Stronger reduction of assisted reproduction technique treatment cycle numbers in economically weak geographical regions following the German healthcare modernization law in 2004

BACKGROUND: As part of the German healthcare modernization law implemented in 2004, infertile couples face a 50% co-payment of the total assisted reproduction technique (ART) treatment costs. This has led to a drastic reduction in ART treatment cycle numbers after January 2004. The hypothesis tested in the present study was that the number of ART treatment cycles in different German federal states changed differentially after implementation of the law, depending on the economical power of the individual state in terms of gross domestic product per capita (GDP pc). METHODS: This was a retrospective data exploratory study. Data from the German IVF registry and the German Federal Statistics Office were utilized. Main outcome parameter was the proportional difference of ART treatment numbers between the time periods 2002-2003 and 2004-2005 stratified for the 16 German federal states. The federal states were grouped by Tukey-Hinges percentile analysis of GDP pc. RESULTS: The reduction of ART treatment cycle number was strongest in the lowest GDP pc group of federal states (Kruskal-Wallis P = 0.038). Mean reduction in ART cycle numbers was 51.5%, 35.7% and 38.8% in the 0-25th, 25-75th and 75-100th GDP pc percentile group, respectively. CONCLUSIONS: Conclusively, reduction in ART treatment cycle numbers following the German healthcare modernization law was significantly stronger in economically weak geographical regions.