New study on IVF Insurance in the USSeptember 15, 2010Carole 3 Comments »
Just when I thought that insurance coverage and IVF were banished from the 2010 public health care discussion, a new study, “Insurance coverage and in vitro fertilization outcomes: a US perspective” was published on-line in the journal Fertility and Sterility. Actually, there results were first released in abstract form at the 2009 ASRM meeting. Basically, even with the advent of better culture conditions to select the most progressive embryos and ASRM’s professional recommendation to transfer fewer embryos per cycle, the number of multiple births did not uniformly decrease across all states. Interestingly, the presence of state mandates to cover IVF insurance was strongly associated with fewer embryos transferred per cycle and a lower multiple birth rate. This data confirms the conclusions of a similar study published eight years earlier in 2002..
The authors speculate that with the insurance mandate in place, both physicians and patients are more comfortable with transferring fewer embryos, even if that meant accepting a slightly lower pregnancy rate, because a second or third attempt was financially feasible if the current attempt failed.
States which mandate insurance coverage for IVF procedures include Arkansas, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, New Jersey and Rhode Island. Seven other states mandate coverage for infertility but specifically exclude coverage for IVF procedures: California, Louisiana, Montana, New York, Ohio, Texas and West Virginia.
If you are interested in seeing a state-by-state tabulation of all kinds of insurance mandates including for IVF , these can be found at www.cahi.org using the search term “health insurance mandates in the States 2007″ to open the pdf. While I appreciate the tables of data, the perspective of this report is clearly anti-mandates and was produced by The Council for Affordable Health Insurance (CAHI) which according to their site ” is a research and advocacy association of insurance carriers active in the individual, small group, HSA and senior markets. CAHI’s membership includes health insurance companies, small businesses, physicians, actuaries and insurance brokers. Since 1992, CAHI has been an advocate for market-oriented solutions to the problems in America’s health care system.”
I feel immensely better knowing the market will take care of us, especially if we need healthcare, because the market is well known for it’s compassion. I suppose we will pay for what we really value. Hopefully we will value insurance mandates that remove financial pressures to take risks with moms and babies.
Why should we be concerned about the multiple birth rate in the US? Should infertility be treated as a public health issue or simply a personal health problem with no greater societal impact? Insurance mandates to cover infertility with inclusive iVF coverage can probably only get political traction if we can agree that infertility (and it’s resolution) has implications for all of society, not just the infertile. If you are interested in reading more about the social implications of infertility in the US and elsewhere and the argument for why infertility should be treated as a public health issue, you might enjoy this in-depth analysis titled “A Global Perspective On Infertility: An Under Recognized Public Health Issue “ by Emily McDonald Evens, MPH. Scroll down on the linked page to find the pdf link for this article.
The CDC issued a report that the infant mortality rate increased in 2002, the first US increase in infant mortality in four decades. Who are these dying babies? Do these dead babies belong to crack addicted moms? Ah, no. Actually these deaths were largely attributed to the rise in the multiple birth rate from ART procedures. Between 1990 and 2002 the multiple birth rate climbed 42 percent. In 1996, 38% of all the births due to ART were multiple births. In 2007, 32% of the births from ART were multiple births. The rate of multiple births in the general population is ten fold less, around 3%.
Having more than one fetus in the uterus strains the female reproductive system. Babies born from multiple gestation pregnancies are more likely to have complications including prematurity, low birth weight, congenital anomalies, respiratory distress syndrome, and infant mortality. Moms are more likely to have problems including an increased risk of hypertension, anemia, post-partum hemorrhage, and even increased rates of mental depression. Raising multiple infants at once is no picnic either and can cause significant emotional and financial strain for parents caring for multiples..
The bottom line is that, IMHO, fertility should be treated like a disease worthy of widespread and comprehensive insurance coverage. Without insurance coverage, the market is driving the production of higher order pregnancies which too often result in tragic outcomes for mothers and babies alike. If protecting mothers and babies isn’t in society’s best interest, what is?
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