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Saying 'no' to the funding of assisted reproduction services in Québec

25 May 2010

By Professor Abby Lippman

McGill University, Montreal, Québec, Canada; member of Fédération du Québec pour le planning des naissances (FQPN)

Appeared in BioNews 560
On 24 March 2010, the Québec Minister of Health and Social Services published two sets of regulations related to assisted reproduction. One specified how the government will supervise clinical and research activities (e.g. IVF); the other laid out the terms for publicly funding these activities. These regulations complement Bill 26 (adopted in June 2009) that approved the public funding of assisted reproduction, a promise by the Liberal government in the last provincial election.

Once the regulations were posted, there was a 45 calendar-day limit for the posting of comments. Such a limited 'consultation' period could guarantee neither dialogue nor concrete change. And, to date, no true public debate has occurred over whether or not assisted reproduction services should be publicly funded.

The Fédération du Québec pour le planning des naissances (FQPN) is - among other groups - opposed to the adoption of the proposed regulations for a number of reasons. Perhaps the most important of these are concerns about how they will divert public funding from essential medical services and further privatise our health care system.

At the same time as it was planning to allocate $80 Million per year (after the first year) of public funds to assisted reproduction - a service that relies on high-technology-based practices to benefit the few - the Charest government was suggesting the possibility of imposing retrogressive user fees for basic health services on all Québecers. The government's willingness to divert taxpayers' money into assisted reproduction services is especially baffling when scarce funding means pregnant women across Québec increasingly lack access to family practitioners, obstetricians, and midwives. Moreover, the government has not even proposed funding for less technologically-intensive ways of preventing infertility. We must ask if the government's choice to finance IVF for some is truly a priority when the health of the general population will be put at risk if the proposed user fees are enacted.

The published regulations also suggest that public funding will cover a much broader set of activities than originally announced when Bill 26 was passed. In 2009, the government said that public funds would cover up to three cycles of IVF. Yet the March 2010 regulations state that, depending on the techniques used, public funds will cover up to six cycles of IVF as well as all related services, such as freezing sperm for an indefinite period of time. They also include funding for poorly-defined research activities and experimental techniques. Worse still, the measures to be used for supervising all of these activities are fragmentary and gravely incomplete.

Secondly, as written, the proposed regulations threaten the separation of public and private health care, something fundamental to the integrity of our universal health care system. For example, the ambiguity in the regulations suggests that there could be public payment for IVF performed in a private facility by physicians who do not participate in the public regime (RAMQ). In other words, non-participating physicians could be fully insured and compensated using public funding. If so, this would seem to contravene the law on health insurance which precludes the use of RAMQ funds to pay non-participating physicians. The regulations are also unclear as to whether physicians in the public system will be able to charge individuals privately for further IVF treatments if their first three to six attempts are unsuccessful.

Regardless of one's views on assisted reproduction, the regulations published in March can only be seen as incomplete, unclear, and inadequate - and certainly fail to justify the considerable amount of public funding to be allocated to these practices. To protect our already fragile universal health care system, the FQPN encourages the public to voice its disapproval of these regulations and of the funding of assisted reproduction at this time.

 

RELATED ARTICLES FROM THE BIONEWS ARCHIVE

05 June 2010 - by Dr Nadeem Shaikh 
Political consensus in Denmark has resulted in an amendment to legislation governing IVF funding. According to the European Society of Human Reproduction and Embryology (ESHRE), free public health services will no longer extend towards assisted reproduction treatments (ART).... [Read More]
01 June 2010 - by Louise Mallon 
In response to claims that assisted reproductive technology (ART) suffers from a lack of oversight, the American Society of Reproductive Medicine (ASRM) has said that: 'ART is already one of the most regulated medical procedures in the United States'.... [Read More]

14 March 2010 - by Rosie Beauchamp 
Yves Bolduc, the Minister for Health in Quebec, Canada, has announced plans to introduce free fertility treatment through the extension of Medicare coverage. This move will fulfil Premier Jean Charest's 2008 campaign promise... [Read More]
22 February 2010 - by Dr Nadeem Shaikh 
Sixty infertile couples protested on Canada's annual Family Day holiday against a lack of provincial government funding for IVF treatment. The February rally was organised by the group Conceivable Dreams, which represents 1,100 infertile couples who say they are suffering because the government refuses to help them.... [Read More]

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