Managed care of infertility.

Mandated managed care of infertility, as for other branches of medicine, demands cost-effectiveness, appropriate use of proven clinical methods, and audit of the services provided. Proper standards, and protocols of clinical diagnosis and selection of treatment need to be agreed, although allowing for valid alternatives. A diagnostic process and classification staged for primary, secondary, and tertiary care as appropriate, which has been derived by consensus, is offered in this paper. It is assumed that all couples would be allowed access to diagnostic services. A national estimate has attributed one-quarter of the costs of full infertility services to diagnostic procedures and three-quarters to treatments. It is assumed that any constraints owing to funding would apply only to access to treatment. One model proposed would limit treatment to those couples and methods which could achieve a 50% birthrate target within a reasonable time limit or number of cycles. Although there is as yet no existing model of managed care on which to base exact costing, it should be possible by initial over-restrictiveness to leave room for annual adjustments of treatment provision and to allow for new developments. Other more equitable ways of sharing resources can be argued, and ethical standards should be agreed in any system of managed care for a population.