Wednesday, July 11, 2012

Why is IVF treatment so expensive ?

I often see lots of infertile patients who could get pregnant if they did IVF treatment. Unfortunately , they just cannot afford to do an IVF cycle for financial reasons, as a result of which  they end up without a baby. Imagine the amount of heartburn and frustration this causes – when you know that you can get pregnant with IVF, but that you will not be able to do so because you can't afford the treatment !

This causes a lot of anguish for IVF specialists as well. It’s heartbreaking when you know that you have a medical solution , but you cannot offer it to the patient because they cannot afford it. Of course, this is not something which is unique to India - it applies all across the world . The question we need to ask ourselves is – What can we do to make IVF more affordable ?

In India, it would make a big difference if the government accepted the fact that family planning and welfare does not just mean limiting family size, but also helping couples to achieve their desired family size . If government hospitals and medical colleges started offering IVF programs , they could easily afford to do so cost-effectively and very inexpensively. It’s high time we did this, because it’s tragic that we are turning out M.D. gynecologists from medical colleges in India who have never had any exposure to IVF treatment. These gynecologists are underqualified , and this is a shame . Offering IVF in these hospitals would end up killing two birds with one stone. Not only would this allow us to provide quality care for infertile patients ; it would also ensure that we are training the next generation of gynecologists properly !

The other major issue is the fact that health insurance companies refuse to cover for IVF treatment . They use all kinds of flimsy excuses to reject infertility claims, by stating that infertility is not a medical disease – it’s just a lifestyle illness, which is why It doesn't need to be covered . The reason they can get away with this ridiculous claim is because they have deep pockets ; and because infertile patients aren't willing to get together and fight for their rights. I wish infertile patients would get together to form an NGO which would establish that infertility is a medical problem ; and that medical insurance should cover treatment for it, just like it covers treatment for other illnesses !. This single simple step would make a world of a difference to a large number of couples , who would then be able to afford infertility treatment.

In fact , this is actually a great business opportunity for a clever insurance company . A smart health insurance company could actually offer a fertility insurance package , which people could gift to newly married couples ! Most married couples have no problem getting pregnant , as a result of which they would never need to use this insurance package . However, because they would pay the premium , the insurance company would be able to collect enough money from fertile couples, which it would then use to help infertile couples to have a baby . It’s possible to come up with lots of clever solutions , if we just apply our minds.

Why is IVF so expensive in the first place ?  One of the reasons is because doctors charge so much ! Doctors use all kinds of reasons and excuses for our high fees ( we have invested so many years in our training ; IVF needs expensive equipment; the disposables are expensive, and so on). While these reasons are true , it’s also possible for a clever doctor to come up with a disruptive innovation , and use economies of scale , to be able to deliver IVF services cost effectively to more patients, just like Sankara Netralaya has done to make cataract surgery much more affordable ! Doctors need to develop a clever business model, so that they would be able to treat a much larger number of patients using a “ focused factory “ approach . It’s possible to easily achieve these volumes in countries like India, because we have such a large population , of which such a significant proportion is infertile.  Developing and adapting innovative technology (such as the use of vitrification for freezing ) to improve success rates will also play a major role in making this dream a reality.


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