Funding ART in Québec is highly justified and ethical use of public funds, says IAAC

Following the announcement on July 13 by Québec's Minister of Health and Social Services, Dr. Yves Bolduc, that assisted reproduction treatments (ART) will be covered by the public health system of Québec as of August 5, 2010, many comments have been made about how this new policy will stress the public health system, and neonatology units in particular.

The Infertility Awareness Association of Canada (IAAC), which advocated for the new law on behalf of infertile couples throughout the country, would like to clarify that, in addition to the benefit of the birth of a child for an additional 1,655 couples per year in Québec, where the birth rate is low, the new measure will clearly translate into savings for the public health system.

The following conclusions have been reached based on a Canadian study, namely, Too early ... too small, released in 2009 by the Canadian Institute for Health Information.

The new Québec program, which includes a single embryo transfer policy, will actually result in savings for Quebec tax payers due to an 83% reduction in multiple birth pregnancies: 77% fewer twins and 95% fewer triplets. In addition, there will be 1368 fewer low birth weight babies.

The savings which will be realized as a result of reducing multiple births down to 5%, as indicated by Bolduc, are as follows:

- Annual savings of at least $27 - $36 million in perinatal hospitalization costs related to the birth of premature multiples. - Annual savings of $15 - $18 million in post-natal health costs for the first year of care for surviving low birth weight multiples. - Annual savings of $46 - $60 million in long-term health and social services costs of caring for children with permanent disabilities as a result of pre-term birth.

Lindy Forte, MSc and Health Economics Analyst concluded in her paper thus:

- The full expense of funding Quebec's IVF program ($35 - $71 million annually in the first 5 years) will be completely offset each year by savings in hospitalization, post-natal healthcare, and long-term disability costs related to the care of low birth weight multiples. - The above figures are conservative in that they do not include the tax revenue lost when a parent of multiple babies leaves the work force to care for their children or the cost associated with the added stress of caring for children with permanent disabilities.

At the moment, women undergoing IVF, either in Canada or abroad, are often having two or more embryos implanted. The high cost of the procedure encourages them to do so, since they hope that implanting a higher number of embryos will either maximize their chances of conceiving and/or allow them to create their new family all at once. This, in spite of substantial medical risks for their babies and themselves.

When he made his announcement, Dr. Bolduc was right to point out that the new Act makes Québec the first place in North America to cover assisted reproduction treatments. However, elsewhere in the world, an increasing number of countries have been offering extensive and often complete coverage for ART through public healthcare. Historically, countries such as France, Belgium, Sweden, the United Kingdom and Israel were quick to offer partial or complete coverage of ART within their national healthcare plans. Other countries such as Slovenia, Croatia, and Turkey have started to publicly fund ART to some extent over the past decade. Reducing the costs of multiple pregnancy was the driving force behind the introduction of public-funding for ART in Belgium and in Quebec as well.

In view of these data, IAAC wishes to convey that funding ART is both a highly justified and ethical use of public funds.