It's rare that physician "insiders" complain about the price of healthcare services in their field. A recent article about the cost of IVF in the U.K. therefore caught my attention (see: IVF clinics 'are ripping off desperate couples). Below is an excerpt from it:
Fertility clinics are charging women who want to have children three times the actual cost of their treatment – with the NHS [National Health Service] as guilty as private practitioners in exploiting desperate couples. The accusation comes from the fertility pioneer Lord Robert Winston, who today launches a scathing attack on the high cost of fertility treatment in the UK and the unfettered use of expensive, unproven tests by private clinics. The Labour peer and former head of the NHS IVF clinic at Hammersmith Hospital said there was a "huge amount of exploitation going on" and that some of the charges were a "scandal". "A combination of avarice on the part of the clinics and desperation on the part of the women is driving this market" ....Figures show over 45,000 women had IVF in 2010, with 60 per cent paying for themselves and 40 per cent treated on the NHS....For the majority of patients, who must pay privately, the average basic cost of treatment is £2,500 a cycle in clinics run by the NHS and £3,500 in private clinics. The price of drugs and tests is added to the bill which can double the cost. Lord Winston said: "My view is that both NHS and private clinics are charging much more than the cost of delivering the treatment." He calculated the costs, taking account of salaries and overheads, for a large unit treating 2,000 patients a year where economies of scale meant it could carry out treatment more efficiently....Lord Winston also attacked the growing use of experimental techniques for which there was little evidence by private clinics trying to enhance their success rates. "There are no randomised controlled trials and without trials we cannot know that they work. Can you imagine going into hospital with cancer and a doctor saying, 'I am going to give you this treatment because I think it might work?
Given that the cost of most IVF services were originally not covered by insurance and also viewed by participating couples as essential, I suspect that the price structure for this service was primarily demand driven. These high price-points have persisted to this day. As Winston says above, "a combination of avarice on the part of the clinics and desperation on the part of the women is driving this market." Note that the price of services which are evoking his criticism in the U.K. are only a portion of those in the U.S, which may be two or more times higher. For what it's worth, here's a link to a web site on IVF cost that shows the cost of services by country. Such high costs drive some couples abroad via the IVF medical tourism route (see: In Vitro Fertilization (IVF) Cost Abroad). I have blogged previously about reproductive tourism including surrogate pregnancy (see: An Introduction to Reproductive Tourism Including Surrogate Pregnancy).
Perhaps even more shocking than these price issues is Winston's claim that private IVF clinics in the U.K. are using unproved experimental techniques to improve their success rates. However, it's well known that, in the U.S., the FDA review of medical procedures and devices is often less rigorous than that required for new drugs. Witness the current controversy about the use of metal-on-metal hip prostheses (see: Metal-on-Metal Hip Implant Controversy Escalates).
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