Boulet Sheree L, Kawwass Jennifer, Session Donna, Jamieson Denise J, Kissin Dmitry M, Grosse Scott D
Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA.
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Matern Child Health J. 2019 May;23(5):623-632. doi: 10.1007/s10995-018-2675-y.
Objectives We aimed to examine the extent to which health plan expenditures for infertility services differed by whether women resided in states with mandates requiring coverage of such services and by whether coverage was provided through a self-insured plan subject to state mandates versus fully-insured health plans subject only to federal regulation. Methods This retrospective cohort study used individual-level, de-identified health insurance claims data. We included women 19-45 years of age who were continuously enrolled during 2011 and classified them into three mutually exclusive groups based on highest treatment intensity: in vitro fertilization (IVF), intrauterine insemination (IUI), or ovulation-inducing (OI) medications. Using generalized linear models, we estimated adjusted annual mean, aggregate, and per member per month (PMPM) expenditures among women in states with an infertility insurance mandate and those in states without a mandate, stratified by enrollment in a fully-insured or self-insured health plan. Results Of the 6,006,017 women continuously enrolled during 2011, 9199 (0.15%) had claims for IVF, 10,112 (0.17%) had claims for IUI, and 23,739 (0.40%) had claims for OI medications. Among women enrolled in fully insured plans, PMPM expenditures for infertility treatment were 3.1 times higher for those living in states with a mandate compared with states without a mandate. Among women enrolled in self-insured plans, PMPM infertility treatment expenditures were 1.2 times higher for mandate versus non-mandate states. Conclusions for Practice Recorded infertility treatment expenditures were higher in states with insurance reimbursement mandates versus those without mandates, with most of the difference in expenditures incurred by fully-insured plans.
目的 我们旨在研究不孕症服务的健康计划支出在以下两方面的差异程度：一是女性居住的州是否有要求涵盖此类服务的规定；二是保险范围是通过受州规定约束的自保计划提供，还是仅受联邦监管的全保健康计划提供。方法 这项回顾性队列研究使用了个体层面的、去识别化的健康保险理赔数据。我们纳入了在2011年持续参保的19至45岁女性，并根据最高治疗强度将她们分为三个相互排斥的组：体外受精（IVF）、宫内人工授精（IUI）或促排卵（OI）药物治疗。使用广义线性模型，我们估计了有不孕症保险规定的州和没有规定的州的女性的调整后年平均、总支出以及每月人均支出（PMPM），并按全保或自保健康计划的参保情况进行分层。结果 在2011年持续参保的6,006,017名女性中，9199人（0.15%）有IVF理赔，10,112人（0.17%）有IUI理赔，23,739人（0.40%）有OI药物治疗理赔。在参加全保计划的女性中，有规定的州的不孕症治疗PMPM支出比没有规定的州高3.1倍。在参加自保计划的女性中，有规定的州与无规定的州相比，不孕症治疗PMPM支出高1.2倍。实践结论 有保险报销规定的州记录的不孕症治疗支出高于没有规定的州，支出差异主要由全保计划造成。
