The diversity of regulation and public financing of IVF in Europe and its impact on utilization
The diversity of regulation and public financing of IVF in Europe and its impact on utilization
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DOI：
10.1093/humrep/des418
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发表时间：
2013-03-01
影响因子：
6.1
通讯作者：
Chevreul, K.
中科院分区：
文献类型：
--
作者：
Brigham, K. Berg;Cadier, B.;Chevreul, K.
在其他类似的欧洲福利国家制度中，不同形式的监管和IVF的公共融资如何影响利用率？社会资格法规更自由的国家的IVF利用率更高，随着国家政策变得更加严格，IVF利用率下降。欧洲是IVF开发和利用的世界领导者，然而，监测显示，在采用不同方法管理和公共资助试管婴儿的国家之间，采用率存在显著差异。在欧盟15个国家中，有13个国家对IVF进行了积极的监管和公共资助。使用欧洲人类生殖和胚胎学学会2009年对欧洲监管框架的研究数据以及其他立法研究，我们检查并描述了在一般资格，公共融资和可用服务范围方面对IVF的限制。多重对应分析用于识别监管模式和具有类似监管模式的国家组，并利用最新的欧洲和国际IVF监测报告的数据探索对IVF利用的影响。基于不适用于其他医疗的寻求治疗者的社会特征的法规，包括关系状况和性取向，似乎对利用率的影响最大。拥有最慷慨的公共融资计划的国家往往会在更大程度上限制获得覆盖的IVF。但是，无法确定试管婴儿的使用与覆盖率的管理方式或公共供资水平之间的联系，由于缺乏关于试管婴儿的公共和私人供资实际水平的数据，无法得出关于公平获得的结论。此外，监管和利用数据在快速变化的监管环境中并不完全匹配。无论是出于成本、资格限制还是特定服务的可用性，跨境治疗寻求都是由监管政策驱动的，这强调了国内政治决策对IVF的域外影响。作者没有利益冲突需要声明。
How do the different forms of regulation and public financing of IVF affect utilization in otherwise similar European welfare state systems?Countries with more liberal social eligibility regulations had higher levels of IVF utilization, which diminished as the countries policies became more restrictive.Europe is a world leader in the development and utilization of IVF, yet surveillance reveals significant differences in uptake among countries which have adopted different approaches to the regulation and and public financing of IVF.A descriptive and comparative analysis of legal restrictions on access to IVF in 13 of the EU15 countries that affirmatively regulate and publicly finance IVF.Using 2009 data from the European Society of Human Reproduction and Embryology study of regulatory frameworks in Europe and additional legislative research, we examined and described restrictions on access to IVF in terms of general eligibility, public financing and the scope of available services. Multiple correspondence analysis was used to identify patterns of regulation and groups of countries with similar regulatory patterns and to explore the effects on utilization of IVF, using data from the most recent European and international IVF monitoring reports.Regulations based on social characteristics of treatment seekers who are not applicable to other medical treatments, including relationship status and sexual orientation, appear to have the greatest impact on utilization. Countries with the most generous public financing schemes tend to restrict access to covered IVF to a greater degree. However, no link could be established between IVF utilization and the manner in which coverage was regulated or the level of public financing.Owing to the lack of data regarding the actual level of public versus private financing of IVF it is impossible to draw conclusions regarding equity of access. Moreover, the regulatory and utilization data were not completely temporally matched in what can be a quickly changing regulatory landscape.Whether motivated by cost, eligility restrictions or the availability of particular services, cross-border treatment seeking is driven by regulatory policies, underscoring the extra-territorial implications of in-country political decisions regarding access to IVF.There was no funding source for this study. The authors have no conflicts of interest to declare.