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

  • Marianne Bitler

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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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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  1. Janet Currie & Rosemary Hyson, 1999. "Is the Impact of Health Shocks Cushioned by Socioeconomic Status? The Case of Low Birthweight," NBER Working Papers 6999, National Bureau of Economic Research, Inc.
  2. 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.
  3. Jonathan Gruber & Phillip Levine & Douglas Staiger, 1997. "Abortion Legalization and Child Living Circumstances: Who is the "Marginal Child?"," NBER Working Papers 6034, National Bureau of Economic Research, Inc.
  4. 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.
  5. 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.
  6. 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.
  7. Ted Joyce, 2004. "Did Legalized Abortion Lower Crime?," Journal of Human Resources, University of Wisconsin Press, vol. 39(1).
  8. Gabor Kezdi, 2005. "Robus Standard Error Estimation in Fixed-Effects Panel Models," Econometrics 0508018, EconWPA.
  9. Sara Markowitz & Jonathan Klick, . "Are Mental Health Insurance Mandates Effective?: Evidence from Suicides," Working Papers Rutgers University, Newark 2004-003, Department of Economics, Rutgers University, Newark.
  10. 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).
  11. Schmidt, Lucie, 2007. "Effects of infertility insurance mandates on fertility," Journal of Health Economics, Elsevier, vol. 26(3), pages 431-446, May.
  12. Summers, Lawrence H, 1989. "Some Simple Economics of Mandated Benefits," American Economic Review, American Economic Association, vol. 79(2), pages 177-83, May.
  13. 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.
  14. John J. Donohue, III & Steven D. Levitt, 2004. "Further Evidence that Legalized Abortion Lowered Crime: A Reply to Joyce," Journal of Human Resources, University of Wisconsin Press, vol. 39(1).
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