drug companies for lower prices.
He and Bowman noted the odds against conception are extremely tough for the severely obese and questioned why specific limits weren’t set.

IVF in Ontario: By the numbers
$50 billion – Ontario’s annual health budget
$50 million – The budget for IVF treatment each year
ABOUT 4,000 – Number of women to be helped annually through the IVF program
UNDER 43 – The IVF program’s age restriction
30 per cent – Typical cost of one cycle of IVF
2 per cent – Rate of IVF live births in Ontario
1 in 6 – Ratio of families with fertility problems

However, the eligibility rules state women must speak to their doctor “to determine if IVF is the most appropriate family-building option,” which Bowman said may be a “code” to get around setting more stringent criteria.

Attaran said the program must be closely audited to make sure physicians are not giving patients “false hope” and called for this to be done by the Ontario Health Quality Council and not the self-regulatory body for doctors, the Ontario College of Physicians and Surgeons.

Hoskins said the government will now start negotiations with the 18 private fertility clinics in the province to pave the way for the program to start in two months.

It is open to Ontario residents with valid OHIP cards, but will be billed to clinics directly, not through the provincial health insurance plan.

Patients who are approved will be entitled to one cycle of treatment, defined as the retrieval of an egg or eggs, and the one-at-a-time transfer of all viable embryos to provide multiple chances for a pregnancy to develop.  This method, known as the “single embryo transfer” is designed to avoid the higher risks and health-care costs associated with multiple births of twins, triplets or more.

In Quebec, single embryo transfers reduced multiple births from 30 per cent to five per cent, Hoskins said.  Complications from multiple births include earlier deliveries, premature babies who sometimes land in neo-natal intensive care, potential development issues and longer hospital stays, along with greater susceptibility to illnesses like cerebral palsy.

It’s hoped that reducing multiple births will help offset the costs of offering the IVF treatments.

< http://www.thestar.com/news/queenspark/2015/10/01/ohip-to-cover-in-vitro-fertization-treatments.html >

Tags: budget, Health, ideology, mental Health, participation

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