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

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  • Marianne P. 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. Many treatments also increase the chance of having a multiple birth, typically a more risky pregnancy. State insurance mandates compelling insurers to cover or offer to cover infertility treatment induce variation across states over time in access to subsidized infertility treatment. Using birth certificate data, this paper finds the infertility mandates are associated with a statistically significant 10 percent increase in twin births 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 births, 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, the paper finds more mixed evidence about longer term effects of the mandates on child health. The findings for twin birth outcomes suggest that positive effects of investment by older mothers in their pregnancies are outweighed by negative impacts of either the infertility treatments themselves or by the selection into pregnancy of women with reduced fecundity.

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File URL: http://www.rand.org/content/dam/rand/pubs/working_papers/2006/RAND_WR330.pdf
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Bibliographic Info

Paper provided by RAND Corporation Publications Department in its series Working Papers with number 330.

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Length: 76 pages
Date of creation: May 2005
Date of revision:
Handle: RePEc:ran:wpaper:330

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Keywords: infertility; infant health; insurance mandates; twins; birth outcomes; fertility timing; impaired fecundity;

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References

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  1. Jonathan Klick & Sara Markowitz, 2003. "Are Mental Health Insurance Mandates Effective? Evidence from Suicides," NBER Working Papers 9994, National Bureau of Economic Research, Inc.
  2. Schmidt Lucie, 2005. "Effects of Infertility Insurance Mandates on Fertility," Labor and Demography 0511014, EconWPA.
  3. Rosemary Hyson & Janet Currie, 1999. "Is the Impact of Health Shocks Cushioned by Socioeconomic Status? The Case of Low Birthweight," American Economic Review, American Economic Association, vol. 89(2), pages 245-250, May.
  4. Douglas Almond & Kenneth Y. Chay & David S. Lee, 2005. "The Costs of Low Birth Weight," The Quarterly Journal of Economics, MIT Press, vol. 120(3), pages 1031-1083, August.
  5. Donohue, John J. & Levitt, Steven D., 2000. "The Impact of Legalized Abortion on Crime," Berkeley Olin Program in Law & Economics, Working Paper Series qt00p599hk, Berkeley Olin Program in Law & Economics.
  6. Ted Joyce, 2004. "Did Legalized Abortion Lower Crime?," Journal of Human Resources, University of Wisconsin Press, vol. 39(1).
  7. Elizabeth Oltmans Ananat & Jonathan Gruber & Phillip Levine, 2007. "Abortion Legalization and Life-Cycle Fertility," Journal of Human Resources, University of Wisconsin Press, vol. 42(2).
  8. Cutler David M. & Meara Ellen, 2000. "The Technology of Birth: Is It Worth It?," Forum for Health Economics & Policy, De Gruyter, vol. 3(1), pages 1-37, January.
  9. Summers, Lawrence H, 1989. "Some Simple Economics of Mandated Benefits," American Economic Review, American Economic Association, vol. 79(2), pages 177-83, May.
  10. 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.
  11. Jonathan Gruber & Phillip Levine & Douglas Staiger, 1999. "Abortion Legalization And Child Living Circumstances: Who Is The ''Marginal Child''?," The Quarterly Journal of Economics, MIT Press, vol. 114(1), pages 263-291, February.
  12. Liu, Zhimei & Dow, William H. & Norton, Edward C., 2004. "Effect of drive-through delivery laws on postpartum length of stay and hospital charges," Journal of Health Economics, Elsevier, vol. 23(1), pages 129-155, January.
  13. Gabor Kezdi, 2005. "Robus Standard Error Estimation in Fixed-Effects Panel Models," Econometrics 0508018, EconWPA.
  14. Grossman, Michael & Joyce, Theodore J, 1990. "Unobservables, Pregnancy Resolutions, and Birth Weight Production Functions in New York City," Journal of Political Economy, University of Chicago Press, vol. 98(5), pages 983-1007, October.
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Citations

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Cited by:
  1. 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.
  2. Marianne Bitler & Lucie Schmidt, 2008. "Utilization of Infertility Treatments: The Effects of Insurance Mandates," Department of Economics Working Papers 2008-05, Department of Economics, Williams College.
  3. Lucie Schmidt, 2005. "Effects of Infertility Insurance Mandates on Fertility," Department of Economics Working Papers 2005-07, Department of Economics, Williams College.
  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. 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.

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