The diversity of regulation and public financing of IVF in Europe and its impact on utilization.

STUDY QUESTION: How do the different forms of regulation and public financing of IVF affect utilization in otherwise similar European welfare state systems? SUMMARY ANSWER: Countries with more liberal social eligibility regulations had higher levels of IVF utilization, which diminished as the countries' policies became more restrictive. WHAT IS KNOWN ALREADY: 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. STUDY DESIGN, SIZE, DURATION: 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. PARTICIPANTS/MATERIALS, SETTING,
METHODS: 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. MAIN RESULTS AND THE ROLE OF CHANCE: 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. LIMITATIONS, REASONS FOR CAUTION: 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. WIDER IMPLICATIONS OF THE
FINDINGS: 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. STUDY FUNDING/COMPETING INTEREST(S): There was no funding source for this study. The authors have no conflicts of interest to declare.