Jain Tarun, Harlow Bernard L, Hornstein Mark D
Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston 02115, USA.
N Engl J Med. 2002 Aug 29;347(9):661-6. doi: 10.1056/NEJMsa013491.
Although most insurance companies in the United States do not cover in vitro fertilization, a few states mandate such coverage.
We used 1998 data reported to the Centers for Disease Control and Prevention by 360 fertility clinics in the United States and 2000 U.S. Census data to determine utilization and outcomes of in vitro fertilization services according to the status of insurance coverage.
Of the states in which in vitro fertilization services were available, 3 states (31 clinics) required complete insurance coverage, 5 states (27 clinics) required partial coverage, and 37 states plus Puerto Rico and the District of Columbia (302 clinics) required no coverage. Clinics in states that required complete coverage performed more in vitro fertilization cycles than clinics in states that required partial or no coverage (3.35 vs. 1.46 and 1.21 transfers per 1000 women of reproductive age, respectively; P<0.001) and more transfers of frozen embryos (0.43 vs. 0.30 and 0.20 per 1000 women of reproductive age, respectively; P<0.001). The percentage of cycles that resulted in live births was higher in states that did not require any coverage than in states that required partial or complete coverage (25.7 percent vs. 22.2 percent and 22.7 percent, respectively; P<0.001), but the percentage of pregnancies with three or more fetuses was also higher (11.2 percent vs. 8.9 percent and 9.7 percent, respectively; P=0.007). The number of fresh embryos transferred per cycle was lower in states that required complete coverage than in states that required partial or no coverage (P=0.001 and P<0.001, respectively).
State-mandated insurance coverage for in vitro fertilization services is associated with increased utilization of these services but with decreases in the number of embryos transferred per cycle, the percentage of cycles resulting in pregnancy, and the percentage of pregnancies with three or more fetuses.
尽管美国大多数保险公司不承保体外受精，但有几个州规定必须提供此类保险。
我们使用了美国360家生育诊所向疾病控制与预防中心报告的1998年数据以及2000年美国人口普查数据，根据保险覆盖情况来确定体外受精服务的利用率和结果。
在可提供体外受精服务的州中，3个州（31家诊所）要求全额保险覆盖，5个州（27家诊所）要求部分覆盖，37个州加上波多黎各和哥伦比亚特区（302家诊所）不要求覆盖。要求全额覆盖的州的诊所进行的体外受精周期比要求部分覆盖或不要求覆盖的州的诊所更多（每1000名育龄妇女分别为3.35次与1.46次和1.21次移植；P<0.001），冷冻胚胎移植也更多（每1000名育龄妇女分别为0.43次与0.30次和0.20次；P<0.001）。不要求任何覆盖的州中活产周期的百分比高于要求部分或全额覆盖的州（分别为25.7%对22.2%和22.7%；P<0.001），但三胎或更多胎儿的妊娠百分比也更高（分别为11.2%对8.9%和9.7%；P=0.007）。要求全额覆盖的州每个周期移植的新鲜胚胎数量比要求部分覆盖或不要求覆盖的州少（分别为P=0.001和P<0.001）。
州规定的体外受精服务保险覆盖与这些服务利用率的提高相关，但与每个周期移植的胚胎数量、妊娠周期的百分比以及三胎或更多胎儿的妊娠百分比的降低相关。
