Insurance mandates and trends in infertility treatments.
OBJECTIVE
To examine the relationship between insurance mandates and the utilization and outcomes of assisted reproductive technologies (ART).


METHODS
Using clinic-level data from 1990 to 2001, we examined differences between states with and without insurance mandates in rates of utilization and outcomes of ART using multivariable least squares regression.


METHODS
National clinic registry data.


METHODS
Clinics performing ART, no patient-level data.


METHODS
The type of insurance mandate in each state during each year of the study.


METHODS
Cycles per 1,000 women aged 25-44 years, live births per 1,000 cycles, and multiple births per live ART birth.


RESULTS
Use of ART grew rapidly during the 1990 s and grew most quickly in states that adopted comprehensive insurance mandates. Compared with states without mandates, births per cycle were 4% lower and multiples per ART birth were 2% lower in states with comprehensive mandates.


CONCLUSIONS
Comprehensive insurance mandates are associated with greater utilization of ART and lower rates of births per cycle and multiple births per ART birth. Whether the differences in outcomes are due to differences in embryo transfer practices or to patient characteristics is unclear.
Henne
Melinda B
MB
Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC 20307, USA. melinda.henne@amedd.army.mil
Bundorf
M Kate
MK
D000328:Adult; D001723:Birth Rate; D005260:Female; D033161:Government Regulation; D017048:Health Care Costs / Q000331:legislation & jurisprudence; D006291:Health Policy; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence; D006301:Health Services Needs and Demand / Q000331:legislation & jurisprudence; D006801:Humans; D007246:Infertility / Q000191:economics / Q000628:therapy*; D019458:Insurance Coverage / Q000331:legislation & jurisprudence; D007348:Insurance, Health / Q000191:economics / Q000331:legislation & jurisprudence*; D016018:Least-Squares Analysis; D050498:Live Birth; D037141:Mandatory Programs / Q000331:legislation & jurisprudence*; D010043:Outcome and Process Assessment, Health Care; D011247:Pregnancy; D012042:Registries; D027724:Reproductive Techniques, Assisted / Q000191:economics / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data / Q000639:trends; D013219:State Government; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States