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Background: Financing ART is variously regulated in the different countries of Europe. In Germany, coverage of assisted reproduction by statutory health insurances was restricted to 50% in 2004. We conducted a national survey among patients, professionals (physicians and other academics in IVF centres, psychosocial counsellors, medical ethicists, social lawyers, health politicians) and the general public in Germany regarding their opinions on financing ART., Methods: Standard questionnaire techniques (paper and pencil interviewing, computer-aided web interviewing, computer-aided telephone interviewing) were used., Results: The vast majority of all groups supported public coverage of ART. Co-payments by patients were considered appropriate by about one-third of the patients, two-third of the physicians and three quarters of all other groups. According to the respondents, the amount of co-payment should cover 15-25% of the costs, considerably less than what patients actually have to pay (50%). Support for public coverage was strongly correlated with the views (i) of infertility as a disease, (ii) that there is a need for assisted reproduction for infertile couples and (iii) that every human should have the opportunity to have children. The respondents had varying opinions on whether to increase medical insurance premiums in order to cover ART. Reducing services in other areas of health care in favour of reproductive medicine was supported only by the group of reproductive physicians. Financial incentives for oocyte sharing were rejected by most groups as was a money-back guarantee for unsuccessful treatments., Conclusions: Experts and the general public in Germany accept moderate co-payments for ART. No clear pattern of opinion emerged regarding the question of how public co-funding should be financed.

In the present retrospective analysis of outpatient health insurance members of the Statutory Health Insurance (SHI) in total and a subgroup of the Techniker Krankenkasse (TK), the effect of the commencement of the SHI Modernization Act (so-called GMG) on the supply and expenditure situation regarding assisted reproductive technologies (ART) in Germany was examined. The implementation of the GMG in Germany in 2004 resulted in a conspicuous decrease of infertility treatments (from 2002-2005 by approximately 60% in the whole SHI population, and by 55% in the TK) for couples with involuntary childlessness, whereby the extremely raised compulsory copayments to the insurance benefits were identified as the determining factor., (Copyright 2010. Published by Elsevier Inc.)

Background: As part of the German healthcare modernization law implemented in 2004, infertile couples face a 50% co-payment of the total assisted reproduction technique (ART) treatment costs. This has led to a drastic reduction in ART treatment cycle numbers after January 2004. The hypothesis tested in the present study was that the number of ART treatment cycles in different German federal states changed differentially after implementation of the law, depending on the economical power of the individual state in terms of gross domestic product per capita (GDP pc)., Methods: This was a retrospective data exploratory study. Data from the German IVF registry and the German Federal Statistics Office were utilized. Main outcome parameter was the proportional difference of ART treatment numbers between the time periods 2002-2003 and 2004-2005 stratified for the 16 German federal states. The federal states were grouped by Tukey-Hinges percentile analysis of GDP pc., Results: The reduction of ART treatment cycle number was strongest in the lowest GDP pc group of federal states (Kruskal-Wallis P = 0.038). Mean reduction in ART cycle numbers was 51.5%, 35.7% and 38.8% in the 0-25th, 25-75th and 75-100th GDP pc percentile group, respectively., Conclusions: Conclusively, reduction in ART treatment cycle numbers following the German healthcare modernization law was significantly stronger in economically weak geographical regions.