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Rationing fertility services in the NHS: A Policy Statement
May 2000
The provision of specialist medical services in society is influenced
by an assessment of the health needs of the population as a whole
(demand), the resources allocated for the purpose (supply), and
importantly the potential for health gain through medical intervention
(clinical effectiveness). Rationing, whereby potentially beneficial
health care may be withheld for financial or organisational reasons,
presents an ethical problem that has been at the heart of state
financing of medical care since the inception of the NHS. Rationing
of health care resources leads to tension for providers of healthcare
between a concern to benefit the maximum number of stakeholders
in society and a desire to respond to the needs of individuals.
Most would acknowledge that the purist view that, irrespective of
cost, the best possible treatment should be available for all patients,
is not attainable.
The proportion of our national gross domestic product that should
be invested in the provision of state funded health care is a matter
of continued political debate. The Society welcomes the recent increase
in NHS funding announced by the Chancellor, and with other professional
bodies would wish the trend towards equality of resource allocation
throughout Europe to continue.
The consequences for patients of inadequate investment to provide
universal funding for care, in any branch of medicine, are either
to access alternative providers of care in the private sector, or,
for those with insufficient personal resources to meet the high
costs of such alternatives, denial of access to treatment. While
neither of these options is desirable it is accepted that private
and state funded healthcare are complementary.
It is generally acknowledged that the management of infertility
represents a healthcare need and that effective treatments are now
available. While these include long established treatment modalities
such as ovulation induction, donor insemination and surgical treatment
of endometriosis, assisted conception techniques including in vitro
fertilisation are now recognised as effective interventions. If
universal health care funding is unattainable, establishing justice
in determining the relative merits of one form of medical treatment
over another presents a problem. Commissioners of health care are
required to prioritise among diverse medical areas. Robust, objective
and transparent mechanisms, free of personal bias, should inform
such policy decisions. It would be desirable for representation
of all stakeholders in bodies making such decisions, and that they
should be accountable for their actions. The Society, which includes
over 900 clinicians, scientists, nurses and counsellors, and in
addition has formal patient representation on committee, would welcome
the opportunity to take part in any discussions with the Department
of Health concerning this important issue.
Specifically with respect to infertility services, the policy of
central government to devolve decisions on funding treatment to
local commissioners has led to inequalities in access to care across
the country. Recent surveys have highlighted the large variation
throughout the country of access to NHS-funded IVF, ranging from
no provision to virtually unlimited treatment. If it is accepted
that not all will have access to treatment within a defined population,
in the pursuit of equity and justice, agreed UK criteria should
be developed and applied in assigning prioritisation among couples
needing IVF. In Scotland, certain criteria, both medical (with reference
to effectiveness of treatment, incorporating factors such as female
age and number of treatment cycle carried out previously) and social
(responsibility for any other children) have been devised and recommended
by the Department of Health to Regional Health Boards. These may
be a model for a national UK policy in this difficult area1.
Reference
- Department of Health in Scotland. Evidence and Equity: A National Service Framework for the Care of the Infertile in Scotland. (2000) www.show.scot.nhs.uk/publications/ME/eagiss
For more information: please contact the British Fertility Society press office
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