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Saturday, July 30, 2011

Speculations on the economics of sterilization: Denmark edition

From the blog of Dan Ariely, professor of behavioral economics:
The Economics of Sterilization 
When it comes to sterilization, Denmark has had a rather turbulent history. In 1929, in the midst of rising social concerns regarding an increase in sex crimes and general “degeneracy,” the Danish government passed legislation bordering on eugenics, requiring sterilization in some men and women. Between 1929 and 1967, while the legislation was active, approximately 11,000 people were sterilized – roughly half of them against their will. 
Then, the policy was changed so that sterilization was still available, still free, but not involuntary. And as you might expect, the sterilization rate in Denmark dropped down dramatically – and stayed this way until 2010. 
Now we come to 2010. In only a few short months, the sterilization rate increased fivefold. No, this was not a regression to the old legislation; it was a result of free choice… 
What happened? Last year, the Danish government announced that sterilization, which had been free, would cost at least 7,000 kroner (~$1,300) for men and 13,000 kroner (~$2,500) for women as of January 1st, 2011. Following the announcement, doctors performing sterilizations found that their patient load suddenly surged. People were scrambling to get sterilized while it was still free. 
Now, it could be that the people who were already planning on getting sterilized at some point in the future just made their appointments a bit sooner, and conveniently saved some money. But I can also imagine that (much like our research on free tattoos) there were many people who did not really think much about sterilization before the price change, but were so averse to giving up such a good deal that it pushed them to take the offer and undergo a fairly serious procedure. 
And although we usually don’t think about sterilization as an impulse purchase, it might just become one when a free deal is about to be snipped.
First thought: I doubt it. It seems far more likely that the people who got sterilized last year were "some dayers," who are married or at least coupled and have a kid or two with no plans for more, with thoughts about him getting a vasectomy "someday." Or possibly getting her tubes tied, though that's more expensive. But once it was announced that the procedures would no longer be publicly funded, "someday" became "today."

Second thought: The U.S. has eugenics in its history too, and it is for that reason that I'm pretty sure publicly funded sterilization here would be met with an outcry that eugenics has returned. Of course Denmark is a bastion of socialized healthcare so it's not unusual that things would be different there....what's unusual to my eyes is that they decided to change things and begin charging. If cutting costs is the goal, isn't it a bit short-sighted to begin with a procedure that prevents all of the future costs that come with having a child which also at least in part will be publicly-funded? Or, for that matter, the costs of abortion? Granted, a first trimester abortion probably costs about a third of what female sterilization would cost....but that's assuming first trimester, and that it's the only abortion she gets. It just seems an odd policy decision to make.

Third thought: There is a dramatically less invasive and expensive form of female sterilization called Essure. But it was not government funded even when other forms of sterilization were, and you have to go to Copenhagen to get it. It would seem like if cutting corners when it comes to sterilization is really deemed a good decision (highly questionable), beginning to fund that and licensing more doctors to perform it would be the way to go.

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