Infertility Insurance Mandates and Fertility.
Infertility Insurance Mandates and Fertility.
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不孕不育保险的要求和生育能力。
DOI：
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发表时间：
2005
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通讯作者：
L. Schmidt
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文献类型：
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作者：
L. Schmidt
不孕症被医学界认为是一种生殖系统疾病。它目前影响着600多万人，十分之一的夫妇在没有医疗帮助的情况下无法怀孕。不孕症的心理影响已经与癌症和心脏病等其他疾病的影响进行了比较（例如，Anne T. Fidler和Judith Bernstein， 1999），治疗的经济成本可能相当高。然而，只有25%的健康计划发起人为不孕不育服务提供保险。为了满足人们对保险的需求，2003年在联邦一级颁布了一项法律，要求医疗计划提供不孕症福利。由于受不孕症影响的人口比例继续上升，可能会继续努力强制覆盖。因此，了解这些政策的成本和收益变得越来越重要。全面分析的第一个组成部分是确定这些规定是否真的会对生育率产生影响。通过降低不孕症治疗的价格，人们可能会期望看到治疗的利用率增加。如果授权扩大了以前负担不起治疗的个人获得治疗的机会，或者如果以前接受治疗的个人现在选择消费更多（或更高质量）的治疗，这可能是正确的。然而，也有可能这些授权对获得治疗或消费治疗没有影响，而只是为那些在没有保险覆盖的情况下本打算购买治疗的个人提供意外收益。最后，任务还可能对生育时间产生动态影响。个人可以更早地寻求治疗，这从医学角度来看是有益的。或者，个人可以进一步推迟生育，因为他们知道他们最终会被覆盖。在这篇论文中，我提出了一个第一阶问题，即不孕不育治疗的强制性保险覆盖范围是否影响了出生率。截至2003年，已有15个州颁布了某种形式的不孕保险规定。使用“差异中的差异”方法，我利用不同州和不同时期的法令制定的差异，确定不应受到不孕不育覆盖影响的对照组。我的研究结果表明，这些法令使35岁以上女性的第一胎生育率提高了32%。
Infertility is considered by the medical community to be a disease of the reproductive system. It currently affects over 6 million individuals, and one in ten couples cannot conceive without medical assistance. The psychological effects of infertility have been compared to the effects of other diseases such as cancer and heart disease (e.g., Anne T. Fidler and Judith Bernstein, 1999), and the financial costs of treatment can be quite large. However, only 25 percent of all health-plan sponsors provide coverage for infertility services. In response to a perceived need for coverage, legislation was introduced at the federal level in 2003 that would require health plans to provide infertility benefits. As the fraction of the population affected by infertility continues to rise, there are likely to be continued efforts to mandate coverage. Understanding the costs and benefits of these policies thus becomes increasingly important. The first component of a full analysis is to determine whether these mandates will actually have an effect on fertility. By reducing the price of infertility treatment, one might expect to see an increase in utilization of treatments. This could be true if the mandate expands access to individuals who previously could not afford treatment, or if individuals who were previously receiving treatment now choose to consume higher quantities (or a higher quality) of treatment. However, it is also possible that these mandates have no effect on access or on treatment consumed but simply provide windfall gains to those individuals who would have purchased treatment in the absence of insurance coverage. Finally, mandates may also have dynamic effects on the timing of births. Individuals could seek treatment earlier, which is beneficial from a medical perspective. Alternatively, individuals could further delay childbearing, with the knowledge that they will ultimately be covered. In this paper, I ask the first-order question of whether the mandated insurance coverage of infertility treatment has affected birth rates. As of 2003, 15 states have enacted some form of infertility insurance mandate. Using a differencein-differences approach, I exploit variation in the enactment of mandates both across states and over time and identify control groups that should not have been affected by infertility coverage. My results suggest that the mandates increase firstbirth rates for women over age 35 by 32 percent.