Health: It just a matter of priorities – IVF and Autism

Before I start I know that this is going to be controversial … but hey … sometimes you need to be controversial to get people talking … and draw out problems in the system. Love to hear your opinions … including if you hate mine ūüôā

… I have chosen a¬†controversial¬†topic this time. And before I start … I actually do agree with IVF being partially funded (as it is today) … but if I had to be the health minister and I had to put my priorities lists together … well it would be lower down … and maybe that would mean it didn’t get funding. I just want to say that I do have tremendous sympathy for families with¬†infertility¬†issues and the street and heartache that this can cause … but I am sorry … but my sympathy is more for a family with a child with autism. A family that struggles everyday with their child with a medical condition that has no ‘real’ government funding … that may have to cash out their superannuation, get a second mortgage .. or just dry out their finances to pay for the required therapy … or worse … know what they need and just can’t afford it … and do what the government¬†institutions¬†offer which can be a 12 month wait for services that are at best less than 10% of the minimum requirement (as outline in the Government’s own guidelines). Why should IVF get unlimited funding … and autism gets left out in the cold?

In a previous post I started what I hope to be a series of posts showing comparisons between funding for Autism and other medical conditions. What I hope to show are the inequities that exist within the current system. I don’t believe that there should be a distinction between conditions dependent on whether they are treated by doctors, drugs and hospitals or by other health care professionals (ie Allied Health care professionals such a psychologists, Speech Pathologists and Occupational Therapists).¬†But in this post I am asking the question … should treatment for¬†infertility (IVF – in-vitro fertilisation)¬†be given priority (and therefore funding) over other conditions (like autism …. that currently doesn’t). Why should a condition that may have no health¬†detrimental¬†effect be given priority for funding (without cap) over a condition that effects every aspect of a person’s life and can be the difference between them living a full and independent life … or instutitionalised? Does it make a difference if the need for IVF is because of ‘lifestyle’ choices (whatever they maybe) … why should government funding (or health insurance funding) be provided for these treatments over autism … So for today’s post I am doing a comparison between IVF and Autism – government funding, health insurance funding … and everything in between.


What do we know about IVF?

  • In vitro fertilisation is the most common assisted reproductive technology in Australia, costing on average $7000 to $8000 a cycle. ¬†(SMH). However prices are not set it is not uncommon for costs to be over $10,000 per cycle dependent on the technologies used, prices for specialists and required drug therapies and unique health requirements. (Huggies)
  • IVF is the process of uniting a sperm and an egg together in a dish at a laboratory. Once the egg and sperm are united, they will be injected into the uterus via the cervix in the hopes that a pregnancy will occur. IVF is performed in cycles and each cycle involves 6 steps. Each time these six steps are completed, it is considered one cycle and one cycle is considered to be one attempt at achieving a pregnancy.(
  • Medicare subsidies for IVF tripled between 2003 and 2007 to $158.7 million, though they have since been restrained by new caps on entitlements last year.Under the new policy, patients and doctors said out-of-pocket costs doubled from about $1000 to $2000 a cycle. (SMH)
  • IVF is not means-tested under Medicare and there is not a limit on the number of cycles funded under Medicare. There is also no age limit or age cap.
  • According to a recent report by The Australian Institute of Health and Welfare report¬†in Australia and New Zealand in 2009¬†(AIHW)
    • there were 70,541 assisted reproductive technology (ART) treatment cycles undertaken in Australian and New Zealand. Of these cycles, 17.2% resulted in a live delivery (the birth of at least one liveborn baby).
    • The average age of women undergoing autologous (treatment cycle in which a woman intends to use or uses her own eggs)¬†cycles was 35.8 years.¬†One in four (26.8%) autologous ¬†fresh cycles undertaken in 2009 was in women aged 40 years or older.¬†Women of this age (40-45) using donor eggs where found to have 6.8% chance of live delivery from initiated cycle and women over 45 were found to have 0.5%¬†chance of live delivery from initiated cycle.
    • The average age of women undergoing treatment using donor oocytes/embryos was 40.8 years. Women of this age using donor eggs where found to have 8.3% chance of live delivery from initiated cycle.
    • For women aged 45 years or older, only one live delivery resulted from every 200 initiated cycles.

Therefore to bring it back to the simple numbers in 2009

  • For women aged 40 years – 45 years from the
    • Fresh 10771 cycles ¬†… it resulted in only 6.8% live births.
    • Thawed 4082 cycles ¬†… it resulted in only¬†9.7% live births.
    • Donor 765¬†cycles ¬†… it resulted in only 19% live births.
  • For women aged over 45 years
    • Fresh ¬†851¬†cycles … it resulted in¬†less than¬†0.5% live births
    • Thawed 290¬†cycles … it resulted in¬†only¬†¬†2.4%¬†live births.
    • Donor 570¬†cycles … it resulted in¬†only ¬†14.7%¬†live births.

What I am suggesting that while I have great sympathy for people who have difficulties with conception and I recognise that it is a medical issue that causes it … why should it get priority for funding with cap or measure ahead of conditions like Autism. Looking from a perspective of society as a whole is this a better investment with our health dollars. Different¬†research¬†projects have shown that early intervention is¬†extremely¬†effective in treating children with autism and that the return to society over the children’s lifetimes up to $2.5 million per child (future savings minus current costs).

“Our findings provide strong evidence that sustained high-quality early childhood programs can contribute to well-being for individuals and society,” said Arthur Reynolds, director of the Chicago Longitudinal Study and co-director of the Human Capital Research Collaborative at the University of Minnesota. “As public institutions are being pressed to cut costs, our findings suggest that increasing access to high-quality programs starting in preschool and continuing into the early grades is an efficient use of public resources.” (Science Daily)

I wish that there was enough funding for everything but their isn’t. I just can’t understand why should an expensive elective procedure with very low success rates like IVF gets preference over treatment for Autism …

Comparison Summary

Costs of therapy (per individual)

  • Autism – Approximately $60K per year (during early intervention years)
  • IVF – Costing on average $7000 to $8000 a cycle. Rates are not set and can be over than $10,000 per cycle for specialist treatment options.

Funding by Government (estimates for 2010-2011)

  • Autism – $47.5 million ($190 million over 4 years)
  • IVF $158.7 (2007) uncapped.

Funding to Individuals

  • Autism – up to $6000 per financial year with a lifetime cap of $12,000
  • IVF –¬†Approximately¬†$5000 per cycle under Medicare. There are no limits on the number of cycles per year and there are no lifetime limits on the number of cycles. Additional funding can be available under health insurance and together with Medicare may result in no out of pocket costs expenses.

Does this really seem fair?? I understand that health care decisions can be difficult … but if there is enough money to fund IVF … there should be more than enough to fund therapy for children with autism.

Photo:IVF BUB…. by Nina Matthews Photography, on Flickr Attribution 2.0 Generic (CC BY 2.0)

  • there is definitely a need for both! and I think it is very hard to compare because they are just totally different issues. It is not comparing apples with apples. Having gone through ivf myself, I am in the 25-30 age bracket, I can guarantee the statistics of success are much higher… obviously…. again, comparing it with women between 40-45 again is not apples and apples. And let me tell you, the emotional rollarcoaster, let alone the cost is unimaginable!

    I only hope for you sake that more funds and efforts are put into supporting children and families with autism. I hope in time things change. Believe me, I support more funding in this area, but comparing it to IVF may not be exactly fair. 

    • Thanks for visiting and your feedback.¬†

      I knew that this was going to be an emotional topic. I guess the hard part with health funding is that they have to compare things that aren’t the same and make decisions on where funding goes. Unfortunately the bucket is not limitless and some conditions miss out. At the moment Autism is one that slips through cracks. I guess the point of these comparisons is to show some situations that do have limitless accesses to funding, to compare and ask the difficult questions.¬†

      For children with autism treatment allows them the opportunity to enjoy some basic human skills Рlike communication (talking, listening & understanding), toileting, the ability to emulate (copy/imitate), self-care skills (dressing, eating) and independent living skills.  With therapy all of these are attainable. Therapy can mean the difference between integration into society and being in a home in a diaper with no interaction with the outside world. I know that sounds dramatic but it is within my lifetime that this would have been the norm. Therapy is the silver bullet. 

      While I haven’t personally done IVF I know many friends of mine who have and at different ages. I agree that it is both an expensive and draining exercise. And while I agree that infertility is a medical condition and the desire that all families have to have children, however treatment is optional. ¬†While it may not feel like it … it is. And the success rates are low. Even for the under 35 age group (they didn’t do specifically under 30 in the study so this is the best I could get)¬†Live deliveries per embryo transfer cycle – fresh 28.4% thawed 20.7% & donor 21%. And this was the best age group.¬†¬†

      At the moment the funding for IVF is is not capped per person, the number of cycles completed or the age of either parent. It is not even limited by the potential success of the transfer. Thereby a 45 year old with a less than 1% chance of a successful birth will get funding. It¬†just¬†doesn’t seem fair. And can you imagine the outcry if it had the same limitations put on it as Autism (maximum $12,000 for life and no more than $6000 per financial year). Things would go nuts.¬†

      I want people to ask questions … to compare with other non-related health conditions … to ask why does something get funding. I am convinced that if a drug came out for autism that costs double what we pay per year it would get funded. Autism misses out because the current treatment is about therapy by allied¬†professionals¬†and not doctors, drugs and hospitals. It has nothing to do with the cost, how effective the therapy is or how much benefit it brings to the person, families and to the community as a whole.¬†

      Thanks again for visiting and contributing to the discussion.