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

项目总结 关于试管受精保险的存在或缺失，仍有许多未知之处 (试管受精)对妇女和婴儿的健康结局、卫生保健利用和试管受精使用的影响较小 富裕而年轻的女性。调查人员的长期目标是产生令人信服的新证据 可以改善妇女和婴儿的健康。此应用程序的目标是量化以下各项的影响 为不孕不育妇女及其婴儿提供试管受精保险。中心假设是保险 试管受精覆盖率与改善与试管受精相关的妇女和婴儿的健康结局有关；减少净额 出生后第一年的保健利用和总医疗费用；以及增加试管受精使用量 在不太富裕和年轻的女性中，通过减少影响女性如何使用 试管受精。这个项目的理由是，很少有健康保险计划涵盖试管受精，这导致 主要有两个问题。首先，许多女性因为费用的原因放弃或推迟使用试管婴儿，而且试管婴儿更成功，而且 年轻时进行手术的并发症较少。其次，当人们自掏腰包支付15,000美元购买 试管受精周期，女性有经济动机通过将多个 在那个试管受精周期中的胚胎。移植多个胚胎对患者没有额外的费用，但 这样做极大地增加了生双胞胎、三胞胎或其他更高级别多胞胎的风险。 对不同不孕症妇女的调查表明，她们愿意每一次试管受精移植较少的胚胎。 如果试管受精在保险范围内，则进行周期治疗。核心假设将通过追求三个具体目标来检验：1) 评估试管受精保险范围对妇女和婴儿健康结局的影响；2) 确定试管受精的保险覆盖范围对医疗保健利用率的影响；以及3)检查 不同收入和年龄段的体外受精保险范围对试管受精使用的影响。所有三个目标都将 从2001年起，使用20-45岁商业保险妇女的全国大样本完成- 2019年，并将确定接受试管受精周期的妇女是否有保险和 从试管受精周期中出生的婴儿。拟议的研究具有创新性，因为它使用了一种新的方法来 在索赔数据中确定试管受精周期，包括自付的试管受精周期。此外，这种方法将 允许--第一次--对多种孕产妇和婴儿健康结果和保健进行强有力的检查 在试管受精和分娩后使用一年。这项拟议的研究意义重大，因为它将回答 关于保险对妇女、婴儿和医疗保健系统的潜在好处的重要问题 覆盖试管受精，并将提供证据指导主要利益攸关方。特别是，更好地理解 试管受精保险的影响将通过为患者提供更健康的妇女和婴儿， 雇主和政策制定者拥有可操作的知识，将帮助他们做出基于证据的决策 关于试管受精的保险范围。

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.