Financial "risk-sharing" or refund programs in assisted reproduction: an Ethics Committee opinion
Ethics Committee of the American Society for Reproductive Medicine
Committee members:Judith Daar, Jean Benward, Lee Collins, Joseph Davis, Leslie Francis, Elena Gates, Elizabeth Ginsburg, Sigal Klipstein, Barbara Koenig, Andrew La Barbera, Laurence McCullough, Richard Reindollar, Mark Sauer, Rebecca Sokol, Sean Tipton, Lynn Westphal, …
Ethics Committee of the American Society for Reproductive Medicine (2016). Financial "risk-sharing" or refund programs in assisted reproduction: an Ethics Committee opinion. Fertility and sterility. https://doi.org/10.1016/j.fertnstert.2016.07.003
Ethics Committee of the American Society for Reproductive Medicine. Financial "risk-sharing" or refund programs in assisted reproduction: an Ethics Committee opinion. Fertility and sterility. 2016. doi:10.1016/j.fertnstert.2016.07.003
Ethics Committee of the American Society for Reproductive Medicine. "Financial "risk-sharing" or refund programs in assisted reproduction: an Ethics Committee opinion." Fertility and sterility, 2016.
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RRM Academy Synopsis
ASRM panel finds IVF refunds might be ethical without IVF coverage
A 2016 ASRM Ethics Committee opinion says IVF refund programs might be ethically offered to patients without IVF insurance, provided conditions that protect patients are met. The committee requires a success measure be named before enrollment.
Key Findings
The committee finds that "risk-sharing" payment for IVF "might be ethically offered" to patients who lack insurance coverage for IVF, provided conditions that protect patients are met.
The conditions: success defined before enrollment, clinic-specific chances of success in consent materials, standard stimulation and embryo transfer practice, and no promise of a pregnancy or delivery.
The committee says patients should understand the program costs more than IVF without it if they succeed on the first or second cycle, and that screening and drug costs are excluded.
The committee did not find that incentives to overstimulate or transfer many embryos are large enough in these plans to warrant condemnation apart from the same risks in fee-for-service plans.
At least one company managing a program reported that 20% of participants received refunds after not achieving a pregnancy.
Interpretation
This is a 2016 ASRM Ethics Committee opinion, approved by the ASRM Board, analyzing the fees, incentives and disclosure terms of IVF refund programs for patients who pay for IVF out of pocket. The 20% refund figure comes from one company's own report on its program. The committee notes that little published literature exists on these programs.
RRM Context
The opinion addresses how IVF cycles are priced and what patients are told. IVF bypasses infertility without establishing why conception fails, so a refund program prices that bypass. Restorative reproductive medicine (RRM) begins by evaluating both partners to find the cause.
Our editorial summary of this paper, not the article's abstract.
Abstract
Financial "risk-sharing" fee structures in assisted reproduction programs charge patients a higher initial fee but provide reduced fees for subsequent cycles and often a partial or complete refund if treatment fails. This opinion of the ASRM Ethics Committee analyzes the ethical issues raised by these fee structures, including patient selection criteria, conflicts of interest, success rate transparency, and patient informed consent. This document replaces the document of the same name, last published in 2013 (Fertil Steril 2013;100:334-6).
Ethics and Policy › Policy and Regulation › Professional Standards · Clinical Guidelines and Standards › Guidelines by Issuing Body › United States Professional Societies · Cost and Access › Cost of Care › Treatment Costs
Judith Daar, Jean Benward, Lee Collins, Joseph Davis, Leslie Francis, Elena Gates, Elizabeth Ginsburg, Sigal Klipstein, Barbara Koenig, Andrew La Barbera, Laurence McCullough, Richard Reindollar, Mark Sauer, Rebecca Sokol, Sean Tipton, Lynn Westphal, 0000-0003-0284-2845
J Daar, J Benward, L Collins, Joe Davis, Joey Davis, J Davis, L Francis, E Gates, Liz Ginsburg, Beth Ginsburg, Betsy Ginsburg, E Ginsburg, S Klipstein, Barb Koenig, B Koenig, Andy Barbera, Drew Barbera, A Barbera, Larry McCullough, L McCullough, Rick Reindollar, Dick Reindollar, Rich Reindollar, R Reindollar, M Sauer, Becky Sokol, R Sokol, S Tipton, L Westphal
PMID 27450188 27450188 DOI 10.1016/j.fertnstert.2016.07.003 10.1016/j.fertnstert.2016.07.003 Ethics Committee of the American Society for Reproductive Medicine et al. 2016, Ethics Committee of the American Society for Reproductive Medicine 2016
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