Quebec Assisted Reproduction Program : The FMSQ Files Its Report
Montreal, May 22, 2013 – After three years of existence, the Quebec Assisted Reproduction Program needs to be subjected to a rigorous evaluation. In this respect, the Fédération des médecins spécialistes du Québec (FMSQ) files its brief today with the Health and Welfare Commissioner, in the context of the mandate that had been entrusted to the Federation by the Minister of Health and Social Services.
It must be recalled that on the very day the Program was announced, July 13, 2010, the Fédération des médecins spécialistes du Québec, the Association of Obstetricians and Gynecologists of Quebec and the Association des pédiatres du Québec, jointly and publicly revealed their reservations regarding a program that had received unanimous approval in the National Assembly : "Never has a public health program of this significance been put in place so rapidly and in such a mad rush for the organization of the healthcare network in Quebec," had said Dr Gaétan Barrette, president of the FMSQ, at the time.
Access and Costs
For the FMSQ, it was already clear that assisted reproduction services could not be offered in public institutions in the short- or even the medium-term and that the Program would require enormous resources, insofar as operating costs and the investments needed to develop the offer of service in the public network are concerned. Between August 5, 2010 and September 30, 2012, the RAMQ's data indicates that the majority of acts, an average of 64%, were performed in private clinics, the latter having collected 90% of overall fees paid.
"The government was in such a rush to start up the Program that it was ready to pay full rates to the private sector, something the FMSQ had vigorously opposed. At our request, an independent audit allowed the rate to be brought down from $7,100 to $4,600 starting on January 1, 2012," explains Dr Barrette. Still, there were 17 months during which the government paid the higher price to private clinics since public institutions were not able to dispense assisted reproduction services. "If the rate had been set at $4,600 from the start, savings of $15 million could have been generated between August 5, 2010 and December 31, 2011," continued Dr Barrette.
"We believe that savings are still possible and we recommend that rates be re-evaluated again by an independent audit. In addition, we believe that public institutions must be the first providers of the Program and that access to private clinics must only be resorted to in case of overflow."
According to statistics available since August 5, 2010, and up to January 10, 2013, if we total up billing details, recurrent costs for the public network and costs associated with medications, the Program will have cost at a minimum close to $109 million to Quebec's Treasury.
Measures and Evaluation
As an adjunct to the official start of the Program, the implementation of a registry was considered essential by medical specialists as well as by the Collège des médecins du Québec. Such a registry was to provide for the documentation of the effects of the Program and its evolution. "Such a registry was included in the government's budget, but it still does not exist. The FMSQ recommends that such a registry be implemented in the shortest delay possible, a registry in which would be recorded, from the very first consultation, all individual details pertinent to the Program including, as the case may be, the resulting pregnancy and a follow-up of births up to the child's first two years of development," explains the FMSQ spokesperson.
"Let us remember that, at present, there is no structured data emanating from the MSSS to allow us to qualify and evaluate the real effects of the Quebec Assisted Reproduction Program, in particular insofar as a reduction of the rate of multiple births is concerned, which reduction was supposed to ensure its self-financing, as was claimed by the Minister at the time," recalls the president of the FMSQ.
Limits and Eligibility
During discussions in committees, the FMSQ thought it important, for medical reasons, to set an upper age limit, beyond which a woman could not access the public Program. Instead, the government chose not to set any limit. The FMSQ remains convinced that such a limit is necessary.
The question of "medically required" has been avoided. This Program was not conceived to treat or remedy a pathological problem affecting fertility. Rather, it was conceived in order to encourage giving birth, by being open to all, without restriction. From Day 1, the FMSQ said it was a good Program to the extent that it aimed to compensate for a problem of a medical nature. "The FMSQ remains convinced of the pertinence of this Program, but only on the basis of "medically required" acts." Should the Program be redirected from now on to cover only cases where infertility problems are medically based ? The FMSQ believes so," states Dr Barrette.
From an ethical point of view, the fundamental question is whether a person has the aptitude to care for a child, to ensure his or her security, to provide a conducive family environment to ensure his full physical and psychological development. And yet, the government has not thought it appropriate to draw up criteria of eligibility to the public Assisted Reproduction Program. In Quebec, strict rules form a framework for the process of adoption. In addition, a psychosocial evaluation of persons wishing to adopt a child is performed by decision-making bodies. Why should it be different for persons wishing to take advantage of the public – and free-of-charge – Assisted Reproduction Program ?
"At the FMSQ, we believe it is necessary to set up a single access window, with a triage protocol, based on established criteria, as much to confirm eligibility for the Program as to direct eligible persons to available public resources," concludes the president, Dr Gaétan Barrette.
The Fédération des médecins spécialistes du Québec represents more than 9,000 medical specialists certified in one of the 53 recognized medical specialties.
La FMSQ a déposé et rendu public un mémoire au Commissaire à la santé et au bien-être concernant le programme de procréation assistée. Consultez le mémoire de la FMSQ.