Rationing policies on access to in vitro fertilisation in the National Health Service, UK

This paper reports on a study of the local policies and specific rationing strategies for in vitro fertilisation (IVF) adopted by Health Authorities in England and Wales. All Health Authorities in England and Wales were asked for this information and a representative sample then took part in a follow-up interview. A majority of Health Authorities had adopted formal eligibility criteria in order to fund access to IVF treatment. These criteria were both overt and covert, and ranged from the clinical to the social. They included infertility, age limits, number of children, status of the couple and sexual orientation. Social criteria tended to exclude from public funding individuals who were not in a stable heterosexual relationship. We found a multiplicity of approaches which were not necessarily consistent with each other nor based on the purported goal of promoting clinical and cost effectiveness. Some policies were discriminatory against certain categories of women. Further, there appeared to be a discrepancy between some Health Authorities' exclusion policies and the 1990 legislative framework on access to IVF treatment in the UK.