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Utilization of Infertility Treatments: The Effects of Insurance Mandates

  • Marianne P. Bitler
  • Lucie Schmidt

Over the last several decades, both delay of childbearing and fertility problems have become increasingly common among women in developed countries. At the same time, technological changes have made many more options available to individuals experiencing fertility problems. However, these technologies are expensive, and only 25% of health insurance plans in the United States cover infertility treatment. As a result of these high costs, legislation has been passed in 15 states that mandates insurance coverage of infertility treatment in private insurance plans. In this paper, we examine whether mandated insurance coverage for infertility treatment affects utilization. We allow utilization effects to differ by age and education, since previous research suggests that older, more educated women should be more likely to be directly affected by the mandates than younger women and less educated women, both because they are at higher risk of fertility problems and because they are more likely to have private health insurance which is subject to the mandate. We find robust evidence that the mandates do have a significant effect on utilization for older, more educated women that is larger than the effects found for other groups. These effects are largest for the use of ovulation-inducing drugs and artificial insemination.

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Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 17668.

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Date of creation: Dec 2011
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Publication status: published as Marianne Bitler & Lucie Schmidt, 2012. "Utilization of Infertility Treatments: The Effects of Insurance Mandates," Demography, Springer, vol. 49(1), pages 125-149, February.
Handle: RePEc:nbr:nberwo:17668
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  1. Lucie Schmidt, 2005. "Effects of Infertility Insurance Mandates on Fertility," Department of Economics Working Papers 2005-07, Department of Economics, Williams College.
  2. Blackburn, McKinley L & Bloom, David E & Neumark, David, 1993. "Fertility Timing, Wages, and Human Capital," Journal of Population Economics, Springer, vol. 6(1), pages 1-30.
  3. Marianne P. Bitler & Christopher S. Carpenter, 2011. "Health Insurance Mandates, Mammography, and Breast Cancer Diagnoses," NBER Working Papers 16669, National Bureau of Economic Research, Inc.
  4. Marianne Bitler & Lucie Schmidt, 2006. "Health disparities and infertility: impacts of state-level insurance mandates," Department of Economics Working Papers 2006-04, Department of Economics, Williams College, revised Nov 2006.
  5. Jane Menken, 1985. "Age and fertility: How late can you wait?," Demography, Springer, vol. 22(4), pages 469-483, November.
  6. Bundorf, M. Kate & Chun, Natalie & Goda, Gopi Shah & Kessler, Daniel P., 2009. "Do markets respond to quality information? The case of fertility clinics," Journal of Health Economics, Elsevier, vol. 28(3), pages 718-727, May.
  7. Robert Kaestner & Kosali Ilayperuma Simon, 2002. "Labor Market Consequences of State Health Insurance Regulation," ILR Review, Cornell University, ILR School, vol. 56(1), pages 136-159, October.
  8. Timothy G. Conley & Christopher R. Taber, 2011. "Inference with "Difference in Differences" with a Small Number of Policy Changes," The Review of Economics and Statistics, MIT Press, vol. 93(1), pages 113-125, February.
  9. Rajeev Dehejia & Adriana Lleras-Muney, 2004. "Booms, Busts, and Babies’ Health," Working Papers 250, Princeton University, Woodrow Wilson School of Public and International Affairs, Center for Health and Wellbeing..
  10. Zavodny, Madeline & Bitler, Marianne P., 2010. "The effect of Medicaid eligibility expansions on fertility," Social Science & Medicine, Elsevier, vol. 71(5), pages 918-924, September.
  11. Paul Oyer, 2005. "Salary or Benefits?," NBER Working Papers 11817, National Bureau of Economic Research, Inc.
  12. Rothschild, Michael & Stiglitz, Joseph E, 1976. "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," The Quarterly Journal of Economics, MIT Press, vol. 90(4), pages 630-49, November.
  13. Marianne P. Bitler, 2005. "Effects of Increased Access to Infertility Treatment on Infant and Child Health Outcomes: Evidence from Health Insurance Mandate," Working Papers 330, RAND Corporation Publications Department.
  14. 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.
  15. 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.
  16. Marianne Bitler & Madeline Zavodny, 2000. "The effect of Medicaid eligibility expansions on births," Working Paper 2000-4, Federal Reserve Bank of Atlanta.
  17. Gruber, Jonathan, 1994. "State-mandated benefits and employer-provided health insurance," Journal of Public Economics, Elsevier, vol. 55(3), pages 433-464, November.
  18. Amalia Miller, 2011. "The effects of motherhood timing on career path," Journal of Population Economics, Springer, vol. 24(3), pages 1071-1100, July.
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