 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 | |  | |  | |  |
The journey to conception is a long, difficult road...
How does the US compare to the rest of the world for infertility coverage?
A mandate would benefit millions.
Approximately 10% of all couples of reproductive age suffer from some form of infertility.
The total number of women with impaired fecundity actually grew between 1982 and 1995 by about
35%, from 4.6 million to 6.2 million. *
Only about 15% of these people will seek treatment and even fewer can afford to follow through.
(Source: Coverage is the Exception)
The majority of health insurance plans currently do not offer coverage for the treatment of infertility.
It is estimated that only 14% of large group plans, 16% of preferred provider organizations (PPOs),
and 17% of point-of-service networks and health maintenance organizations (HMOs) routinely cover
procedures related to assisted reproductive technologies (ARTs). For the six million Americans
struggling with a medical disorder causing infertility, cost is a significant barrier to care. The average
infertile couple will pay close to $60,000 for a successful delivery using ARTs - well out of reach for
many Americans without the benefit of health insurance coverage. (Source: Does our Insurance
Cover Treatment Costs?)
Many advocates argue that the infertile pay premiums and help to cover the maternity costs for other
members of the plan; therefore, they are carrying an unfair burden since their infertility treatment is
not paid for.
Our current system is biased and unfair.
The private funding of IVF creates a potential maldistribution of resources along 2 population
dimensions: between the subfertile and those without fertility concerns and between the wealthy and
the poor.*
Currently, the private expense of IVF effectively reserves it for the wealthy or impoverishes those
with limited resources who chosen to pursue treatment.*
A mandate will cost about $3 a year and many may be willing to sacrifice this small amount.
Currently only 14% of large plans and 16% of preferred plans offer IVF coverage.
A 1997 study by William M. Mercer, a human resources consulting firm, found that covering
infertility treatments, including advanced procedures such as IVF, would add about $3.14 a year to
each member's health insurance premium. This study further stated, "Offering a comprehensive
infertility treatment benefit with appropriate utilization controls may actually reduce costs and improve
outcomes by eliminating the use of costly, inappropriate, 'covered' procedures and allowing specialists
to use the most effective treatment for a specific type of infertility." (Source: Drive for Insurance
Coverage of Infertility Treatment Raises Questions of Equity, Cost)
IVF and other ART procedures account for only .003% of all health care costs. (Source: A Global
Perspective on Infertility: An Under Recognized Public Health Issue) Requires Adobe Reader
An evaluation published in The Journal of Reproductive Medicine in 1997 of one health plan's
experience found that despite a utilization rate substantially higher than the U.S. average, the annual
cost per employee was still around $3. A broader study of insurers in the state, published in Fertility
and Sterility in 1998, found that expenditures did not outpace overall inflation, despite an increase in
coverage and utilization. The authors cited increased treatment success rates, cost-effective advances
in treatment technology and, most importantly, discounts for services under managed care provider
arrangements and capitation plans as factors contributing to these stable costs. (Source: Drive for
Insurance Coverage of Infertility Treatment Raises Questions of Equity, Cost)
A survey of healthy medical professionals indicated the average person was willing to pay $1466 per
lifetime for access to assisted reproductive services. Another study was done utilizing college
undergraduates. They were offered a choice of two plans. Plan A covered 100% of maternity
benefits, while Plan B covered 90% of maternity benefits and 90% of infertility benefits. Sixty two
percent of the college undergraduates chose Plan B. They were willing to accept a 10% co-pay for
maternity benefits in return for 90% coverage of infertility services. This group of college students
was willing to pay $2.00 per month for the infertility portion. These studies represent somewhat
limited constituencies. Whether "willingness to pay" can be equated to "public demand" is open to
question.
Dr. William Panak, Ph.D predicts that both cost per treatment and cost to provide insurance coverage
will decrease as a result of the mandate. He maintains, "Cost per procedure will be reduced as clinics
and HMOs negotiate provider arrangements that lower physician fees and other costs in exchange for
increasing the number of referrals to that clinic."
A mandate will make IVF safer for mother and child.
In a study from Massachusetts, researchers have found that mandated infertility insurance coverage
effectively lowers the multiple birth rate in in vitro fertilization (IVF). The study showed that
programs in states with mandated insurance coverage transferred fewer embryos during ART
procedures than did programs in non-mandated states. The authors concluded that infertility insurance
mandates do lower the multiple birth rate in IVF. They theorize that the reasons for the lowered
multiple birth rate could be due to decreased pressure from patients to achieve pregnancy at any cost
by transferring more embryos and due to pressure from the insurance companies to reduce the
multiple birth rate. (Source: Infertility Insurance Mandates Lower Multiple Births in IVF)
Inadequate or absent health care coverage for IVF may force couple to limit the number of IVF cycles
and request more embryos be transferred. The average number of fresh embryos transferred per
cycle in states with comprehensive insurance coverage was lower in states without coverage.
Furthermore, the percentage of pregnancies with 3 or more fetuses was lower in states with mandated
insurance coverage than in states without coverage.** Since prenatal and postnatal care is so
expensive for multiple births, states with mandated coverage may actually be saving money.
* Go to your local college library for reference: Hughes, E.G. & Giacomini, M. (2001). Funding for
in vitro fertilization for persistent subfertility: the pain and the politics. Fertility and Sterility, 76,
431-442.
** Check you local college library for reference: Jain, T. & Hornstein, M.D. (2003). To pay or not
to pay. Fertility and Sterility, 80, 27-29.
A mandate would benefit millions.
Approximately 10% of all couples of reproductive age suffer from some form of infertility.
The total number of women with impaired fecundity actually grew between 1982 and 1995 by about
35%, from 4.6 million to 6.2 million. *
Only about 15% of these people will seek treatment and even fewer can afford to follow through.
(Source: Coverage is the Exception)
The majority of health insurance plans currently do not offer coverage for the treatment of infertility.
It is estimated that only 14% of large group plans, 16% of preferred provider organizations (PPOs),
and 17% of point-of-service networks and health maintenance organizations (HMOs) routinely cover
procedures related to assisted reproductive technologies (ARTs). For the six million Americans
struggling with a medical disorder causing infertility, cost is a significant barrier to care. The average
infertile couple will pay close to $60,000 for a successful delivery using ARTs - well out of reach for
many Americans without the benefit of health insurance coverage. (Source: Does our Insurance
Cover Treatment Costs?)
Many advocates argue that the infertile pay premiums and help to cover the maternity costs for other
members of the plan; therefore, they are carrying an unfair burden since their infertility treatment is
not paid for.
Our current system is biased and unfair.
The private funding of IVF creates a potential maldistribution of resources along 2 population
dimensions: between the subfertile and those without fertility concerns and between the wealthy and
the poor.*
Currently, the private expense of IVF effectively reserves it for the wealthy or impoverishes those
with limited resources who chosen to pursue treatment.*
A mandate will cost about $3 a year and many may be willing to sacrifice this small amount.
Currently only 14% of large plans and 16% of preferred plans offer IVF coverage.
A 1997 study by William M. Mercer, a human resources consulting firm, found that covering
infertility treatments, including advanced procedures such as IVF, would add about $3.14 a year to
each member's health insurance premium. This study further stated, "Offering a comprehensive
infertility treatment benefit with appropriate utilization controls may actually reduce costs and improve
outcomes by eliminating the use of costly, inappropriate, 'covered' procedures and allowing specialists
to use the most effective treatment for a specific type of infertility." (Source: Drive for Insurance
Coverage of Infertility Treatment Raises Questions of Equity, Cost)
IVF and other ART procedures account for only .003% of all health care costs. (Source: A Global
Perspective on Infertility: An Under Recognized Public Health Issue) Requires Adobe Reader
An evaluation published in The Journal of Reproductive Medicine in 1997 of one health plan's
experience found that despite a utilization rate substantially higher than the U.S. average, the annual
cost per employee was still around $3. A broader study of insurers in the state, published in Fertility
and Sterility in 1998, found that expenditures did not outpace overall inflation, despite an increase in
coverage and utilization. The authors cited increased treatment success rates, cost-effective advances
in treatment technology and, most importantly, discounts for services under managed care provider
arrangements and capitation plans as factors contributing to these stable costs. (Source: Drive for
Insurance Coverage of Infertility Treatment Raises Questions of Equity, Cost)
A survey of healthy medical professionals indicated the average person was willing to pay $1466 per
lifetime for access to assisted reproductive services. Another study was done utilizing college
undergraduates. They were offered a choice of two plans. Plan A covered 100% of maternity
benefits, while Plan B covered 90% of maternity benefits and 90% of infertility benefits. Sixty two
percent of the college undergraduates chose Plan B. They were willing to accept a 10% co-pay for
maternity benefits in return for 90% coverage of infertility services. This group of college students
was willing to pay $2.00 per month for the infertility portion. These studies represent somewhat
limited constituencies. Whether "willingness to pay" can be equated to "public demand" is open to
question.
Dr. William Panak, Ph.D predicts that both cost per treatment and cost to provide insurance coverage
will decrease as a result of the mandate. He maintains, "Cost per procedure will be reduced as clinics
and HMOs negotiate provider arrangements that lower physician fees and other costs in exchange for
increasing the number of referrals to that clinic."
A mandate will make IVF safer for mother and child.
In a study from Massachusetts, researchers have found that mandated infertility insurance coverage
effectively lowers the multiple birth rate in in vitro fertilization (IVF). The study showed that
programs in states with mandated insurance coverage transferred fewer embryos during ART
procedures than did programs in non-mandated states. The authors concluded that infertility insurance
mandates do lower the multiple birth rate in IVF. They theorize that the reasons for the lowered
multiple birth rate could be due to decreased pressure from patients to achieve pregnancy at any cost
by transferring more embryos and due to pressure from the insurance companies to reduce the
multiple birth rate. (Source: Infertility Insurance Mandates Lower Multiple Births in IVF)
Inadequate or absent health care coverage for IVF may force couple to limit the number of IVF cycles
and request more embryos be transferred. The average number of fresh embryos transferred per
cycle in states with comprehensive insurance coverage was lower in states without coverage.
Furthermore, the percentage of pregnancies with 3 or more fetuses was lower in states with mandated
insurance coverage than in states without coverage.** Since prenatal and postnatal care is so
expensive for multiple births, states with mandated coverage may actually be saving money.
* Go to your local college library for reference: Hughes, E.G. & Giacomini, M. (2001). Funding for
in vitro fertilization for persistent subfertility: the pain and the politics. Fertility and Sterility, 76,
431-442.
** Check you local college library for reference: Jain, T. & Hornstein, M.D. (2003). To pay or not
to pay. Fertility and Sterility, 80, 27-29.