'Screening should not be based on ability to pay': Australian healthcare providers' and consumers' perspectives on public funding for non-invasive prenatal testing.

Background: Non-invasive prenatal testing (NIPT) does not receive any Medicare rebate. This study investigated the views of Australian healthcare providers and consumers on public funding of NIPT.

Materials and methods: Two anonymous online, cross-sectional surveys were conducted from September 2022 to January 2023. Surveys targeted maternity healthcare professionals ('providers'), and individuals who had recently conceived a pregnancy ('consumers'). Quantitative data were analysed using χ² test. Free-text responses were analysed by inductive content analysis.

Results: Responses from 381 providers and 630 consumers were analysed. The overwhelming majority of providers (96.8%) identified financial cost as a consumer barrier to NIPT access. Public funding for NIPT was supported by 86.4% of providers and 90.4% of consumers, with free-text responses citing equity, clinical, health economic, reproductive autonomy, and ethical justifications. Of the 145 consumers who did not use NIPT in a recent pregnancy, 63.1% rated cost as an 'important/very important' factor in foregoing NIPT. NIPT non-users were younger, had lower household income and education, and were more likely to live in a rural or remote area than consumers who used NIPT.

Conclusion: Maternity healthcare providers and consumers are highly supportive of public funding for NIPT as a first-line screening test on clinical, equity, health economic, and ethical grounds. Our results confirm the presence of significant socioeconomic disparities between NIPT users and non-users, with cost being the most important factor impeding equitable access to best practice in prenatal screening. Further research and advocacy are needed to achieve equitable access to best practice in antenatal care.