Health Technology Assessment Report: Inclusion of IVF in ayushman Bharat-Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) – Summary
This document summarizes a Health Technology Assessment (HTA) report prepared for the National Health Authority (NHA) regarding the potential inclusion of In Vitro Fertilization (IVF) under the AB-PMJAY scheme.
Key Findings & Recommendations:
* recommendation: The report recommends including IVF under AB-PMJAY,citing the critically important prevalence of infertility in India and the substantial financial barriers to treatment.
* Reimbursement Rate: A proposed reimbursable package rate of Rs 81,332 per IVF cycle is suggested, based on calculated health-system costs.
* Prevalence of Infertility: An estimated 2.8 crore couples in India face infertility, with female factors accounting for 46% of cases and male factors for 20%.
* Financial Burden:
* Catastrophic Expenditure: 25% of couples seeking infertility treatment already experience catastrophic health expenditure before even considering IVF costs.
* Median Out-of-Pocket Expenditure: Rs 11,317 for infertility treatment across facilities.
* Disparities: Private sector patients have higher direct costs (medicines, investigations), while public sector patients bear higher indirect costs (travel, accommodation, wage loss).
* Unaffordability: Even public hospital costs (Rs 6,822 – Rs 11,075 annually) are unaffordable for many without insurance.
* Common Cause of Infertility: Polycystic Ovarian Syndrome (PCOS) is the most common identified cause of infertility in the study.
* Current PMJAY Limitations: Currently, outpatient department (OPD) services are not covered under PMJAY, which is a significant issue as most infertility treatment, including IVF, is OPD-based.
* Need for Broader Coverage: The report suggests considering reimbursement for catastrophic expenditure related to infertility treatment.
Data Source:
The analysis is based on data collected from:
* 3 Government Centres: PGIMER Chandigarh, Maulana Azad Medical College (Delhi), SAT Hospital (Thiruvananthapuram)
* 2 Private Facilities: Jawaharlal Nehru medical College (Wardha), Sri Ramachandra Institute (Chennai)
* 130 couples undergoing infertility treatment or IVF.
Expert Opinions:
* Dr. Nandita Palshetkar (Mumbai-based IVF specialist): Highlights the crucial role of the public health system given the rising infertility burden and points to the positive impact of IVF inclusion in PMJAY in Madhya Pradesh.
* Abhishek Aggarwal (CEO, Birla fertility & IVF): Argues that infertility care should be considered an essential medical service and advocates for integrating infertility diagnostics and IVF into national insurance benefits. He emphasizes the financial devastation infertility interventions can cause for lower- and middle-income families.
the report strongly advocates for the inclusion of IVF under AB-PMJAY to improve access to fertility treatment for economically vulnerable couples in India and alleviate the significant financial burden associated with it.
