title: The Great Recession, insurance mandates, and the use of in vitro fertilization services in the United States.
abstract: OBJECTIVE
  To investigate the relationship between economic activities, insurance mandates, and the use of in vitro fertilization (IVF) in the United States.
  
  
  METHODS
  We examined the correlation between the coincident index (a proxy for overall economic conditions) and IVF use at the national level from 2000 to 2011. We then analyzed the relationship at the state level through longitudinal regression models. The base model tested the correlation at the state level. Additional models examined whether this relationship was affected, both separately and jointly, by insurance mandates and the Great Recession.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  None.
  
  
  METHODS
  Direction and magnitude of the relationship between the coincident index and IVF use, and influences of insurance mandates and the Great Recession.
  
  
  RESULTS
  The coincident index was positively correlated with IVF use at the national level (correlation coefficient = 0.89). At the state level, an increase of one unit in the coincident index was associated with an increase of 16 IVF cycles per 1 million women, with a significantly greater increase in IVF use in states with insurance mandates than in states without mandates (27 versus 15 IVF cycles per 1 million women). The Great Recession did not alter the relationship between the coincident index and IVF use.
  
  
  CONCLUSIONS
  Our study demonstrates a positive relationship between the economy and IVF use, with greater magnitude in states with insurance mandates. This relationship was not affected by the Great Recession regardless of mandated insurance coverage.
authors.affiliation: Harvard University's Interfaculty Initiative in Health Policy, Cambridge, Massachusetts; Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Sasin Graduate Institute of Business Administration of Chulalongkorn University, Bangkok, Thailand.
authors.forename: Sorapop
authors.initials: S
authors.lastname: Kiatpongsan
authors.affiliation: Harvard Business School, Harvard University, Boston, Massachusetts.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Huckman
authors.affiliation: Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: mhornstein@partners.org.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Hornstein
mesh_terms: D057172:Economic Recession / Q000639:trends; D005260:Female; D005307:Fertilization in Vitro / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000639:trends; D007348:Insurance, Health / Q000191:economics / Q000639:trends; D008137:Longitudinal Studies; D034121:Reproductive Health Services / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States
keywords: Coincident index; Great Recession; economic condition; insurance mandate; in vitro fertilization