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Maternal and Child Health Journal

, Volume 23, Issue 5, pp 623–632 | Cite as

US State-Level Infertility Insurance Mandates and Health Plan Expenditures on Infertility Treatments

  • Sheree L. BouletEmail author
  • Jennifer Kawwass
  • Donna Session
  • Denise J. Jamieson
  • Dmitry M. Kissin
  • Scott D. Grosse
Article
  • 183 Downloads

Abstract

Objectives We aimed to examine the extent to which health plan expenditures for infertility services differed by whether women resided in states with mandates requiring coverage of such services and by whether coverage was provided through a self-insured plan subject to state mandates versus fully-insured health plans subject only to federal regulation. Methods This retrospective cohort study used individual-level, de-identified health insurance claims data. We included women 19–45 years of age who were continuously enrolled during 2011 and classified them into three mutually exclusive groups based on highest treatment intensity: in vitro fertilization (IVF), intrauterine insemination (IUI), or ovulation-inducing (OI) medications. Using generalized linear models, we estimated adjusted annual mean, aggregate, and per member per month (PMPM) expenditures among women in states with an infertility insurance mandate and those in states without a mandate, stratified by enrollment in a fully-insured or self-insured health plan. Results Of the 6,006,017 women continuously enrolled during 2011, 9199 (0.15%) had claims for IVF, 10,112 (0.17%) had claims for IUI, and 23,739 (0.40%) had claims for OI medications. Among women enrolled in fully insured plans, PMPM expenditures for infertility treatment were 3.1 times higher for those living in states with a mandate compared with states without a mandate. Among women enrolled in self-insured plans, PMPM infertility treatment expenditures were 1.2 times higher for mandate versus non-mandate states. Conclusions for Practice Recorded infertility treatment expenditures were higher in states with insurance reimbursement mandates versus those without mandates, with most of the difference in expenditures incurred by fully-insured plans.

Keywords

In vitro fertilization Infertility Artificial insemination Assisted reproductive technologies Ovulation induction Expenditures Insurance 

Notes

Supplementary material

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Supplementary material 1 (DOCX 18 KB)
10995_2018_2675_MOESM2_ESM.docx (20 kb)
Supplementary material 2 (DOCX 19 KB)

References

  1. Agency for Healthcare Research and Quality. (2011). Percent of private-sector enrollees that are enrolled in self-insured plans at establishments that offer health insurance by firm size and state: United States, 2011. Center for Financing, Access and Cost Trends. http://meps.ahrq.gov/mepsweb/data_stats/summ_tables/insr/state/series_2/2011/tiib2b1.pdf. Accessed 21 Dec 2018.
  2. Barry, C. L., Epstein, A. J., Marcus, S. C., Kennedy-Hendricks, A., Candon, M. K., Xie, M., & Mandell, D. S. (2017). Effects of state insurance mandates on health care use and spending for autism spectrum disorder. Health Affairs, 36(10), 1754–1761.CrossRefGoogle Scholar
  3. Bitler, M. P., & Schmidt, L. (2012). Utilization of infertility treatments: The effects of insurance mandates. Demography, 49(1), 125–149.CrossRefGoogle Scholar
  4. Chambers, G. M., Sullivan, E. A., Ishihara, O., Chapman, M. G., & Adamson, G. D. (2009). The economic impact of assisted reproductive technology: A review of selected developed countries. Fertility and Sterility, 91(6), 2281–2294.CrossRefGoogle Scholar
  5. Chandra, A., Copen, C. E., & Stephen, E. H. (2013). Infertility and impaired fecundity in the United States, 1982–2010: Data from the National Survey of Family Growth. National Health Statistics Reports, 67, 1–18.Google Scholar
  6. Chandra, A., Copen, C. E., & Stephen, E. H. (2014). Infertility service use in the United States: Data from the National Survey of Family Growth, 1982–2010. National Health Statistics Reports, 73, 1–21.Google Scholar
  7. Collins, J. A., Bustillo, M., Visscher, R. D., & Lawrence, L. D. (1995). An estimate of the cost of in vitro fertilization services in the United States in 1995. Fertility and Sterility, 64(3), 538–545.CrossRefGoogle Scholar
  8. Griffin, M., & Panak, W. F. (1998). The economic cost of infertility-related services: An examination of the Massachusetts infertility insurance mandate. Fertility and Sterility, 70(1), 22–29.CrossRefGoogle Scholar
  9. Hamilton, B. H., & McManus, B. (2012). The effects of insurance mandates on choices and outcomes in infertility treatment markets. Health Economics, 21(8), 994–1016.CrossRefGoogle Scholar
  10. Henne, M. B., & Bundorf, M. K. (2008). Insurance mandates and trends in infertility treatments. Fertility and Sterility, 89(1), 66–73.CrossRefGoogle Scholar
  11. Jensen, G. A., & Morrisey, M. A. (1999). Employer-sponsored health insurance and mandated benefit laws. The Milbank Quarterly, 77(4), 425–459.CrossRefGoogle Scholar
  12. Johnston, J., Gusmano, M. K., & Patrizio, P. (2014). Preterm births, multiples, and fertility treatment: Recommendations for changes to policy and clinical practices. Fertility and Sterility, 102(1), 36–39.CrossRefGoogle Scholar
  13. Katz, P., Showstack, J., Smith, J. F., Nachtigall, R. D., Millstein, S. G., Wing, H., … Adler, N. (2011). Costs of infertility treatment: Results from an 18-month prospective cohort study. Fertility and Sterility, 95(3), 915–921.CrossRefGoogle Scholar
  14. Martin, J. R., Bromer, J. G., Sakkas, D., & Patrizio, P. (2011). Insurance coverage and in vitro fertilization outcomes: A U.S. perspective. Fertility and Sterility, 95(3), 964–969.CrossRefGoogle Scholar
  15. Mercer Health and Benefits LLC. (2006). Employer experience with, and attitudes toward, coverage of infertility treatment. Accessed August 28, 2018, from https://resolve.org/wp-content/uploads/2017/09/Mercer_-_Resolve_Final_Report.pdf.
  16. Neumann, P. J. (1997). Should health insurance cover IVF? Issues and options. Journal of Health Politics, Policy and Law, 22(5), 1215–1239.CrossRefGoogle Scholar
  17. Thoma, M. E., McLain, A. C., Louis, J. F., King, R. B., Trumble, A. C., Sundaram, R., & Louis, G. M. B. (2013). Prevalence of infertility in the United States as estimated by the current duration approach and a traditional constructed approach. Fertility and Sterility, 99(5), 1324–1331.CrossRefGoogle Scholar
  18. Wu, A. K., Odisho, A. Y., Washington, S. L. 3rd, Katz, P. P., & Smith, J. F. (2014). Out-of-pocket fertility patient expense: Data from a multicenter prospective infertility cohort. The Journal of Urology, 191(2), 427–432.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Sheree L. Boulet
    • 1
    Email author
  • Jennifer Kawwass
    • 1
    • 2
  • Donna Session
    • 3
  • Denise J. Jamieson
    • 1
  • Dmitry M. Kissin
    • 2
  • Scott D. Grosse
    • 4
  1. 1.Department of Gynecology and ObstetricsEmory University School of MedicineAtlantaUSA
  2. 2.Division of Reproductive Health, National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaUSA
  3. 3.Division of Reproductive Endocrinology and InfertilityVanderbilt University School of MedicineNashvilleUSA
  4. 4.National Center on Birth Defects and Developmental DisabilitiesCenters for Disease Control and PreventionAtlantaUSA

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