Financing policies of IVF in Sweden

As we will see, policies on the public funding of IVF diverge to a considerable extent in the different Landsting, or regional political administrations in Sweden. All the Landsting offer at least one IVF-treatment per couple, with the exception of Norrbotten, that offers a total sum of 25 treatments per year. Since the “baby take home rate” is approximately 20-30 % per treatment, one is rarely enough. Each treatment costs between 100 and 150 Swedish kronor for the patients, which is roughly 6-10 £. To be entitled to subvention on IVF- treatment, one has to meet up with certain requirements. A battery of tests is routinely performed on the couple in order to ensure that they are both infertile and apt for parenthood. The medical tests aim to inquire, aside from contagious diseases that could be carried on to the infant , whether there are any somatic or psychological disorders or disabilities. The inquiry should focus on the judged ability to take care of the child throughout all its infancy. An estimation whether the couple has social and psychological aptitude to become parents is thereafter performed by a physician and a psychologist (SOSFS 2002: X (M)).

The age of the prospective mother(s) should not, according to the recommendations of The National Board of Health and Welfare, Socialstyrelsen, have reached to the point where the infertility is normally rapidly declining (SOSFS 2002: X (M)). Different Landsting interpret this recommendation in various ways. Örebro places itself on the most generous end, allowing subsidized IVF-treatments to 43-year old women. On the other end we find no less than five Landsting, all allocated in the north of Sweden, banning all women over 37 from subsidized treatment . Further, the Board of Health and Welfare recommends that the age of the prospective father be at a level where one can expect that he could take care of the future child throughout all its childhood. All the Landsting, with the exception of Stockholm and Norra Halland interpret this level to be at the age of 55. Stockholm and Norra Halland have no age limit for prospective fathers. Although the Board of Health and Welfare does not have a recommendation on the minimum age of the parents, eight Landsting require that both of them have reached the age of 19. The rest of the Landsting have higher demands on age of the couple. Jämtland has the highest requirement, 24 years. Most Landsting have considerable queues to IVF- treatment, since the demand is considerably higher than the public availability.

If couples, or single women, do not wish to go through these tests, or prefer not to wait for several months, or fail to meet the requirements stated, they are offered assistance in private clinics. In Sweden there are eight of them and their policy differ, although they are generally much more permissive than the public clinics. The requirement that the couple is infertile is for example not held by private clinics. A treatment costs 18 000-29 000 Swedish kronor (1300-2100 £), but most clinics offer three treatments for the price of 40 000-50 000 (2900-3500£), which has roughly 60-70 % “baby take home rate”, depending on the age of the mother and the medical expertise. Where most of the private healthcare is somewhat subsidized by the welfare- state, IVF- treatments are not. This implies that couples that for any reason could not receive this treatment in public clinics have to pay the amount all by themselves.

These amounts are, one could argue, not unreasonably high. And the requirements that one has to meet to be entitled to public assistance are not unsound. Thus the Swedish system seems to be, although not entirely consequent in its application, at least fair and to some extent reasonable. To question this system and its rationale we will have to inquire deeper into various notions of justice and fairness and to controversial issues on distributive justice.

Publicerad torsdag, juni 8th, 2006 i Allmänt.

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