The Effects of Insurance Mandates on Choices and Outcomes in Infertility Treatment Markets

Abstract

SUMMARYFor the 10% to 15% of American married couples who experience reproductive problems, in vitro fertilization (IVF) is the leading technologically advanced treatment procedure. However, IVF's expense may prevent many couples from receiving treatment, and those who are treated may take an overly aggressive approach to reduce the probability of failure. Aggressive treatment, which occurs through an increase in the number of embryos transferred during IVF, can lead to medically dangerous multiple births. We evaluated the principle policy proposal-insurance mandates-for improving IVF access and outcomes. We used data from US markets during 1995-2003 to show that broad insurance mandates for IVF result in not only large increases in treatment access but also significantly less aggressive treatment. More limited insurance mandates, which may apply to a subset of insurers or provide weaker guidelines for insurer behavior, generally have little effect on IVF markets.

Assisted Reproductive Technology in Europe: Usage and Regulation in the Context of Cross-Border Reproductive Care

“…Remarkably, this finding holds even after accounting for important factors such as GDP per capita, the number of physicians, and the number of ART clinics in a country. Studies that have looked at variation within countries and over time (e.g., Hamilton and McManus 2012) have also found evidence that affordability is an important driver not only of utilization, but also of the use of safer ART practices. Norms and beliefs also seem to play an important role for cross-national differences in ART usage.…”

Assisted reproductive technology in the USA: is more regulation needed?

“…Chambers et al (2013) have commented that the financial context of infertility treatment has a substantial effect on the acceptability of elective SET to patients, 'presumably because more affordable treatment reduces the financial incentive to achieve pregnancy in the shortest number of treatment cycles.' In the USA, with the variability of insurance coverage for infertility treatment, the resulting high cost may encourage particular practices, such as transferring more embryos (Hamilton and McManus, 2012). These authors found that insurance mandates (i.e.…”

Coverage of infertility treatment and fertility outcomes

“…Concerns about policy endogeneity have been discussed in previous studies, such as Bitler and Schmidt (2012) and Hamilton and McManus (2012). The latter two studies in particular reached the conclusion that the enactment of infertility treatment mandates was largely the result of the efforts of a national infertility association (RESOLVE) and the political rather than fertility preferences of state residents.…”

“…For example, in 1992, a birth from an IVF procedure cost between 44,000 and 211,942 USD (Neumann et al 1994). Over time, however, ART patients have faced substantially lower costs due to increased competition (Hamilton and McManus 2012), a reduced number of cycles due to better technology, 1,2 and most importantly, the availability of insurance in both the United States and in Europe. 3 In this paper, we analyse whether easier access to ARTs induces women to delay motherhood and whether, in the long term, it affects women's completed fertility by the end of their reproductive lives.…”

“…Other authors, such as Hamilton and McManus (2012), Bundorf et al (2007), and Mookim et al (2008), classify Illinois, Massachusetts, and Rhode-Island (hereafter IL-MA-RI) as having 'universal', 'comprehensive', and the 'most comprehensive coverage', respectively. In this paper, the effects of infertility treatment mandates on this specific group of states are also analysed.…”