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Article contents
Medical Necessity and the Public Funding of In Vitro Fertilization in Ontario
Published online by Cambridge University Press: 24 October 2019
Abstract
The recognition of a health care service as medically necessary under the Canada Health Act is contingent on a variety of practical and political factors. This article examines how in vitro fertilization (IVF) came to be understood as a medically necessary service in Ontario, focusing on the establishment of public funding for one cycle of treatment. The article argues that the legitimacy of medical necessity in the contemporary period is tied to three interrelated factors: the recognition of a service as sufficiently “medical,” as efficient and as urgent—that is, something to be funded now and not later. By applying this framework to the case of IVF in Ontario, the article demonstrates not only the ongoing malleability of medical necessity but also how the government of Ontario has mobilized the three aspects of medical necessity to make a case for the public funding of a highly contested health care service.
Résumé
La reconnaissance d'un service de soins de santé jugé médicalement nécessaire en vertu de la Loi canadienne sur la santé dépend de divers facteurs pratiques et politiques. Cet article examine comment la fécondation in vitro en est venue à être considérée en Ontario comme un service médicalement nécessaire, axé sur l'octroi d'un financement public d'un cycle de traitement. Il soutient que la légitimité de la nécessité médicale à l'époque contemporaine est liée à trois facteurs interdépendants, à savoir la reconnaissance d'un acte « médicalement nécessaire », efficace et urgent dont le financement ne saurait être différé. En appliquant un tel cadre au cas de la fécondation in vitro en Ontario, cet article démontre non seulement la malléabilité continue de la « nécessité médicale », mais également comment le gouvernement de l'Ontario a mobilisé les trois aspects pour justifier le financement public d'un service de santé très contesté.
Keywords
- Type
- Research Article/Étude originale
- Information
- Canadian Journal of Political Science/Revue canadienne de science politique , Volume 53 , Issue 1 , March 2020 , pp. 61 - 77
- Copyright
- Copyright © Canadian Political Science Association (l'Association canadienne de science politique) and/et la Société québécoise de science politique 2019
References
Advisory Process for Infertility Services. 2015. “Advisory Process for Infertility Services: Key Recommendations Report.” June 23. Toronto: Ministry of Health and Long-Term Care. http://health.gov.on.ca/en/public/programs/ivf/docs/ivf_report.pdf.Google Scholar
Bhatia, Vandna and Orsini, Michael. 2016. “Narrating Sustainability in Canadian Health Care Reform Discourse.” Social Policy & Administration 50 (3): 297–315.CrossRefGoogle Scholar
Boyajian, Talar, Bronskill, Susan, Farrar, Sheryl, Gilbart, Erin, Kromm, Seija K., Labreque, Lise, Mawani, Mina, Medved, Wendy, Tanaka, Phyllis, Tassie, Dan, Verbeeten, Judy and Deber, Raisa B.. 2014. “Down the Tubes: Should In Vitro Fertilization Be Insured in Ontario?” In Case Studies in Canadian Health Policy and Management, ed. Deber, Raisa B. and Mah, Catherine L.. Toronto: University of Toronto Press.Google Scholar
Bushnik, Tracey, Cook, Jocelynn L., Albert Yuzpe, A., Tough, Suzanne and Collins, John. 2013. “Estimating the Prevalence of Infertility in Canada.” Human Reproduction 27 (3): 738–46.CrossRefGoogle Scholar
Cameron v. Nova Scotia (Attorney General) (1999), 172N.S.R. (2d) 227; [1999] N.S.J. No. 33 (N.S. S.C.) (QL).Google Scholar
Carsley, Stefanie. 2012. “Funding In Vitro Fertilization: Exploring the Health and Justice Implications of Quebec's Policy.” Health Law Review 20 (3): 15–32.Google Scholar
Cattapan, Alana. 2015a. “Controlling Conception: Citizenship and the Governance of Assisted Reproductive Technologies in Canada (1989–2004).” Doctoral dissertation. York University, Toronto, Ontario.Google Scholar
Cattapan, Alana. 2015b. “Ontario Should Focus on Preventing Infertility Instead of Treating It.” Healthydebate.Ca (blog), November 11. http://healthydebate.ca/opinions/ontario-ivf-funding-infertility-prevention.Google Scholar
Charles, Cathy, Lomas, Jonathan, Giacomini, Mita and Vincent, Victoria A.. 1997. “Medical Necessity in Canadian Health Policy: Four Meanings and … a Funeral?” Milbank Quarterly 75 (3): 365–94.CrossRefGoogle Scholar
Conceivable Dreams, . 2016. “Ontario Leads Provinces in Helping Canadians Grow Their Families.” Conceivable Dreams. https://conceivabledreams.org/newsroom/funding-stats/ontario-leads-provinces-in-helping-canadians-grow-their-families/ (May 11, 2016).Google Scholar
Conceivable Dreams. 2015. “’Building Blocks’ Event.” Conceivable Dreams (blog) https://conceivabledreams.org/newsroom/building-blocks-event/ (February 15, 2015).Google Scholar
Conrad, Peter. 2007. The Medicalization of Society. Baltimore: Johns Hopkins University Press.Google Scholar
Expert Panel on Infertility and Adoption. 2009. Raising Expectations: Recommendations of the Expert Panel on Infertility and Adoption. Toronto: Ministry of Children and Youth Services (Ontario).Google Scholar
Ferguson, Rob. 2015. “Ontario to Cover In-Vitro Fertilization Treatments.” Toronto Star, October 1. https://www.thestar.com/news/queenspark/2015/10/01/ohip-to-cover-in-vitro-fertization-treatments.html.Google Scholar
Fierlbeck, Katherine. 2011. Health Care in Canada: A Citizen's Guide to Policy and Politics. Toronto: University of Toronto Press.Google Scholar
Flood, Colleen. 2014. “Litigating Health Rights in Canada: A White Knight for Equity?” In The Right to Health at the Public/Private Divide: A Global Comparative Study, ed. Flood, Colleen and Gross, Aeyal. New York: Cambridge University Press.CrossRefGoogle Scholar
Flood, Colleen and Erdman, Joanna. 2004. “The Boundaries of Medicare: Tensions in the Dual Role of Ontario's Physician Services Review Committee.” Health Law Journal 12: 1–16.Google ScholarPubMed
Flood, Colleen M., Tuohy, Carolyn and Stabile, Mark. 2006. “What Is In and Out of Medicare? Who Decides?” In Just Medicare: What's In, What's Out, How We Decide, ed. Flood, Colleen M.. Toronto: University of Toronto Press.CrossRefGoogle Scholar
Fosket, Jennifer Ruth. 2010. “Breast Cancer Risk as Disease: Biomedicalizing Risk.” In Biomedicalization: Technoscience, Health, and Illness in the U.S., ed. Clarke, Adele E., Mamo, Laura, Fosket, Jennifer Ruth, Fishman, Jennifer R., Shim, Janet K. and Fishman, Jennifer R.. Durham: Duke University Press.Google Scholar
Giacomini, Mita, Hurley, Jeremiah and Stoddart, Greg. 2000. “The Many Meanings of Deinsuring a Health Service: The Case of In Vitro Fertilization in Ontario” Social Science and Medicine 50 (10): 1485–1500.CrossRefGoogle ScholarPubMed
Government of Ontario, Ministry of Health and Long-Term Care. 2014. “Improving Access to Safe Fertility Treatments.” Toronto: Ministry of Health and Long-Term Care. https://news.ontario.ca/mohltc/en/2014/04/improving-access-to-safe-fertility-treatments.htmlGoogle Scholar
Hughes, Edward G. and Giacomini, Mita. 2001. “Funding In Vitro Fertilization Treatment for Persistent Subfertility: The Pain and the Politics.” Fertility and Sterility 76 (3): 431–42.CrossRefGoogle ScholarPubMed
Hurley, Jeremiah, Birch, Stephen, Stoddart, Greg and Torrance, George. 1997. “Medical Necessity, Benefit and Resource Allocation in Health Care.” Journal of Health Services Research & Policy 2 (4): 223–30.CrossRefGoogle ScholarPubMed
Ikonomidis, Sharon and Dickens, Bernard. 1995. “Ontario's Decision to Defund In Vitro Fertilization Treatment Except for Women with Bilateral Fallopian Tube Damage.” Canadian Public Policy 21 (3): 379–81.CrossRefGoogle ScholarPubMed
Irving, Dan. 2012. “Elusive Subjects: Notes on the Relationship between Critical Political Economy and Trans Studies.” In Transfeminist Perspectives in and beyond Transgender and Gender Studies, ed. Enke, Anne. Philadelphia: Temple University Press.Google Scholar
Kazanjian, Arminée, Green, Carolyn J., Bassett, Ken and Brunger, Fern. 1999. “Bone Mineral Density Testing in Social Context.” International Journal of Technology Assessment in Health Care 15 (4): 679–85.CrossRefGoogle ScholarPubMed
Krashinsky, Susan. 2009. “Funding Fertility: The Fight to Have Treatments Covered.” Globe and Mail, August 19. http://www.theglobeandmail.com/news/national/funding-fertility-the-fight-to-have-treatments-covered/article1256655/.Google Scholar
L'Espérance, Audrey. 2013. “Fertilize-This: Framing Infertility in Quebec, Ontario and England Between 1990 and 2010.” Dissertation, Ottawa: University of Ottawa.Google Scholar
Mamo, Laura. 2007. Queering Reproduction: Achieving Pregnancy in the Age of Technoscience. Durham: Duke University Press.CrossRefGoogle Scholar
McLeod, Carolyn. 2017a. “Does Reproductive Justice Demand Insurance Coverage for IVF?: Reflections on the Work of Anne Donchin.” IJFAB: International Journal of Feminist Approaches to Bioethics 10 (2): 133–43.Google Scholar
McLeod, Carolyn. 2017b. “The Medical Nonnecessity of In Vitro Fertilization.” IJFAB: International Journal of Feminist Approaches to Bioethics 10 (1): 78–102.Google Scholar
Medical Advisory Secretariat. 2006. In Vitro Fertilization and Multiple Pregnancies: An Evidence- Based Analysis. Ontario Health Technology Assessment Series 6 (18). Toronto: Ministry of Health and Long-Term Care.Google Scholar
Mladovsky, Philipa and Sorenson, Corinna. 2010. “Public Financing of IVF: A Review of Policy Rationales.” Health Care Analysis: HCA: Journal of Health Philosophy and Policy 18 (2): 113–28.CrossRefGoogle ScholarPubMed
Moynihan, Ray and Cassels, Alan. 2005. Selling Sickness: How the World's Biggest Pharmaceutical Firms Are Turning Us All into Patients. Vancouver: Greystone Books.Google Scholar
Nisker, Jeff. 2009. “Socially Based Discrimination against Clinically Appropriate Care.” Canadian Medical Association Journal 181 (10): 764.CrossRefGoogle ScholarPubMed
Purdy, Laura. 2001. “Medicalization, Medical Necessity, and Feminist Medicine.” Bioethics 13 (3): 248–61.CrossRefGoogle Scholar
Royal Commission on New Reproductive Technologies. 1993. Proceed with Care: Final Report of the Royal Commission on New Reproductive Technologies. Ottawa: Minister of Government Services Canada.Google Scholar
Scala, Francesca. 2014. “IVF Policy and the Stratification of Reproduction in Canada.” In Fertile Ground: Reproduction in Canada, ed. Paterson, Stephanie, Scala, Francesca and Sokolon, Marlene. Montreal: McGill-Queen's University Press.Google Scholar
Snow, Dave. 2018. Assisted Reproduction Policy in Canada: Framing, Federalism, and Failure. Toronto: University of Toronto Press.CrossRefGoogle Scholar