Pricing and Phasing of In Vitro Fertilization Services in Republic of Macedonia

Abstract

Introduction: In vitro fertilization (IVF) services in North Macedonia are mainly provided in private hospitals. The expenses for this service are covered by the HIF, by issuance of a voucher to the patients. One voucher is for one IVF cycle. Price of the voucher was determined in 2012 and specified protocols for provision of the service were set. Since then, the price was not revised or adjusted. Objective of this research is to adjust the price for IVF services in the country, based on existing national protocols and in accordance to the realistic costs.

Materials and Methods: Data from RE-MEDIKA’s electronic system for patients’ medical information (BIRPIS) was extracted. Information was related to patients who undergo the procedure covered by the Health Insurance Fund (HIF) - voucher. For defining direct costs, internal data from the hospital was used and adjusted. For defining indirect costs, data for overhead expenditures of the hospital was adjusted. Description of costs was made in accordance with the national protocol for IVF. Tables (excel spread sheets) used for the calculation are developed by the HIF.  

Results: The process of IVF was divided in three consecutive phases: phase 1- induction, phase 2 - fertilization and phase 3 - embryo transfer (ET). Each phase was priced accordingly. If all three phases are finished and ET is performed, the final full price for one IVF cycle - voucher is about 104,000 Macedonian denars (about 1,700 Euros).

Conclusion: We suggest introducing of phasing for the IVF process related to payment per phases’ finalization, where the next phase follows consequently. This phasing enables the patients to understand the procedures and the progress of the process; enables doctors to follow up the finalization and successfulness of the procedure; and gives the payer (buyer of the service, HIF) complete overview of the procedure and payment for each phase separately. Thus, success or failure of the entire process in specific phases can be monitored and evaluated.