Quantifying the Impact of Insurance Coverage for IVF on Maternal and Infant Health

项目摘要 关于体外受精保险的存在或不存在如何影响 (IVF)影响妇女和婴儿的健康结果，卫生保健利用率和IVF使用率 富裕的年轻女性研究人员的长期目标是产生令人信服的新证据， 可增进妇女和婴儿的健康。本应用程序的目的是量化的影响， 为不孕妇女及其婴儿提供体外受精保险。核心假设是， IVF的覆盖率与改善妇女和婴儿的IVF相关健康结果相关; 出生后第一年的医疗保健利用率和总医疗支出;以及增加IVF使用 通过减轻影响妇女如何使用避孕药具的关键财务障碍， 试管婴儿该项目的基本原理源于这样一个事实，即很少有健康保险计划涵盖IVF，这导致 两个主要问题。首先，许多女性由于成本而放弃或推迟使用IVF，IVF更成功， 更少的并发症，在年轻的时候进行。第二，当离开支付15,000美元的自掏腰包， IVF周期中，女性有经济动力通过转移多个孩子来增加分娩的可能性 IVF周期中的胚胎。移植多个胚胎对患者没有额外费用，但 这样做会大大增加双胞胎、三胞胎或其他高风险多胞胎的几率。 对不同不孕症妇女的调查表明，她们愿意在每次试管婴儿中移植较少的胚胎。 如果IVF是由保险覆盖。中心假设将通过追求三个具体目标进行检验：1） 评估IVF保险范围对妇女和婴儿健康结果的影响; 2） 确定IVF保险范围对医疗保健利用的影响; 3）检查 IVF保险覆盖范围对不同收入和年龄组IVF使用的影响。三个目标将 使用2001年以来全国范围内20 - 45岁商业保险妇女的大样本来完成， 2019年，并将确定接受IVF周期的妇女，无论是否有保险， 这些IVF周期中出生的婴儿。这项研究是创新的，因为它使用了一种新的方法， 在索赔数据中识别IVF周期，包括自付IVF周期。此外，这种方法将 第一次允许对多种母婴健康结果和卫生保健进行强有力的检查 在IVF和分娩后一年内使用。这项研究很重要，因为它将回答 关于对妇女、婴儿和医疗保险制度的潜在好处的重要问题 覆盖IVF，并将提供证据，以指导主要利益相关者。特别是，更好地了解 保险覆盖IVF的影响将通过为患者提供， 雇主和政策制定者拥有可操作的知识，这将有助于他们做出基于证据的决策 关于试管婴儿的保险

PROJECT SUMMARY Much remains unknown about how the presence or absence of insurance coverage for in-vitro fertilization (IVF) affects the health outcomes of women and infants, health care utilization, and IVF use among less affluent and younger women. The investigators’ long-term goal is to generate compelling new evidence that can improve the health of women and infants. The objective of this application is to quantify the impact of insurance coverage for IVF on women with infertility and their infants. The central hypothesis is that insurance coverage for IVF is associated with improved IVF-related health outcomes for women and infants; reduced net health care utilization and total medical expenditures during the first year after birth; and increased IVF use among less affluent and younger women by mitigating a key financial barrier that influences how women use IVF. The rationale for this project stems from the fact that few health insurance plans cover IVF, which leads to two main issues. First, many women forgo or delay using IVF due to cost, and IVF is more successful and has fewer complications when performed at younger ages. Second, when left to pay $15,000 out-of-pocket for an IVF cycle, women have a financial incentive to increase the likelihood of a birth by transferring multiple embryos during that IVF cycle. There is no additional cost to patients for transferring multiple embryos, but doing so greatly increases the chance of having high-risk twin, triplet, or other higher-order multiple births. Surveys of diverse women with infertility have shown that they are willing to transfer fewer embryos per IVF cycle if IVF is covered by insurance. The central hypothesis will be tested by pursuing three Specific Aims: 1) Evaluate the impact of insurance coverage for IVF on health outcomes for women and infants; 2) Determine the impact of insurance coverage for IVF on health care utilization; and 3) Examine the impact of insurance coverage for IVF on IVF use in different income and age groups. All three Aims will be completed using a large, national sample of commercially insured women aged 20-45 years from 2001- 2019, and will identify women who undergo IVF cycles both with and without insurance coverage and the infants born from those IVF cycles. The proposed research is innovative because it uses a novel approach to identify IVF cycles in claims data, including IVF cycles paid for out-of-pocket. In addition, this approach will allow–for the first time–a robust examination of multiple maternal and infant health outcomes and health care utilization for one year following IVF and childbirth. The proposed research is significant because it will answer important questions about the potential benefits to women, infants, and the health care system of insurance coverage for IVF and will provide evidence to guide major stakeholders. In particular, a better understanding of the impact of insurance coverage for IVF will lead to healthier women and infants by providing patients, employers, and policymakers with actionable knowledge that will help them make evidence-based decisions about insurance coverage for IVF.