Medical Necessity and the Public Funding of In Vitro Fertilization in Ontario

• Published in: Canadian journal of political science 2020-03, Vol.53 (1), p.61-77
• Main Author: Cattapan, Alana
• Format: Article
• Language: English
• Subjects: Acknowledgment; Ambulatory care; Artificial insemination; Associations; Canada Health Act; Childlessness; Effectiveness; Efficiency; Embryos; Funding; Health care; Health care policy; Health insurance; Health services; Illnesses; In vitro fertilization; Infertility; Insurance coverage; Intervention; Legitimacy; Medical screening; Medical treatment; Political factors; Political science; Provinces; Public health; Reproductive technologies; Tax credits; Womens health
• ISSN: 0008-4239; 1744-9324
• DOI: 10.1017/S000842391900074X

The recognition of a health care service as medically necessary under the Canada Health Act is contingent on a variety of practical and political factors. This article examines how in vitro fertilization (IVF) came to be understood as a medically necessary service in Ontario, focusing on the establishment of public funding for one cycle of treatment. The article argues that the legitimacy of medical necessity in the contemporary period is tied to three interrelated factors: the recognition of a service as sufficiently “medical,” as efficient and as urgent—that is, something to be funded now and not later. By applying this framework to the case of IVF in Ontario, the article demonstrates not only the ongoing malleability of medical necessity but also how the government of Ontario has mobilized the three aspects of medical necessity to make a case for the public funding of a highly contested health care service. La reconnaissance d'un service de soins de santé jugé médicalement nécessaire en vertu de la Loi canadienne sur la santé dépend de divers facteurs pratiques et politiques. Cet article examine comment la fécondation in vitro en est venue à être considérée en Ontario comme un service médicalement nécessaire, axé sur l'octroi d'un financement public d'un cycle de traitement. Il soutient que la légitimité de la nécessité médicale à l'époque contemporaine est liée à trois facteurs interdépendants, à savoir la reconnaissance d'un acte « médicalement nécessaire », efficace et urgent dont le financement ne saurait être différé. En appliquant un tel cadre au cas de la fécondation in vitro en Ontario, cet article démontre non seulement la malléabilité continue de la « nécessité médicale », mais également comment le gouvernement de l'Ontario a mobilisé les trois aspects pour justifier le financement public d'un service de santé très contesté.