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

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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.