Ripples from fertility post

My post a week ago on implications for consumer directed health care based on lessons learned in the fertility market (A pretty strong case against consumer directed care) set off an active debate (see the comments section) about in vitro fertilization .

It also sparked posts on some other blogs. See:

Once the dust settles, it will be interesting to re-examine the broader implications for consumer directed care.

October 14, 2005

4 thoughts on “Ripples from fertility post”

  1. Wow! I should check David’s blog more often (our internet is down at work, and yesterday was a holiday – sorry excuses I know)

    In any case, does anybody care to answer the question at hand, which is “why do consumers ignore outcomes data?”

    I opined that the passions surrounding this issue (see original thread for abundant evidence) cloud the consumer’s judgment. That’s a shame. Do I suspect correctly that our blogger agrees?

  2. .
    Rob:

    You asked why patients ignore outcomes data.

    I’m not convinced that they do: asking the question presupposes that consumers are aware of such data, and I’ve not been pursuaded that they are.

    The nature of the current system encourages patients to seek treatment where and how a 3rd party (the insurer or the government) encourages them to. Some patients — and I’m thinking those with critical illnesses, for example — do research options and outcomes. But I believe that most folks simply experience a symptom (or symptoms) and seek out whomever their insurer says is in network.

    And yes, the nature of the example given — IVF — leads some folks to ignore the fundamental financial aspects and concentrate on the issue about which they are so passionate. The beauty of the blogosphere, of course, is that we are free to do so, and blogs such as this encourage that free exchange.

  3. I don’t know that IVF patients ignore the available data. Since most of us do pay out of pocket, we look seriously at success rates. One problem is that the CDC doesn’t publish current success rates. The latest stats out are from 2002. A lot can change in a clinic in nearly four years.

    As for the multiples issue, most reputable clinics will not transfer more than 2-3 good quality embroyos in a healthy women with a good uterus. Usually the only time more are transferred is if their is a history of multiple failed cycles, or the quality of the embryos is poor. In either case it is suspected that most will not make it.

    The multiples issue is more of a problem with IUI (intrauterine insemination) because there are no embryos to control how many are put back. I’ve and an IUI cancelled because I developed three follicles, which could of led to triplets. In a later cycle, I again had three follicles, but they went ahead because I had multiple failed cycles at that point. I got pregnant, with one baby, that I subsequently lost.

    I think a lot of conclusions about IVF and infertility treatments in general are based on misconceptions and misinformation. I admit I didn’t know much about this process either until I found myself smack in the middle of it.

  4. It could be the case that we have no idea whether patients pay attention to outcomes data or not. Having not seen the WSJ article, I take David at his word.

    But it might be the case that we don’t have a reliable why to measure attention to outcomes data.

    One thing for sure is that the data are hard to interpret.

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