Iscare gynaecologist Jozef Valky poses with three babies born through assisted reproduction procedures. photo: Courtesy Iscare |
The Iscare Centrum asistovanej reprodukcie (Assisted Reproduction Centre) on February 13 was added to the Health Net, a group of medical companies recognised by the Health Ministry. The membership is significant for couples unable to have children without help, since fees for Iscare's artificial insemination procedures are expensive for Slovaks. Deputy Director Marína Hrušecká said that in vitro fertilisation (IVF), a means of helping barren women to conceive, costs 31,500 Slovak crowns ($640) almost three times the average monthly wage. Intracytoplasmic sperm injection (ICSI), used when the male is impotent, costs 45,000 crowns. These treatments, and others, will now be covered.
But Iscare is not completely satisfied with the inclusion. In granting the Israeli-funded firm Health Net status, the ministry added a key stipulation - that artificial reproduction procedures and medication are separate issues, even though most of the medications required are used specifically for the procedures.
"This means that a medical establishment which performs IVF treatments doesn't automatically have the ability to prescribe the medications necessary for IVF," explained Iscare director Nadav Lasser. "On the other hand, any gynaecologist or endocrinologist on the Health Net can prescribe these drugs.
"An IVF centre can provide reimbursable treatment but not reimbursable medications which are necessary for treatment," he continued. "A gynaecologist can provide reimbursable medications necessary for IVF, but hasn't the ability to perform IVFs."
Medication for Iscare procedures costs anywhere from 10,000 Slovak crowns to 60,000 crowns ($212 to $1,275).
As a result of the Ministry decision, were patients to receive treatment at Iscare today they would have to first go to Iscare to be diagnosed, then go to a gynaecologist on the Health Net for a prescription suggested by the Iscare doctor, then return to Iscare for the actual treatment. Ideally, Lasser said, Iscare would be able to provide patients with all they needed in one package.
"This is not good for the patient," said Lasser. "It is better for the patient to get everything in one package and to let us worry about dealing with insurance companies. You have a situation where drugs which are used primarily for a specific treatment are not actually connected to this treatment "
When contacted by The Slovak Spectator, the Health Ministry said that the employee responsible for the decision was was unavailable for comment.
The Ministry's decision leaves Iscare now trying to sign a deal with a Slovak health insurer, which would create a "framework" for the treatments. Lasser said that his firm had begun preliminary discussions with Slovakia's largest insurer, Všeobecná Zdravotná Poisťovňa (VšZP), as well as smaller firms.
VšZP head Eduard Kováč said that official talks had not begun with Iscare since their inclusion to the Health Net. He added that he did not know if his firm would be able to help Iscare in finding a workable solution to their prescription problem.
"We cannot solve problems which were caused by someone else [the Health Ministry]," he said. "Maybe the ministry had its reasons for not allowing them to write prescriptions."
While a deal with the insurer is being formed, Nasser said that Iscare had been put in the awkward position of having to advise patients to delay receiving treatment.
"We have to tell patients to wait until we know the nature of the framework we'll be operating under," he said.
For potential parents impatient to have a baby, however, heeding Iscare's advice to wait is not always an option. "Some patients cannot wait," Nasser said. "They understand that the logical approach is to wait, but they can't.
"There is a lot of pressure and stress on a couple that wants a baby," he continued. "You might think that you can understand, but you probably can't. I don't think I can. They want a baby."
Deputy Director Hrušecká added that some patients were more anxious than others, as only women below the age of 38 were assured of insurance coverage for Iscare treatments. "We must get this settled soon," she said. "Many women cannot wait even another year."
As many babies born as possible
Iscare launched operations in Slovakia on October 15, 1999. Marketing Manager Denisa Vlková said that, as of last October, Iscare had performed 463 procedures resulting in 156 pregnancies and 49 births. She added that as of late February, the total number of births had risen to approximately 60.
Lasser said that Iscare was in the business of "getting as many babies born as possible. In the world, 16% of all couples are affected by general infertility, defined by failure for over a year to achieve pregnancy, or several failed pregnancies [miscarriages]."
At Iscare, patients in the 'first phase' are diagnosed to determine if the couple is actually infertile, and then if an IVF or an ICSI is required.
Some 34% of the treatments carried out at Iscare result in pregnancies, Nasser said, slightly above the international average of around 30%.
