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Impact of Mandated Insurance Coverage on Utilization and Outcomes of In Vitro Fertilization
by Tarun Jain, M.D., F.A.C.O.G.
More than 6 million women of reproductive age in the United States (US) are unable to have children. A substantial number of these women cannot conceive with conventional methods of treatment, such as ovulation induction, surgery, and insemination, and subsequently become candidates for in vitro fertilization (IVF). Since IVF was introduced in 1978, there has been a growing debate about whether the substantial medical costs associated with this procedure should be covered by health insurance. According to ASRM, the average charge for a single IVF cycle in the US is $12,400 (which does not include medication costs).
Although most insurance companies in the US do not cover in vitro fertilization, a few states have passed laws requiring that insurance companies provide either partial or complete coverage of in vitro fertilization. We used 1998 data reported to the Centers for Disease Control and Prevention (CDC) by 360 fertility clinics in the US and 2000 US Census data to determine IVF utilization and outcomes according to the status of insurance coverage. This study was published in The New England Journal of Medicine in August 2002.
In 1998, of the states in which IVF services were available, 3 states (31 clinics) required complete insurance coverage, 5 states (27 clinics) required partial coverage, and 37 states plus Puerto Rico and the District of Columbia (302 clinics) required no coverage. Clinics in states that required complete coverage performed more IVF cycles than clinics in states that required partial or no coverage (3.35 vs. 1.46 and 1.21 IVF cycles per 1000 women of reproductive age, respectively) and more transfers of frozen embryos (0.43 vs. 0.30 and 0.20 per 1000 women of reproductive age, respectively). The percentage of cycles that resulted in live births was higher in states that did not require any coverage than in states that required partial or complete coverage (25.7 percent vs. 22.2 percent and 22.7 percent, respectively), but the percentage of pregnancies with three or more fetuses was also higher (11.2 percent vs. 8.9 percent and 9.7 percent, respectively). The number of fresh embryos transferred per cycle was lower in states that required complete coverage than in states that required partial or no coverage.
In summary, our study showed that state-mandated insurance coverage for IVF services is associated with increased utilization of these services but with decreases in the number of embryos transferred per cycle, the percentage of cycles resulting in pregnancy, and the percentage of pregnancies with three or more fetuses. Click on the document below to read more.