Abstract
The aim of this study was to assess the lifetime economic benefits of assisted reproduction in Spain by calculating the return on this investment. We developed a generational accounting model that simulates the flow of taxes paid by the individual, minus direct government transfers received over the individual’s lifetime. The difference between discounted transfers and taxes minus the cost of either IVF or artificial insemination (AI) equals the net fiscal contribution (NFC) of a child conceived through assisted reproduction. We conducted sensitivity analysis to test the robustness of our results under various macroeconomic scenarios. A child conceived through assisted reproduction would contribute €370,482 in net taxes to the Spanish Treasury and would receive €275,972 in transfers over their lifetime. Taking into account that only 75% of assisted reproduction pregnancies are successful, the NFC was estimated at €66,709 for IVF-conceived children and €67,253 for AI-conceived children. The return on investment for each euro invested was €15.98 for IVF and €18.53 for AI. The long-term NFC of a child conceived through assisted reproduction could range from €466,379 to €-9,529 (IVF) and from €466,923 to €-8,985 (AI). The return on investment would vary between €-2.28 and €111.75 (IVF), and €-2.48 and €128.66 (AI) for each euro invested. The break-even point at which the financial position would begin to favour the Spanish Treasury ranges between 29 and 41 years of age. Investment in assisted reproductive techniques may lead to positive discounted future fiscal revenue, notwithstanding its beneficial psychological effect for infertile couples in Spain.
Highlights
Birth and fertility rates in Spain have declined significantly in recent years
The average waiting time for an artificial insemination (AI) or IVF cycle in a public health facility was 339 days (Matorras Weinig, 2011), so women or couples who can afford to pay for treatment, and those who do not fulfil inclusion criteria, may choose to go to a private health facility without a waiting list (Matorras Weinig, 2011)
T t −X t ð1 þ rÞt where N is the individual’s life expectancy, T is gross revenues received by the government through taxes paid by the individual, X is direct transfers to the individual, K is the cost of assisted reproductive treatment, r is the discount rate and t corresponds to 1 year
Summary
In 2011 the birth rate stood at 10.2 births per 1000 inhabitants, its lowest level since 2003, while the fertility rate was 1.36 children per woman (INE National Institute of Statistics, 2014), which is below the replacement level (2.1) This is partly attributable to the greater integration of women into the labour market and consequent delay in maternity (IMW Instituto Max Weber, 2012), but it is compounded by the prevalence of infertility, defined as the inability of one or both partners to conceive naturally after a year of frequent unprotected sexual intercourse. The average waiting time for an AI or IVF cycle in a public health facility was 339 days (Matorras Weinig, 2011), so women or couples who can afford to pay for treatment, and those who do not fulfil inclusion criteria, may choose to go to a private health facility without a waiting list (Matorras Weinig, 2011). Is there an excess demand for assisted reproductive treatment and inequity of access to that treatment
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