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The death of Denmark's public ART funding

28 June 2010
By Dr Søren Ziebe
Chief biologist and Laboratory director, The Fertility Clinic, Rigshospitalet, University Hospital of Copenhage
Appeared in BioNews 564
A majority coalition between the Danish Government and another parliamentary party - Dansk Folkeparti - has decided to cut funding for public Assisted Reproductive Technology (ART) treatment. By doing so, the Government expects to save 200 million Danish kroner (approx £25 million) next year - equivalent to around 0.25 per cent of Denmark's national health budget.

At present, the Danish Government has only decided that they will cut public ART funding by 80 per cent, but not how they will do it. Will it only affect public fertility clinics? Or will it also affect diagnostic tests and analysis? We don't know. The Danish Government has, however, reserved the remaining 20 per cent of the current funding (approx six million GBP) to avoid any 'negative consequences' of their decision.

Public infertility treatment in Denmark makes up a significant fraction of all infertility care. It is currently supplied by nine public clinics, which perform approximately 55 per cent of all ART treatments, and 12 private clinics that carry out the remaining 45 per cent. Almost all ART research and professional education is done by the public clinics.

Provided couples don't already have a child together, they can currently receive up to three complete cycles of Government-funded IVF. On top of this, all patients - including those attending private clinics - can be reimbursed for 75 per cent of the cost of hormones and there are also publicly funded IUI programs.

In total, around two children in each Danish school class was conceived using some form of ART and Danish fertility clinics are involved in the birth of eight per cent of children born each year. So ART in Denmark has a substantial impact on the population.

It is, therefore, extremely troubling that the Government has chosen to play roulette with Danish fertility by introducing 100 per cent patient payment for ART in public clinics. Where patient co-payment has been introduced elsewhere in Europe, it has been a disaster.

Germany introduced 50 per cent co-payment in 2003 - the result was a dramatic and persistent drop in the number of ART cycles performed. In Norway, a system of patient co-payment was dropped after just seven months. I anticipate an even bigger drop than in Germany with a direct impact on the Danish birth cohort.

Facing a scenario where patients will have to pay for ART treatments in full, it is only fair to also expect a huge drop in the number of patients participating in research at clinics. Denmark has, for many years, been very active in scientific ART research - per capita it is one of the most productive countries in the world. Much of this research aims to develop safer and better patient treatments. One of the major reasons for this high level of research is that patients are much more willing to participate in trials if they are receiving treatment for free.

Patients are also extremely concerned about the cut in funding. A newly organised Facebook group already has more than 31,000 members and this number is increasing all the time.

Denmark - like most other European countries - needs investment in fertility treatments, not cuts. RAND published a study showing ART techniques earn a net income to society of £130,000 per child. So there is a lot to gain financially from offering ART, but you need to look further forward than one fiscal year or election term.

In Denmark, we may be going from the best system in the world to the worst. No other country in Western Europe has 100 per cent patient payment in public ART clinics. Given the current world financial situation, where Denmark has led, other European countries may follow. This will have severe consequences for the childless couples and the rest of us.

 
SOURCES & REFERENCES
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