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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. 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).
  2. Summers, Lawrence H, 1989. "Some Simple Economics of Mandated Benefits," American Economic Review, American Economic Association, vol. 79(2), pages 177-83, May.
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  4. repec:tpr:qjecon:v:114:y:1999:i:1:p:263-291 is not listed on IDEAS
  5. Lucie Schmidt, 2005. "Effects of Infertility Insurance Mandates on Fertility," Department of Economics Working Papers 2005-07, Department of Economics, Williams College.
  6. Jonathan Klick & Sara Markowitz, 2003. "Are Mental Health Insurance Mandates Effective? Evidence from Suicides," NBER Working Papers 9994, National Bureau of Economic Research, Inc.
  7. Jonathan Gruber & Phillip Levine & Douglas Staiger, 1999. "Abortion Legalization and Child Living Circumstances: Who is the "Marginal Child"?," The Quarterly Journal of Economics, Oxford University Press, vol. 114(1), pages 263-291.
  8. John J. Donohue III & Steven D. Levitt, 2001. "The Impact of Legalized Abortion on Crime," The Quarterly Journal of Economics, Oxford University Press, vol. 116(2), pages 379-420.
  9. 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.
  10. repec:tpr:qjecon:v:120:y:2005:i:3:p:1031-1083 is not listed on IDEAS
  11. 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.
  12. Elizabeth Oltmans Ananat & Jonathan Gruber & Phillip B. Levine, 2004. "Abortion Legalization and Lifecycle Fertility," NBER Working Papers 10705, National Bureau of Economic Research, Inc.
  13. Gabor Kezdi, 2005. "Robus Standard Error Estimation in Fixed-Effects Panel Models," Econometrics 0508018, EconWPA.
  14. Douglas Almond & Kenneth Y. Chay & David S. Lee, 2004. "The Costs of Low Birth Weight," NBER Working Papers 10552, National Bureau of Economic Research, Inc.
  15. 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.
  16. 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.
  17. Ted Joyce, 2004. "Did Legalized Abortion Lower Crime?," Journal of Human Resources, University of Wisconsin Press, vol. 39(1).
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