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Effects of Increased Access to Infertility Treatment on Infant and Child Health Outcomes: Evidence from Health Insurance Mandates

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  • Marianne Bitler

Abstract

This paper examines the association between use of infertility treatment and infant and child health outcomes. Infertility treatment makes conception possible for many couples who otherwise would have been unable to reproduce. Access to subsidized infertility treatment varies across states over time because some states have insurance mandates compelling insurers to cover, or offer to cover, infertility treatment. Many infertility treatments also increase the chances of having multiple births. Using birth certificate data, we find the infertility mandates are associated with a statistically significant 10 percent increase in the twin birth rate among older mothers. Twin pregnancies are typically more dangerous (and costly) than singleton pregnancies. Thus, even if the only effect of the mandates is to increase twin birth rates, they have likely had a negative effect on infant health. For twins born to older mothers, the mandates are also associated with small but statistically significant negative effects on birth weight, gestation, and the 5-minute Apgar score. Effects for singletons born to older mothers are smaller in magnitude but still negative. Using Census data, we find more mixed evidence about longer-term effects of the mandates on child health. Our findings for twin birth outcomes suggest that the positive effects of investment by older mothers in their pregnancies are outweighed by the negative effects of the infertility treatments themselves or by the selection into pregnancy of women with reduced fecundity.

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Bibliographic Info

Paper provided by Public Policy Institute of California in its series PPIC Working Papers with number 2005.06.

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Length: 75 pages
Date of creation: May 2005
Date of revision:
Handle: RePEc:ppi:ppicwp:2005.06

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References

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  1. John J. Donohue III & Steven D. Levitt, 2003. "Further Evidence that Legalized Abortion Lowered Crime: A Reply to Joyce," NBER Working Papers 9532, National Bureau of Economic Research, Inc.
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  5. Schmidt Lucie, 2005. "Effects of Infertility Insurance Mandates on Fertility," Labor and Demography 0511014, EconWPA.
  6. John J. Donohue & Steven D. Levitt, 2001. "The Impact Of Legalized Abortion On Crime," The Quarterly Journal of Economics, MIT Press, vol. 116(2), pages 379-420, May.
  7. Jonathan Klick & Sara Markowitz, 2003. "Are Mental Health Insurance Mandates Effective? Evidence from Suicides," NBER Working Papers 9994, National Bureau of Economic Research, Inc.
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Cited by:
  1. Ohinata, A., 2011. "Did the US Infertility Health Insurance Mandates Affect the Timing of First Birth?," Discussion Paper 2011-102, Tilburg University, Center for Economic Research.
  2. Schmidt Lucie, 2005. "Effects of Infertility Insurance Mandates on Fertility," Labor and Demography 0511014, EconWPA.
  3. Marianne P. Bitler & Lucie Schmidt, 2011. "Utilization of Infertility Treatments: The Effects of Insurance Mandates," NBER Working Papers 17668, National Bureau of Economic Research, Inc.
  4. Thomas DeLeire & Leonard M. Lopoo & Kosali I. Simon, 2007. "Medicaid Expansions and Fertility in the United States," NBER Working Papers 12907, National Bureau of Economic Research, Inc.
  5. Machado, Matilde Pinto & Sanz-de-Galdeano, Anna, 2011. "Coverage of Infertility Treatment and Fertility Outcomes: Do Women Catch Up?," CEPR Discussion Papers 8445, C.E.P.R. Discussion Papers.
  6. M. Kate Bundorf & Melinda Henne & Laurence Baker, 2007. "Mandated Health Insurance Benefits and the Utilization and Outcomes of Infertility Treatments," NBER Working Papers 12820, National Bureau of Economic Research, Inc.

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