title: Insurance mandates and trends in infertility treatments.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC 20307, USA. melinda.henne@amedd.army.mil
authors.forename: Melinda B
authors.initials: MB
authors.lastname: Henne
authors.forename: M Kate
authors.initials: MK
authors.lastname: Bundorf
mesh_terms: 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