Monday, 24 September 2012
Contraception and costs: Why are intervention costs public, but prevention a private affair?
In no situation is it more clear how Canada does not value prevention compared to treatment than in looking at the issues of contraception.
Of course, one risks the deluge of philosophically based and theology arguments on the value of life, we shall spare that discussion. In Canada, life under the legal definition begins with birth, and even if you prefer some other time frame like 20 or 26 weeks gestation, the following still holds.
Children are precious and priceless. The cost to the medical system of caring for and delivering a child without complications is about $2000 to the physicians or midwives, and a similar amount in terms of hospital based costs.
The costs for an infant born that requires intensive care will run $2000 or more per day in the NICU. This is a key point given that pregnancies that are unplanned are more likely to have complications resulting in NICU care.
The cost of a pregnancy termination is about $500 in a clinic and twice that in a hospital. Both are publically funded in Canada. Similar costs in the US with prices increasing with gestation.
The costs for the standard emergency contraceptive (morning-after) pill is in the range of $35-60 and usually not covered by insurance benefits.
The costs for most routinely used contraceptive options are in the range of $25-45 per month, are not covered by the public system but often are covered by private insurers. Private insurance is rarely helpful given most young adults are still in the education system or just beginning employment where benefits may be limited.
While the economics are not exact, the point to be made is that we are willing to fund the costs for the interventions necessary for pregnancy and delivery, we are willing to fund the costs for pregnancy termination – but we are not willing to fund the prevention costs of emergency contraception prior to pregnancy implantation or to fund contraception to prevent pregnancy. The relative health care costs are comparable between these paths, the social costs of unplanned pregnancy are massive in comparison.
While sexual health clinics may provide support to some of those most in need in defraying the costs, most young women carry the costs independently. Those on income assistance are often expected to include contraception costs within their assistance levels. Ultimately it is gender inequality that requires correction.
Even with relatively right wing leaning governments, the economic arguments should be on the table. Only when the issues of theology are interspersed in the arguments do we shy away from the discussion on what is the right social choice.
As a society we have frequently espoused the concept of prevention, but here amongst other gloomy examples, policy does not follow prose.
Health Evidence.Ca recently released a summary of a Cochrane synthesis on the effectiveness of emergency contraception from a Chinese team. Unfortunately in Canada we have limited choice to the aptly named “Plan B”, and while over the counter in most provinces, it still under the counter in Saskatchewan and only available by prescription in Quebec. The evidence review is accessed at Emergency contraception review