NHS to ration IVF?

False economy again

IVF treatment could be rationed under new rules to be considered by the fertility treatment regulator. The Human Fertility and Embryology Authority (HFEA) is set to start a public consultation about whether only one embryo, rather than two, should be implanted in patients. The authority believes that it will cut the number of multiple births and protect the health of mothers and babies.

Fertility specialists say that it will severely reduce the odds of successful conception. About 30,000 women each year in the UK turn to IVF after failing to conceive naturally. In most cases two embryos are implanted with each cycle of treatment to increase the chances of pregnancy. But a report by an independent group published last year suggested that the huge rise in multiple births put the health of mothers and babies at far greater risk.

One key proposal of the One Child at a Time report was to set criteria for selecting first-time IVF patients who would be offered single embryo transfers only. These would be the youngest, healthiest patients at highest risk of multiple pregnancies. Such pregnancies carry much higher risks of miscarriage, preeclampsia and birth complications, while twins, triplets and other babies who have shared a womb together are more likely to be born prematurely.

Unlike natural conception, where the chance of a multiple birth is relatively low (1 delivery in 80 is of twins), the latest figures suggest that almost a quarter of IVF pregnancies result in multiple births, accounting for half of the 10,000 such births each year in the UK. Women who undergo IVF treatment are currently limited to two embryos under rules introduced by the HFEA in 2003. Since then, the incidence of triplets is thought to have more than halved. But cutting the number of embryos implanted in each IVF patient also reduces the already low chances of the treatment working at all, meaning that a woman may need more or repeated cycles. Last year's report said research had found that implanting only one fresh embryo in the first IVF cycle for women under 34 cut pregnancy rates to 38 per cent from about 75 per cent when two were implanted at the same time.

It has been suggested that under the revised rules, doctors should still be able to use their clinical judgment to decide if a woman should get two embryos, but that clinics will be told to reduce the number of multiple births through IVF from 25 per cent to 5 to 10 per cent. This could be achieved only if half or more women were limited to one embryo. The HFEA said yesterday that a decision was not expected to be taken until the autumn

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Australian Labor party embraces private health care

Recognizing reality in a country where 40% of the population have already abandoned the "free" government health system

LABOR will dump its opposition to higher health insurance rebates paid to the over-65s as the party prepares to drop its traditional antagonism to private health care. It comes as the ALP national conference later this month will move to excise from its platform a provision opposing growth in private care at the expense of the public system. The Opposition's health spokeswoman, Nicola Roxon, is today expected to tell private health funds that Labor accepts the role of a strong private health sector and supports higher rebates for older health fund members.

The move is an acknowledgement of the growth in health insurance in recent years and is in line with the strategy of the Opposition Leader, Kevin Rudd, of removing targets vulnerable to Government attack, including the private schools hit list and the pledge to reinstate workers sacked under the Government's looser unfair dismissal laws.

Labor has opposed the higher rebates - 35 per cent for the over 65s and 40 per cent for those over 70 - since they were introduced two years ago, giving the Government ammunition to raise doubts about Labor's commitment to the existing 30 per cent rebate which benefits about 10 million people. Since the introduction of the perks for older members, health fund membership for the over-60s has climbed sharply to more than 1.5 million in that age group. Labor has previously argued that the higher rebates would not be necessary because of its now aborted Medicare Gold plan to give free treatment to the elderly.

Ms Roxon said that clearly there were many people, particularly the elderly, who relied on the rebate to afford health insurance. "We don't believe we should add to their pressures by taking these away. I think this is a sign about Labor being able to move with the times. It is definitely an acceptance that private services are playing a more important role in health." She said it was important for the party "to concentrate on the issues we think the community wants us to deal with" and not on "outmoded debates that do not accept the community is changing".

Federal Labor has already signalled it is prepared for an even greater role for the private sectors in public health care, including investigating the training of doctors in private hospitals. Ms Roxon said she did not expect problems in getting the more private-friendly platform through the national conference. That was so long as the conference appreciated that Labor intended to invest in public health care to ensure the best quality service "and not some sort of safety net that the Government wants to turn it into".

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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