a reduction in public funding for fertility treatment - an econometric analysis of access to treatment and savings to government公共资金的减少生育治疗,获得治疗的计量经济学分析,政府储蓄.pdfVIP

Chambers et al. BMC Health Services Research 2012, 12:142 /1472-6963/12/142 RESEARCH ARTICLE Open Access A reduction in public funding for fertility treatment - an econometric analysis of access to treatment and savings to government Georgina M Chambers1*†, Van Phuong Hoang1†, Rong Zhu2† and Peter J Illingworth3† Abstract Background: Almost all assisted reproductive technology (ART) and intrauterine insemination (IUI) treatments performed in Australia are subsidized through the Australian Government’s universal insurance scheme, Medicare. In 2010 restrictions on the amount Medicare paid in benefits for these treatments were introduced, increasing patient out-of-pocket payments for fresh and frozen embryo ART cycles and IUI. The aim of this study was to evaluate the impact of the policy on access to treatment, savings in Medicare benefits and the number of ART conceived children not born. Methods: Pooled quarterly cross-sectional Medicare data from 2007 and 2011 where used to construct a series of Ordinary Least Squares (OLS) regression models to evaluate the impact of the policy on access to treatment by women of different ages. Government savings in the 12 months after the policy was calculated as the difference between the predicted and observed Medicare benefits paid. Results: After controlling for underlying time trends and unobserved factors the policy change reduced the number of fresh embryo cycles by almost 8600 cycles over 12 months (a 16% reduction in cycles, p 0.001). The policy effect was greatest on women aged 40 years and older (38% reduction in cycles, p 0.001). Younger women engaged in relatively more anticipatory behaviour by bringing forward their fresh cycles to 2009. Frozen embryo cycles, which are approximately one quarter of the cost of a fresh cycle, were only marginally impacted by the