Financial implications of COVID19

In these weekly COVID19 blogs for IVF units, I am exploring crisis management, marketing and communications. This week I want to look at the financial implications for both clinics and patients.

Economists usually look to the assisted reproduction market to indicate how a country’s economy is performing. If cycle numbers are up then this indicates a healthy economy. Couples can afford treatment and are confident of job security to raise a child. When cycle numbers decline, this shows people are worried about their financial future and will hold off on fertility treatment.

In our current COVID19 situation, many clinics have suspended all fertility treatments so this gauge of the economy is useless! However, we can see that in only a couple of weeks the economic crisis is already upon us.


The Federal Labor Department, USA announced that 3.3 million people filed for unemployment by 21 March 2020. The following week, a further 6.65 million had filed by 28 March 2020. This now brings the total of new claims to 9.95 million. The sharpest rise ever seen in American history.

Across the Atlantic in the UK, the Department of Work and Pensions has reported that 950,000 made unemployment claims by 31 March. The financial picture across the globe looks very bleak. However, looking at historic data we can get some pointers as to how, we as an industry can survive this.

Economic recession in Greece

Since 2009, the world has focussed on the decline of the Greek economy. The National Center for Biotechnical Information, US published an interesting paper in September 2019. “The Impact of the Economic Recession in Greece on Assisted Reproduction Demand: A Retrospective Longitudinal Study.” (1) This study recruited patient records from 2005-2017. The study split the timeframe in to three groups:

Period A – Prior to the economic crisis

Period B – During the economic crisis prior to cost reduction

Period C – During the economic crisis following cost reduction.

The study noted a decline in new patient enquiries in both periods B & C compared to period A. As anticipated, there was a decline regarding assisted reproduction techniques (ART) demand. However, the authors concluded that refining the cost of infertility treatments may have contributed towards overcoming patients postponing pregnancy due to financial concerns.

The Great Recession

The American Society of Reproductive Medicine published another interesting study in Fertility and Sterility in February 2015. “The Great Recession, insurance mandates and the use of in vitro fertilization services in the United States.” (2) This study examined the data on the use of IVF services between 2000-2011. It then looked at the relationship between the economic downturn and states that had mandatory healthcare insurance.

This study demonstrated for the first time a positive relationship between economic conditions and the use of IVF services. Importantly, it showed that this positive relationship was significantly stronger in states with mandated insurance coverage. Though typical economic fluctuations were associated with changes in IVF use, the Great Recession did not significantly alter the direction or magnitude of these relationships.


The simple fact is when clinics can resume treatments, the economic landscape globally will look very different. During the Great Recession we saw US clinics slash treatment prices from an average back in 2009 from $15,000 USD down to as little as $2000USD!

Finance Directors are going to have to adjust budgets and make some very bold decisions to see this crisis through. Marketeers are also going to have to challenge that Finance Director to ensure the marketing budget is not cut. Together finance and marketing are going to have to think outside the box!

Patient perspective

Patients are keen to have their treatment as soon as possible. But there will be a reduction in the number of IVF cycles. There are many factors that come in to play here. On one hand, emotive industry sectors do well in a recession. Infertility treatment is driven by emotion and the desire to have a family. But on the other hand, financial insecurity may mean couples won’t be able to afford treatment.

Recession history has also shown us that one industry sector that sees fewer job losses and remains stable is healthcare. Let’s just look at ways in which IVF patients pay for their treatment.

  • Have already paid for treatment that has now been suspended
  • Have savings
  • Secured a loan
  • Credit card
  • Health insurance that covers fertility treatments
  • Employee benefit that covers fertility

How COVID19 pandemic affects payment

Now if we play devil’s advocate, let’s look again at how the COVID19 pandemic may affect those methods of payment.

  • Have already paid for treatment that has now been suspended – no change
  • Have savings – may be inclined to hang on to those savings to live on if they have lost income
  • Secured a loan – may not go ahead if employment status has changed
  • Credit card – may be using this for everyday living costs
  • Health insurance that covers fertility treatments – depends on whether this is a personal policy or an employer policy, which may be affected if job is no longer secure
  • Employee benefit that covers fertility – again all depends on job security.

For each individual couple, their circumstances will determine who can and who can’t go ahead with treatment. For younger couples if the lack of financial resource means they can delay starting a family, they have time on their side. But for older couples, time is running out, they are more likely to be financially secure and still go ahead with treatment.

Clinic perspective

Running an IVF unit is an expensive business. An IVF unit is also a small to medium size business. As discussed in last week’s blog, not all clinics even have a dedicated marketing department. Not all clinics have a finance director. So, how are these clinics going to survive the economic downturn?

The sad truth is, some won’t survive this indefinite period of suspension of services. They just don’t have the capital to keep paying the overheads with no income. Some governments are stepping in to encourage businesses to keep staff on. In the UK the system is known as furlough. This means the business remains in operation, but staff salaries are paid by the government instead of the employer at a lower rate, in the UK this is 80%.

Increase marketing budget

Some of the larger more established clinics have capital that will tide them over and it is these units who continue to market who will weather the storm. Some of these Finance Directors will make cuts to the budget to ensure the overheads are met, but it takes a very bold individual to INCREASE the marketing budget during this period. History has shown us that companies who do this will increase market share and presence of mind in their customers. The same applies to IVF units. It does sound insane, but you have to stop looking at marketing as a cost and now look at it as in INVESTMENT. An investment in the future of your unit. This is survival of the fittest.

As I said earlier, marketing and finance have to work very closely now. Marketing should be involved in pricing decisions. Don’t slash rates because everyone else is! By looking at how your patients pay for treatment, you can decide whether a price reduction would encourage patients to go ahead with treatment. If 90% of your patients are covered by health insurance then it would be crazy to reduce prices. But if 90% of your patients are self-funded then a price reduction makes sense.

Most clinics adopt an upfront payment method, now during this period is it worth considering a 12-month payment plan for patients? This would bring in much needed revenue now and allows patients to budget monthly for the cost of IVF. It still means that patients have paid upfront for their cycle and allows the clinic to schedule treatments in 12 months’ time.

Involve the team in decisions

As leaders of your company, it is really important to keep all staff in the loop. It is OK to show vulnerability and share your concerns for the future. It is better to prepare staff than shock them further down the line. Keep the lines of communication open, you never know who might have a genius idea that keeps your unit going!

In the coming weeks through this blog, I will look at various marketing methods such as:

  • the use of PR
  • your brand
  • online marketing
  • seminars
  • newsletters
  • video
  • podcasts.

If you would like to discuss any of these subjects in more detail then please drop me a line.

You can read part one and part two of this series here.

Veronica Montgomery, Clinic and Patient Liaison Consultant

The Fertility Hub


  1. The Impact of the Economic Recession in Greece on Assisted Reproduction Demand: A Retrospective Longitudinal Study
  2. The Great Recession, insurance mandates and the use of in vitro fertilization services in the United States