Estimating the Fiscal Value of Children Conceived from Assisted Reproduction Technology in Australia Applying a Public Economic Perspective.

IF 2.3 Q2 ECONOMICS

Journal of Health Economics and Outcomes Research Pub Date : 2025-04-18 eCollection Date: 2025-01-01 DOI:10.36469/001c.133796

Mark Connolly, Nikos Kotsopoulos, Jinjing Li, Georgina Chambers

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Objective: To evaluate annual public spending on assisted reproduction technology (ART) in Australia to determine the likely fiscal impact for government over the projected lifetime of an ART-conceived birth cohort. Methods: A public economic framework was used to evaluate the number of children born from ART procedures performed in Australia in 2021 based on projected future lifetime tax contributions and public benefits received. We leveraged data from the Survey of Income and Housing conducted by the Australian Bureau of Statistics and imputations from tax-transfer microsimulations over the lifetime of the cohort estimating cumulative net-taxes. Public spending per pupil for education and lifetime health costs (in Australian dollars) were included in the benefits estimates. 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Abstract

Background: Public funding for assisted reproduction varies across countries, which can influence the numbers of infertile couples treated annually, and consequently the numbers of children born each year from this technology. As infertility is a medical condition treated within the healthcare system, it must compete against all other medical interventions for funding. This raises questions about how to evaluate a technology that gives rise to human life compared with other healthcare interventions that reduce morbidity and mortality. Objective: To evaluate annual public spending on assisted reproduction technology (ART) in Australia to determine the likely fiscal impact for government over the projected lifetime of an ART-conceived birth cohort. Methods: A public economic framework was used to evaluate the number of children born from ART procedures performed in Australia in 2021 based on projected future lifetime tax contributions and public benefits received. We leveraged data from the Survey of Income and Housing conducted by the Australian Bureau of Statistics and imputations from tax-transfer microsimulations over the lifetime of the cohort estimating cumulative net-taxes. Public spending per pupil for education and lifetime health costs (in Australian dollars) were included in the benefits estimates. Results: We estimated lifetime gross taxes per individual of A $841 631, c o n s i s t i n g o f A$ 580 182 in direct taxation of earnings and A $261 448 i n c o n s u m p t i o n t a x e s . A f t e r d e d u c t i n g l i f e t i m e t r a n s f e r s r e c e i v e d a n d A R T t r e a t m e n t c o s t s, a n A R T - c o n c e i v e d c h i l d w a s p r o j e c t e d t o g e n e r a t e A$ 70 688 in discounted lifetime net tax revenue. Based on average government spend per child, a lifetime fiscal benefit-cost ratio of 2.68 was observed. Based on the 2021 ART treatment cohort, the government was projected to net A$1.29 billion in future taxes over the lifetime of the 18 364 children born. Conclusion: A positive net fiscal gain was achieved from current government spending on ART. We observed that every A $1 s p e n t o n a s s i s t e d r e p r o d u c t i o n y i e l d e d A$ 2.68 in future discounted net tax revenue. These findings were sensitive to economic conditions such as future wage growth and inflation.

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从公共经济角度估计澳大利亚辅助生殖技术受孕儿童的财政价值。

背景：各国对辅助生殖的公共资助各不相同，这可能影响每年接受治疗的不育夫妇的数量，从而影响每年通过这项技术出生的儿童的数量。由于不孕症是在医疗保健系统内治疗的一种医疗状况，它必须与所有其他医疗干预措施竞争资金。这就提出了一个问题，即与其他降低发病率和死亡率的医疗保健干预措施相比，如何评估一项提高人类生命的技术。目的：评估澳大利亚在辅助生殖技术（ART）上的年度公共支出，以确定政府在ART受孕队列的预计寿命期间可能产生的财政影响。方法：根据预计的未来终身税收贡献和收到的公共福利，使用公共经济框架评估2021年澳大利亚ART手术中出生的儿童数量。我们利用了澳大利亚统计局进行的收入和住房调查的数据，以及在估计累计净税收的队列的整个生命周期中从税收转移微观模拟中推算出的数据。每个学生的教育和终身保健费用的公共支出（以澳元计算）已列入福利估计数。结果：我们估计每个人一生的总税收为841 631澳元，其中581 182澳元为收入直接税，261 448澳元为收入直接税。f t e r d e d u c t我n g l f e t m e t r n s f e r s r e n c e i v e d d r t t r e A t m e n c o s t s n r t - c o n c e i v e d c h i l d w s p r o j e c t e d t o g e n e r t e 70 688打折一生中净税收收入。根据每个儿童的平均政府支出，可以观察到终身财政收益-成本比为2.68。根据2021年ART治疗队列，预计在18364名出生儿童的一生中，政府将净赚12.9亿澳元的未来税收。结论：当前政府在抗逆转录病毒治疗方面的支出实现了正的净财政收益。我们观察到，每增加1澳元，就会有2.68澳元的未来折现净税收，而每增加1澳元，就会有2.68澳元的未来折现净税收。这些发现对未来工资增长和通货膨胀等经济状况很敏感。

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