STUDY QUESTION:What was the impact on access to assisted reproductive technology (ART) treatment by different socioeconomic status (SES) groups after the introduction of a policy that increased patient out-of-pocket costs? SUMMARY ANSWER:After the introduction of a policy that increased out-of-pocket costs in Australia, all SES groups experienced a similar percentage reduction in fresh ART cycles per 1000 women of reproductive age. Higher SES groups experienced a progressively greater reduction in absolute numbers of fresh ART cycles due to existing higher levels of utilization. WHAT IS KNOWN ALREADY:Australia has supportive public funding arrangements for ARTs. Policies that substantially increase out-of-pocket costs for ART treatment create financial barriers to access and an overall reduction in utilization. Data from the USA suggests that disparities exist in access to ART treatment based on ethnicity, education level and income. STUDY DESIGN, SIZE, DURATION:Time series analysis of utilization of ART, intrauterine insemination (IUI) and clomiphene citrate by women from varying SES groups before and after the introduction of a change in the level of public funding for ART. PARTICIPANTS/MATERIALS, SETTING, METHODS:Women undertaking fertility treatment in Australia between 2007 and 2010. MAIN RESULTS AND THE ROLE OF CHANCE:Women from higher SES quintiles use more ART treatment than those in lower SES quintiles, which likely reflects a greater ability to pay for treatment and a greater need for ART treatment as indicated by the trend to later childbearing. In 2009, 10.13 and 5.17 fresh ART cycles per 1000 women of reproductive age were performed in women in the highest and lowest SES quintiles respectively. In the 12 months after the introduction of a policy that increased out-of-pocket costs from ∼$1500 Australian dollars (€1000) to ∼$2500 (€1670) for a fresh IVF cycle, there was a 21-25% reduction in fresh ART cycles across all SES quintiles. The absolute reduction in fresh ART cycles in the highest SES quintile was double that in the lowest SES quintile. LIMITATIONS, REASONS FOR CAUTION:In this study, SES was based on the average relative socioeconomic advantage and disadvantage of small geographic areas, and therefore may not reflect the SES of an individual. Additionally, the policy impact was limited to the 12 months following its introduction, and may not reflect longer term trends in ART treatment. WIDER IMPLICATIONS OF THE FINDINGS:While financial barriers are an important obstacle to equitable access to ARTs, socioeconomic differences in utilization are likely to persist in countries with supportive public funding, due in part to differences in childbearing patterns and treatment seeking behaviour. Policy makers should be informed of the impact that changes in the level of cost subsidization have on access to ART treatment by different socioeconomic groups. STUDY FUNDING/COMPETING INTEREST(S):G.M.C. receives grant support to her institution from the Australian Government, Australian Research Council (ARC) Linkage Grant No LP1002165; ARC Linkage Grant Partner Organisations are IVFAustralia, Melbourne IVF and Queensland Fertility Group. V.P.H. is employed as an Economics Research Associate on the same grant. P.J.I. is Medical Director of the IVF Clinic, IVFAustralia and has a financial interest in the parent group, Virtus. TRIAL REGISTRATION NUMBER:N/A.

译文

研究问题:引入增加患者自付费用的政策后,不同的社会经济地位(SES)组对获得辅助生殖技术(ART)的治疗有什么影响?
总结:在澳大利亚实施了一项增加自付费用的政策之后,所有SES组的每1000名育龄妇女的新鲜抗逆转录病毒治疗周期都经历了类似的减少。较高的SES组由于现有较高的利用水平而使新鲜ART周期的绝对数量逐渐减少。
已经知道的内容:澳大利亚为ARTs提供了支持性的公共资助安排。大幅增加抗逆转录病毒治疗自付费用的政策为获取药物和建立整体降低利用率带来了财务障碍。来自美国的数据表明,根据种族,教育水平和收入的不同,获得抗逆转录病毒治疗的机会也存在差异。
研究设计,大小,时间:在引入公共ART资金水平之前和之后,来自不同SES组的妇女对ART,子宫内授精(IUI)和柠檬酸克罗米芬的利用的时间序列分析。
参与者/材料,环境,方法:2007年至2010年间,澳大利亚接受生育治疗的妇女。
主要结果和机会的作用:SES五分位数较高的妇女比SES五分位数较低的妇女更多地接受ART治疗,这可能反映出更高的支付能力和对ART治疗的需求,这一趋势表明了以后生育的趋势。 2009年,SES五分位数最高和最低的女性每1000名育龄妇女分别进行了10.13和5.17个新鲜的ART周期。在新政策实施后的12个月中,新的IVF周期的自付费用从约1500澳元(1000欧元)增加到2500美元(1670欧元),新的试管婴儿费用减少了21-25% ART遍及所有SES五分位数。 SES最高的五分位数中新鲜ART循环的绝对减少量是SES最低的五分位数中绝对减少的两倍。
局限性,注意事项的原因:在本研究中,SES基于较小地理区域的平均相对社会经济优势和劣势,因此可能无法反映个人的SES。此外,该政策的影响仅限于实施后的12个月,可能无法反映出抗逆转录病毒治疗的长期趋势。
财务结果的障碍是公平获得抗逆转录病毒疗法的重要障碍,而在公共资金支持的国家,利用方面的社会经济差异可能会继续存在,部分原因是生育方式和寻求治疗方式的差异。应告知政策制定者费用补贴水平的变化对不同社会经济群体获得抗逆转录病毒治疗的影响。
研究经费/竞争兴趣:G.M.C.获得澳大利亚政府澳大利亚研究委员会(ARC)链接资助号LP1002165对其机构的资助; ARC Linkage Grant合作伙伴组织包括IVFAustralia,墨尔本IVF和昆士兰生育力集团。 V.P.H.在同一笔赠款中被聘为经济研究助理。 J是IVFAustralia IVF诊所的医学总监,在母公司Virtus中拥有财务利益。
试用注册号:N / A。

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