Buyers in the Baby Market: Toward a Transparent Consumerism

TLDR: In the context of assisted reproduction technologies (ART) as mentioned in this paper, the benefits of competition in the fertility field have been studied extensively in the past few decades, and it has been shown that the competition for fertility services involves selection for particular services as much as, if not more, than selection for price.

Abstract: INTRODUCTIONHealth care today, taken as a whole, is often characterized by the increasing consolidation of health care providers, opaque payment systems in which neither doctors nor patients understand the full price of medical procedures, and increasing distance between doctors and patients.Yet, certain segments of the health care industry such as cosmetic surgery, many dental and mental health services, and most of assisted reproduction, have until recently defied the trends. They did so in large part because insurance and government subsidies cover a much smaller portion of these procedures. Instead, these services have usually occurred in the context of relatively small or solo practices, or university centers where patients pay for the services they receive with much less (if any) subsidization or third party involvement, and deal directly with individual professionals in the process. As a result, market forces influence supply and demand much more directly than in other parts of the health care industry, and the health care provider-patient relationship is a more commercially driven seller-buyer one.These forces-particularly the absence of wide scale insurance or government subsidization-have shaped assisted reproduction technologies (ART) from their inception. Almost every aspect of ART has been controversial, from the initial use of artificial insemination with donor sperm (AID), to use of fertility drugs that increase the frequency of multiple births, to in vitro fertilization (IVF), which permits conception outside of the human body. The Catholic Church, for instance, identifies human dignity with conception by a married couple within a woman's body, and it therefore opposes IVF-and government subsidization of IVF-altogether.1 Others have expressed concern about the health effects of fertility drugs, the hormones used in IVF, the increased incidence of multiples, and other ART practices.2 The combination of religious objections to the procedures, and concern that government inquiries would result in restrictive measures, have blocked inclusion of ART in national health legislation and funding for research that would contribute to better understandings of the long term health risks involved with these procedures.3 Instead, relatively little regulatory oversight exists and only a small number of states mandate any form of insurance coverage.4For most of its existence, therefore, ART practices have taken place in the context of a different consumer and ethical infrastructure than other health care services. This means that even where fertility clinics experience many of the same forces as the rest of the medical profession, the implications may not be the same. For example, ART practitioners, like other medical clinics, face pressures to innovate. This innovation increases returns to scale and take place in the context of global competition. In the fertility context, consolidation, at least initially, may offer more rather than less price competition and competition across jurisdictional lines offers not just opportunities to leverage price differences but to jurisdiction shop for different regulatory environments. Competition for providers across state and national lines may therefore give consumers a wider array of choices.At the same time, the competition for fertility services involves selection for particular services as much as, if not more, than selection for price. The global market for fertility services includes wealthy and sophisticated patients who may scour the world for a place willing to provide surrogacy services for older or non-traditional couples. It also includes those who would like to employ new techniques to select a child of a desired sex, to avoid the transmission of hereditary diseases, or to conceive a "savior sibling" capable of providing a bone marrow transplant to a family member whose life depends on finding a compatible donor.5 Increased competition and "fertility tourism" may thus expand the availability of services not just by making them more affordable, but also by making it easier to evade ethical restrictions that limit the availability of controversial services. …