Public funding increases access to Assisted Reproductive Technology

Researchers: Martin Keane, Dr Jean Long, Dr Gerald O’Nolan, Louise Farragher, HRB Evidence Centre

In summary

One in six couples experiences problems with fertility, and in some cases Assisted Reproductive Technology (ART) can help couples to have a baby. The Department of Health is considering whether to provide public funding for ART and what form this funding, if approved, might take. To help in their considerations, the Department asked the HRB Evidence Centre to review the literature on ART funding and access in other countries. The findings will inform the development of policy on ART in Ireland.

The problem

The Department of Health is considering whether to provide public funding for ART, which applies laboratory or clinical technology to human eggs or sperm and/or embryos for the purposes of reproduction, and requested a study of funding schemes internationally.

The project

The HRB carried out a systematic review of the international literature about public funding mechanisms for ART, the costs and benefits and the criteria, rationale and clinical evidence for accessing such publicly funded ART services.

The outcomes

We now know that, for the countries included in the review:

  • Full public funding for ART is available in six countries in Europe and in Israel, New Zealand and Ontario (Canada). Within Europe 19 countries offer partial public funding and Australia provides partial funding.
  • Public funding for ART can increase access and the overall economic cost to society is relatively modest in the context of public spending from the overall health budget.
  • Since 2008, the number of countries providing public funding for ART has increased, but individual countries’ level of public funding has decreased and out-ofpocket payments have increased.
  • Criteria used to determine access to funded ART are clinical and social, and national policies are a hybrid of political, cultural and economic pressure combined with clinical evidence.
  • The HRB report is contributing directly to Oireachtas debates and policymaking in Ireland on assisted human reproduction and associated areas of research.

Dr Gerald O’Nolan, Researcher at the HRB Evidence Unit, says: “ The pressure on those seeking fertility treatment, due to its cost in relation to average take-home pay, is immense, particularly for lower income groups. From the HRB analysis we can see that partial or full public funding of ART can help to support more clinically and economically beneficial procedures and outcomes. The report is now helping to shape Government discussion and policy on assisted human reproduction in Ireland.”