Who should pay for assisted reproductive techniques? Answers from patients, professionals and the general public in Germany.
BACKGROUND
Financing ART is variously regulated in the different countries of Europe. In Germany, coverage of assisted reproduction by statutory health insurances was restricted to 50% in 2004. We conducted a national survey among patients, professionals (physicians and other academics in IVF centres, psychosocial counsellors, medical ethicists, social lawyers, health politicians) and the general public in Germany regarding their opinions on financing ART.


METHODS
Standard questionnaire techniques (paper and pencil interviewing, computer-aided web interviewing, computer-aided telephone interviewing) were used.


RESULTS
The vast majority of all groups supported public coverage of ART. Co-payments by patients were considered appropriate by about one-third of the patients, two-third of the physicians and three quarters of all other groups. According to the respondents, the amount of co-payment should cover 15-25% of the costs, considerably less than what patients actually have to pay (50%). Support for public coverage was strongly correlated with the views (i) of infertility as a disease, (ii) that there is a need for assisted reproduction for infertile couples and (iii) that every human should have the opportunity to have children. The respondents had varying opinions on whether to increase medical insurance premiums in order to cover ART. Reducing services in other areas of health care in favour of reproductive medicine was supported only by the group of reproductive physicians. Financial incentives for oocyte sharing were rejected by most groups as was a money-back guarantee for unsuccessful treatments.


CONCLUSIONS
Experts and the general public in Germany accept moderate co-payments for ART. No clear pattern of opinion emerged regarding the question of how public co-funding should be financed.
Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Markstr. 258a, D-44799 Bochum, Germany. oliver.rauprich@rub.de
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Rauprich
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Berns
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Vollmann
D003625:Data Collection; D005260:Female; D005382:Financing, Personal / Q000191:economics; D005858:Germany; D006282:Health Personnel; D006801:Humans; D007246:Infertility / Q000191:economics / Q000628:therapy; D019458:Insurance Coverage / Q000191:economics; D008297:Male; D009313:National Health Programs / Q000191:economics; D010361:Patients; D011247:Pregnancy; D011639:Public Opinion; D027724:Reproductive Techniques, Assisted / Q000191:economics*; D011795:Surveys and Questionnaires