title: Socioeconomic disparities in access to ART treatment and the differential impact of a policy that increased consumer costs.
abstract: OBJECTIVE
  What was the impact on access to assisted reproductive technology (ART) treatment by different socioeconomic status (SES) groups after the introduction of a policy that increased patient out-of-pocket costs?
  
  
  CONCLUSIONS
  After the introduction of a policy that increased out-of-pocket costs in Australia, all SES groups experienced a similar percentage reduction in fresh ART cycles per 1000 women of reproductive age. Higher SES groups experienced a progressively greater reduction in absolute numbers of fresh ART cycles due to existing higher levels of utilization.
  
  
  BACKGROUND
  Australia has supportive public funding arrangements for ARTs. Policies that substantially increase out-of-pocket costs for ART treatment create financial barriers to access and an overall reduction in utilization. Data from the USA suggests that disparities exist in access to ART treatment based on ethnicity, education level and income.
  
  
  METHODS
  Time series analysis of utilization of ART, intrauterine insemination (IUI) and clomiphene citrate by women from varying SES groups before and after the introduction of a change in the level of public funding for ART.
  
  
  METHODS
  Women undertaking fertility treatment in Australia between 2007 and 2010.
  
  
  RESULTS
  Women from higher SES quintiles use more ART treatment than those in lower SES quintiles, which likely reflects a greater ability to pay for treatment and a greater need for ART treatment as indicated by the trend to later childbearing. In 2009, 10.13 and 5.17 fresh ART cycles per 1000 women of reproductive age were performed in women in the highest and lowest SES quintiles respectively. In the 12 months after the introduction of a policy that increased out-of-pocket costs from ∼$1500 Australian dollars (€1000) to ∼$2500 (€1670) for a fresh IVF cycle, there was a 21-25% reduction in fresh ART cycles across all SES quintiles. The absolute reduction in fresh ART cycles in the highest SES quintile was double that in the lowest SES quintile.
  
  
  CONCLUSIONS
  In this study, SES was based on the average relative socioeconomic advantage and disadvantage of small geographic areas, and therefore may not reflect the SES of an individual. Additionally, the policy impact was limited to the 12 months following its introduction, and may not reflect longer term trends in ART treatment.
  
  
  CONCLUSIONS
  While financial barriers are an important obstacle to equitable access to ARTs, socioeconomic differences in utilization are likely to persist in countries with supportive public funding, due in part to differences in childbearing patterns and treatment seeking behaviour. Policy makers should be informed of the impact that changes in the level of cost subsidization have on access to ART treatment by different socioeconomic groups.
  
  
  BACKGROUND
  G.M.C. receives grant support to her institution from the Australian Government, Australian Research Council (ARC) Linkage Grant No LP1002165; ARC Linkage Grant Partner Organisations are IVFAustralia, Melbourne IVF and Queensland Fertility Group. V.P.H. is employed as an Economics Research Associate on the same grant. P.J.I. is Medical Director of the IVF Clinic, IVFAustralia and has a financial interest in the parent group, Virtus.
  
  
  BACKGROUND
  N/A.
authors.affiliation: National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health, University of New South Wales (UNSW), Level 2, McNevin Dickson Building, Randwick Hospitals Campus, Sydney 2031 Australia.
authors.forename: G M
authors.initials: GM
authors.lastname: Chambers
authors.forename: V P
authors.initials: VP
authors.lastname: Hoang
authors.forename: P J
authors.initials: PJ
authors.lastname: Illingworth
mesh_terms: D000328:Adult; D001315:Australia; D002996:Clomiphene / Q000627:therapeutic use; D005260:Female; D005102:Health Expenditures / Q000331:legislation & jurisprudence*; D006297:Health Services Accessibility; D006801:Humans; D007315:Insemination, Artificial; D009313:National Health Programs; D027724:Reproductive Techniques, Assisted; D012959:Socioeconomic Factors
chemical_list: D002996:Clomiphene
keywords: assisted reproductive techniques; health economics; health policy; healthcare disparities