Book Review: <i>The Pursuit of Parenthood: Reproductive Technology from Test-Tube Babies to Uterus Transplants</i>

Walker, Alicia M.

doi:10.1177/0092055x20959844

Cited by 1 publication

(3 citation statements)

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“…Specifically, ART cycles are often expensive, insurance coverage minimal, and many ART clinics are for-profit. [47][48][49][50] It would be unwise, however, to recommend reduction of insurance coverage, increases in fee-for-service care, or high out-of-pocket costs for other venues of care. That being said, shifts in the incentive structure that are more consistent with "bending the cost curve," such as global or capitated payments, may help to reduce provider gaming and may improve quality as well.…”

Section: Discussionmentioning

confidence: 99%

“…For example, the incentive structure of ART clinics may contribute to these findings. Specifically, ART cycles are often expensive, insurance coverage minimal, and many ART clinics are for‐profit 47–50 . It would be unwise, however, to recommend reduction of insurance coverage, increases in fee‐for‐service care, or high out‐of‐pocket costs for other venues of care.…”

Section: Discussionmentioning

confidence: 99%

“…47 Among those with insurance, the median out-of-pocket cost for in-vitro fertilization was $19,234 in a study from 2014. 48 With high costs, even with insurance, many ART clinics are privately owned and for-profit, 50 unlike other health systems. Given the high cost of ARTs and the fee-for-service, for-profit market they are in, such clinics may be driven to recruit patients irrespective of the likelihood of success.…”

Section: Lagged-dependent Variable Approachesmentioning

confidence: 99%

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Accounting for past patient composition in evaluations of quality reporting

Tierney

Fishman

2022

Health Services Research

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Objective To investigate whether accounting for past patient composition in evaluations of the association between public quality reports and patient selectivity changes findings and conclusions. Data Sources Secondary data analysis of public reports of Assisted Reproductive Technology Clinic success rates between 2011 and 2018. Study Design Two sets of fixed effects models, (1) a standard fixed‐effects model (FE) and (2) a dynamic panel model using structural equation modeling estimated with maximum‐likelihood (ML‐SEM) with one‐ and two‐year lagged patient characteristics, are compared. The outcome variables are patient composition features associated with success rates, including two age categories and eight diagnoses of infertility. Two‐year lagged success rates for any live birth and a singleton live birth are central predictor variables. Data Collection/Extraction Methods Clinics with complete records for the 2011–2018 period were included (N = 303). Principal Findings For live birth success rates, the two models show increases in the two‐year lagged success rate is associated with a reduction in (1) the transformed percentage of patients with endometriosis (FE: β = −0.006, SE = 0.002, p < 0.01; ML‐SEM: β = −0.005, SE = 0.002, p < 0.01) and (2) the percentage of patients with tubal diagnoses (FE: β = −0.090, SE = 0.017, p < 0.001; ML‐SEM: β = −0.064, SE = 0.027, p < 0.05). For singleton birth success rates, the models show positive associations between the two‐year lagged success rate and the percent of patients over 35 years old (FE: β = 0.219, SE = 0.033, p < 0.001; ML‐SEM: β = 0.095, SE = 0.047, p < 0.05). Overall, the FE models show numerous significant associations with the two‐year lagged success rate not observed in the ML‐SEM models. Thus, the preferred and theoretically appropriate model (ML‐SEM) and the more commonly used model (FE) yield different results. Conclusions Researchers and policymakers should use models that account for past patient composition when evaluating the associations between quality reports and patient selectivity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%