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Patients' perspectives on allocation of publicly funded in vitro fertilization in Ontario: a qualitative study
Angela Assal1, Nipa Chauhan2, Eyun-Jung Shin1
1Sunnybrook Health Sciences Centre (Assal); Joint Centre for Bioethics (Assal, Chauhan), University of Toronto; Department of Bioethics (Chauhan, Bowman) and Mount Sinai Fertility (Shin, Jones), Mount Sinai Hospital, Sinai Health System; Departments of Family and Community Medicine (Bowman) and Obstetrics and Gynaecology (Jones), Faculty of Medicine, University of Toronto; Faculty of Medicine (Assal), University of Toronto, Toronto, Ont.
Background:
The aim of this study was to determine consumers' perspectives on fair allocation of publicly funded in vitro fertilization (IVF) in the recently implemented Ontario Fertility Program (OFP). The research questions were as follows: 1) What factors do those who require IVF think are important to consider when distributing funded IVF? and 2) What are the barriers to accessing publicly funded IVF?
Methods:
We approached this qualitative study with a social constructivist interpretative framework with grounded theory methodology. Data were obtained via focus group. We recruited participants eligible for the OFP from a tertiary care fertility clinic. Two researchers conducted all interviews, independently reviewed the transcriptions and analyzed the data for open coding, followed by axial coding and then selective coding to determine themes.
Results:
A total of 13 participants (10 women and 3 men with an average age of 36.4 [range 28-40.7] yr) partook in 4 focus groups. The average duration of infertility was 1.9 (range 0.4-3) years. Three important domains were identified. First, the procedure of distributing funds should be done in a transparent and consistent manner. Second, everyone should have a fair and equal chance to accessing the funds. Participants suggested a combination of first-come, first-served and a scoring system as a method to distribute funds. Lack of communication, associated costs and stress of experiencing infertility were cited as barriers to accessing publicly funded IVF.
Interpretation:
Ensuring equal and fair access to funds should be prioritized, and information about the process and distribution method to obtain OFP funding should be clearly provided to patients. Transparency, standardization and better communication should be implemented to uphold procedural justice for patients and reduce emotional stress. The findings may be considered by policy-makers to improve the current OFP and when developing similar programs.