Insurance Mandates and Trends in Infertility Treatments

Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC 20307, USA.
Fertility and sterility (Impact Factor: 4.59). 02/2008; 89(1):66-73. DOI: 10.1016/j.fertnstert.2007.01.167
Source: PubMed


To examine the relationship between insurance mandates and the utilization and outcomes of assisted reproductive technologies (ART).
Using clinic-level data from 1990 to 2001, we examined differences between states with and without insurance mandates in rates of utilization and outcomes of ART using multivariable least squares regression.
National clinic registry data.
Clinics performing ART, no patient-level data.
The type of insurance mandate in each state during each year of the study.
Cycles per 1,000 women aged 25-44 years, live births per 1,000 cycles, and multiple births per live ART birth.
Use of ART grew rapidly during the 1990 s and grew most quickly in states that adopted comprehensive insurance mandates. Compared with states without mandates, births per cycle were 4% lower and multiples per ART birth were 2% lower in states with comprehensive mandates.
Comprehensive insurance mandates are associated with greater utilization of ART and lower rates of births per cycle and multiple births per ART birth. Whether the differences in outcomes are due to differences in embryo transfer practices or to patient characteristics is unclear.

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    • "There seems to be a gap between the development of low-cost ART technology and the use of these strategies in a clinical context. The results of recent research on the new low-cost and simplified ART system for culturing gametes without the needs of a sophisticated laboratory [76] are encouraging, because this work addresses a fundamental obstacle for millions of couples worldwide, namely access to ART at very low or at least affordable cost [77, 82]. It is obvious that further studies are needed to validate these early results and to replicate them in different settings. "
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    ABSTRACT: Background The overall prevalence of infertility was estimated to be 3.5–16.7% in developing countries and 6.9–9.3% in developed countries. Furthermore, according to reports from some regions of sub-Saharan Africa, the prevalence rate is 30–40%. The consequences of infertility and how it affects the lives of women in poor-resource settings, particularly in developing countries, has become an important issue to be discussed in reproductive health. In some societies, the inability to fulfill the desire to have children makes life difficult for the infertile couple. In many regions, infertility is considered a tragedy that affects not only the infertile couple or woman, but the entire family. Methods This is a position paper which encompasses a review of the needs of low-income infertile couples, mainly those living in developing countries, regarding access to infertility care, including ART and initiatives to provide ART at low or affordable cost. Information was gathered from the databases MEDLINE, CENTRAL, POPLINE, EMBASE, LILACS, and ICTRP with the key words: infertility, low income, assisted reproductive technologies, affordable cost, low cost. Results There are few initiatives geared toward implementing ART procedures at low cost or at least at affordable cost in low-income populations. Nevertheless, from recent studies, possibilities have emerged for new low-cost initiatives that can help millions of couples to achieve the desire of having a biological child. Conclusions It is necessary for healthcare professionals and policymakers to take into account these new initiatives in order to implement ART in resource-constrained settings.
    Reproductive Biology and Endocrinology 09/2014; 12(1):87. DOI:10.1186/1477-7827-12-87 · 2.23 Impact Factor
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    • "Currently, increased ART use is expected to have a demographic impact if women take advantage of it earlier rather than later in life. Moreover, women who may have been able to conceive with a less aggressive therapy, may request ART earlier in states with a comprehensive insurance policy [47]. "
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    ABSTRACT: Background Delayed childbearing in European countries has resulted in an increase in the number of women having children later in life. Thus more women face the problem of age-related infertility and cannot achieve their desired number of children. Childbearing postponement is one of the main reasons for the increasing use of assisted reproductive technology (ART) and conversely, the latter may be one of the factors contributing to the rise in female childbearing age. The research goal of our article is to evaluate the demographic importance of ART increased use and to examine its impact on both the fertility rate and birth timing. Methods Comparative analysis based on demographic and ART data collected by the European IVF-monitoring (EIM) Consortium for the European Society of Human Reproduction and Embryology (ESHRE). Results Most countries with a higher total fertility rate (TFR) also registered a higher number of treatment cycles per 1 million women of reproductive age. Despite the positive relationship between the postponement rate and the demand for ART among women aged 35 and older, the highest share of children born after ART was not found in countries characterized by a “delayed” fertility schedule. Instead, the highest proportion of ART births was found in countries with fertility schedules concentrated on women aged between 25 and 34. Accordingly, the effective use of ART can be expected in populations with a less advanced postponement rate. Conclusions ART can have a demographic relevancy when women take advantage of it earlier rather than later in life. Furthermore it is suggested that the use of ART at a younger age increases women’s chance of achieving their reproductive goals and reduces the risk of age-related infertility and failed ART. Based on a demographic approach, reproductive health policy may become an integral part of policies supporting early childbearing: it may keep women from delaying too long having children and increase the chance of diagnosing potential reproductive health problems requiring a timely ART application.
    Reproductive Health 05/2014; 11(1):37. DOI:10.1186/1742-4755-11-37 · 1.88 Impact Factor
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    • "It should be recognised that it is not only the infertile couple that suffers when funding is reduced but the quality of ART clinical practice, which ultimately negatively impacts the health outcomes of ART children. A number of studies in the United States [18-22] and Australia [23], have shown that when ART treatment costs increase, not only is equity of access reduced, but a financial incentive is created to transfer multiple embryos during treatment, thereby increasing the chance of a pregnancy in one cycle (i.e. it is costly to fail treatment and pay for another cycle). For example, in countries with supportive funding for ART such as the Nordic Countries and Australia the percentage of cycles where one embryo is transferred during treatment (single embryo transfer), is over 65%. "
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    ABSTRACT: Almost all assisted reproductive technology (ART) and intrauterine insemination (IUI) treatments performed in Australia are subsidized through the Australian Government's universal insurance scheme, Medicare. In 2010 restrictions on the amount Medicare paid in benefits for these treatments were introduced, increasing patient out-of-pocket payments for fresh and frozen embryo ART cycles and IUI. The aim of this study was to evaluate the impact of the policy on access to treatment, savings in Medicare benefits and the number of ART conceived children not born. Pooled quarterly cross-sectional Medicare data from 2007 and 2011 where used to construct a series of Ordinary Least Squares (OLS) regression models to evaluate the impact of the policy on access to treatment by women of different ages. Government savings in the 12 months after the policy was calculated as the difference between the predicted and observed Medicare benefits paid. After controlling for underlying time trends and unobserved factors the policy change reduced the number of fresh embryo cycles by almost 8600 cycles over 12 months (a 16% reduction in cycles, p < 0.001). The policy effect was greatest on women aged 40 years and older (38% reduction in cycles, p < 0.001). Younger women engaged in relatively more anticipatory behaviour by bringing forward their fresh cycles to 2009. Frozen embryo cycles, which are approximately one quarter of the cost of a fresh cycle, were only marginally impacted by the policy. Utilisation of IUI cycles were not impacted by the policy. After adjusting for anticipatory behaviour, $76 million in Medicare benefits was saved in the 12 months after the policy change (0.47% of annual Medicare benefits). Between 1200 and 1500 ART conceived children were not born in 2010 as a consequence of the policy. The introduction of the policy resulted in a significant reduction in fresh ART cycles in the first 15 months after its introduction. Further evaluation on the long term impact of the policy with regard access to treatment and on clinical practice, particularly the number of embryos transferred, is crucial to ensuring equitable access to fertility treatment and the health and welfare of ART children.
    BMC Health Services Research 06/2012; 12(1):142. DOI:10.1186/1472-6963-12-142 · 1.71 Impact Factor
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