Norman Swan reported this story on Monday, May 11, 2015 08:10:00

MICHAEL BRISSENDEN: A leading expert in in vitro fertilisation (IVF) claims that tens of millions of dollars of Medicare funds is wasted each year, and perhaps around $20 million in personal out of pocket expenses by couples because they're unknowingly attending low performing IVF Clinics.



And even though the performance information is available on each clinic, it's being kept from infertile couples by the Fertility Society of Australia.



Norman Swan of RN's Health Report has the story.



NORMAN SWAN: In 2012 there were 62,000 IVF cycles - that's an implantation of an embryo - performed on 33,000 women with 12,000 live babies being produced.



Australia has been a global leader in IVF and has kept detailed performance information on each IVF clinic for several decades. Clinics only know what their own take home baby rate is and consumers know nothing.



Yet, as Dr Richard Henshaw of Monash IVF argues, there's a huge gap between the highest performing clinics and the lowest ones.



RICHARD HENSHAW: In 2012 the top clinic had a live birth rate of 30.9 per cent and the bottom clinic had a live birth rate of only 4 per cent.



NORMAN SWAN: What does that mean for the patient?



RICHARD HENSHAW: Well that means that if you are a patient in the lowest performing clinic you have to undergo seven times more treatment cycles than if you're a patient attending the top clinic.



For Medicare, clinics in the top 25th percentile cost around $2 million of Medicare money to produce a 100 live births, whereas clinics in the bottom 25th percentile spend around $6 million to produce a 100 live babies.



NORMAN SWAN: And that's not to mention the out of pocket costs of the individual, because there's a gap for a lot of clinics.



RICHARD HENSHAW: There is. There's around about a $4000 gap paid by the patients.



NORMAN SWAN: So the Government's out of money and you can be out of money as a couple by anything up to $20,000 per live birth.



RICHARD HENSHAW: That's right.



NORMAN SWAN: And so if you gross that up, what does that come down to in terms of potentially wasted money by the Commonwealth?



RICHARD HENSHAW: The answer is an excess cost of around about $50 million, just in Commonwealth outlay.



NORMAN SWAN: Surely the public have a right to know so they can choose the best place to go.



Why does the fertility society refuse to make this available? What have they told you?



RICHARD HENSHAW: That it's not policy currently.



NORMAN SWAN: And is this lobbying by the low performing clinics or what?



RICHARD HENSHAW: Well of course the only people who really benefit from the data remaining covert are the low performing clinics. Patients don't benefit, Medicare doesn't benefit, and of course good quality providers don't benefit. That can only be the answer, that it is lobbying by the low performing clinics.



The thing that frightens me though is that here we are collecting these data and we're keeping them covert.



NORMAN SWAN: With me on the line is associate professor Mark Bowman of the University of Sydney, he's also president of the Fertility Society of Australia.



Mark Bowman, what do you think of what Richard Henshaw's been saying, that essentially we owe it to the Government as the payer, and we owe it above all to women and their partners to tell people what are high performing clinics and what are low performing clinics?



MARK BOWMAN: I think we would all agree that patients and society need the best results and the best information they can to help them about the decisions regarding treatment and about outcomes. The challenge is that it's not quite as simple as using very simple numerators and denominators because there's so many differences. Some infertility problems are more difficult to treat with IVF.



NORMAN SWAN: Richard Henshaw is alleging that basically the low performing clinics are jacking up and the fertility society's run for cover.



MARK BOWMAN: Don't get me wrong. I personally do believe that a reasonable amount of benchmarking is an appropriate process. I'm just simply saying that a simple numerator and denominator is not necessarily going to help our patients who might then make a choice on a small percentage between unit A or unit B.



NORMAN SWAN: But a 32 per cent chance for a success cycle compared to a 4.7 per cent is not a small percentage.



MARK BOWMAN: And I do believe that that warrants some analysis.



MICHAEL BRISSENDEN: Associate professor Mark Bowman from the Fertility Society of Australia ending that report by Norman Swan. And you can hear the full story on Radio National's Health Report.