Friday, May 16th, 2014
A study of insurance coverage of in vitro fertilization (IVF) in Canada has found that the more complete the coverage of the common fertility procedure, the fewer multiple births are recorded. Multiple births–twins, triplets, or more–often happen when multiple embryos are transferred into a woman’s uterus as part of IVF. And multiple-embryo transfers often happen when women have limited resources to pursue a number of IVF cycles. Reuters has more on the Canadian study:
Quebec’s universal health insurance started covering all IVF-related costs in mid-2010. The new research is based on data from the first full year of coverage.
“Multiple pregnancies have important health consequences for pregnant women and their babies,” said lead author Dr. Maria Velez, from the University of Montreal.
Multiple pregnancies have an emotional and economic impact on families and cost the health system, which is a delicate point to bring up with patients dealing with fertility issues, she told Reuters Health by email. Patients are often misinformed about the negative consequences of multiple pregnancies, she said.
“Our obligation as medical doctors is to place the health of our patients above all,” Velez said. “Our role is to prevent a patient choosing a treatment that may cause harm if there is a safer alternative.”
Five fertility centers offer IVF in Quebec. The new study compared data from the Canadian Assisted Reproductive Technologies Register from those centers in 2009, before IVF was covered, and in 2011.
There were 1,875 fresh IVF cycles performed in 2009, which rose to 5,489 cycles in 2011. The number of clinical pregnancies and projected live births increased, while the rate of multiple pregnancies decreased from 29 percent to six percent.
And although public coverage of IVF led to more government spending per treatment cycle, the cost per live birth decreased, according to results published in Human Reproduction.
Researchers said the rate of multiple pregnancies likely fell because in Quebec, as in other areas with covered IVF, public policy requires that only one embryo be transferred at a time into women under age 36, called single-embryo transfer (SET). There were no restrictions on the number of embryos transferred at one time before the public coverage policy.
Under the policy, women who undergo IVF can still have several eggs harvested and embryos produced at once, but only one fresh one is implanted. The rest are frozen, and if the first embryo does not survive, another can be thawed and implanted.
Single-embryo transfer was much more common under universal coverage: 32 percent of cycles were elective SET in 2011, compared to two percent in 2009.
“This confirms what a lot of IVF practitioners have held in the U.S., that with insurance coverage single-embryo transfers are more likely to be done which is going to lower multiple birth rates which is safer and less expensive,” said Dr. Bradley J. Van Voorhis, director of the IVF Program at the University of Iowa Carver College of Medicine in Iowa City.
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Thursday, February 6th, 2014
Fewer than half of women keep the appointments their doctors recommend they make shortly after giving birth, according to a new study conducted by researchers at Johns Hopkins University. Especially for women with complications like gestational diabetes or high blood pressure, those visits are important to future health, the researchers said. More from the university:
The researchers found that women with pregnancy complications were more likely to see a doctor post-delivery, but overall, visit rates were low.
“Women need to understand the importance of a six-week visit to the obstetrician — not only to address concerns and healing after delivery, but also to follow up on possible future health risks, review the pregnancy and make the transition to primary care,” says Wendy Bennett, M.D., assistant professor of medicine and the lead researcher for the study, described online last week in the Journal of General Internal Medicine. “Women with pregnancy complications are at higher risk for some chronic diseases, such as diabetes, high blood pressure and heart disease, and these visits are an opportunity to assess risks and refer to primary care providers to work on long-term preventive care.”
Physician groups, such as the American College of Obstetrics and Gynecology, recommend women with complications like high blood pressure during pregnancy or gestational diabetes not only visit their obstetricians six weeks after a birth, but that they also see their primary care doctors within a year.
For the study, the researchers collected data from one commercial health insurance plan and multiple Medicaid insurance plans in Maryland. The aims were to determine different predictors of receiving post-delivery primary and obstetric care in women with and without pregnancy complications, including gestational or pregestational diabetes mellitus and hypertensive disorders, such as preeclampsia. Women with these conditions are much more likely to develop long-term health problems, such as type 2 diabetes and cardiovascular disease.
Among women with tax-supported Medicaid insurance, 56.6 percent of those with a complicated pregnancy and 51.7 percent of those without a complicated pregnancy visited a primary care doctor within a year. Among women with commercial health insurance, 60 percent of those with a complicated pregnancy and 49.6 percent of those without a complicated pregnancy did so.
White patients, older patients and patients with depression or preeclampsia were also more likely to visit their primary care doctor.
Of the women on Medicaid, 65 percent of those with complicated pregnancies and 61.5 percent of those without complicated pregnancies had a postpartum obstetric visit within three months. Numbers were slightly lower for those with commercial insurance, at 50.8 percent of those with complicated pregnancies and 44.6 percent of those without complicated pregnancies.
Bennett says providers need to develop creative ways to improve attendance at postpartum visits. A pilot project at Johns Hopkins Bayview Medical Center, for example, involves combined “mommy-baby” visits, she says. If the baby’s checkup is included in the mother’s visit, the mother may be more likely to keep the appointment, and thus would receive important education about improving health behaviors and the need for primary care follow-up. Other options are home visits and collaborations with day care centers, community centers and churches to make visits and health promotional activities more convenient.
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Wednesday, September 18th, 2013
The average out-of-pocket cost of fertility treatments tops $5,000, according to a new study of fertility clinics in the San Francisco area. More from Reuters.com:
As expected, researchers found costs were especially high for couples undergoing in vitro fertilization (IVF) – over $19,000, on average – and rose with each additional treatment cycle.
“One of the very early questions people ask after we figure out what we need to do to help them get pregnant is how much the treatment is going to cost,” Dr. James Smith, director of male reproductive health at the University of California, San Francisco, and the study’s senior author, said.
That expense, he told Reuters Health, “has a big impact – they’re taking out second mortgages on homes, they’re borrowing from friends and family.”
Smith and his colleagues interviewed 332 couples attending one of eight fertility clinics for their first evaluation and gave each a cost diary to record all treatment-related expenses. They then interviewed the couples three more times over the next year and a half about those expenses, including money spent on clinic visits and procedures, medications and miscellaneous items such as travel and parking.
Among all couples, the average out-of-pocket cost of fertility treatment was $5,338. However, that varied depending on what type of treatment they received – from $595 for basic, one-time procedures such as uterine fibroid removal or counseling about timing sex to $19,234 for IVF, the technique used by a majority of couples.
Expenses were higher for couples who took more time to get pregnant and underwent more treatment cycles, the researchers found.
However, there was no clear difference in out-of-pocket expenses based on whether couples reported having insurance coverage for fertility care, according to findings published in The Journal of Urology.
“Usually insurance companies will cover things like labs, the basic diagnostic testing,” Smith said. “But the expensive items, like in vitro fertilization, that’s much less well covered.”
He said that is the case in California and most other states, but that a few – including Massachusetts and Illinois – require insurance companies to have more extensive coverage of fertility treatment.
According to the Society for Assisted Reproductive Technology, women received more than 150,000 cycles of IVF in 2011.
Image: Fertility lab technician, via Shutterstock
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Monday, January 28th, 2013
A number of religious organizations are filing lawsuits to challenge the provision of the new health care law that requires employers to cover birth control in their health plans. The flurry of lawsuits may mean the question will eventually be presented to the U.S. Supreme Court, legal analysts are saying. The New York Times reports:
In recent months, federal courts have seen dozens of lawsuits brought not only by religious institutions like Catholic dioceses but also by private employers ranging from a pizza mogul to produce transporters who say the government is forcing them to violate core tenets of their faith. Some have been turned away by judges convinced that access to contraception is a vital health need and a compelling state interest. Others have been told that their beliefs appear to outweigh any state interest and that they may hold off complying with the law until their cases have been judged. New suits are filed nearly weekly.
“This is highly likely to end up at the Supreme Court,” said Douglas Laycock, a law professor at the University of Virginia and one of the country’s top scholars on church-state conflicts. “There are so many cases, and we are already getting strong disagreements among the circuit courts.”
President Obama’s health care law, known as the Affordable Care Act, was the most fought-over piece of legislation in his first term and was the focus of a highly contentious Supreme Court decision last year that found it to be constitutional.
But a provision requiring the full coverage of contraception remains a matter of fierce controversy. The law says that companies must fully cover all “contraceptive methods and sterilization procedures” approved by the Food and Drug Administration, including “morning-after pills” and intrauterine devices whose effects some contend are akin to abortion.
As applied by the Health and Human Services Department, the law offers an exemption for “religious employers,” meaning those who meet a four-part test: that their purpose is to inculcate religious values, that they primarily employ and serve people who share their religious tenets, and that they are nonprofit groups under federal tax law.
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Wednesday, May 23rd, 2012
Out-of-pocket expenses for kids’ health care are rising, and health care spending is growing fastest among Americans under age 18, a new study by the Health Care Cost Institute has found. CNN.com reports:
The institute is an independent nonprofit research organization that partnered with four major insurance companies (Aetna, Kaiser, United and Humana) to analyze 3 billion insurance claims of people with group employer-sponsored health insurance.
The study said consumers’ out-of-pocket expenses rose 7% from 2009 to 2010, according to the institute. For insurers, costs only rose 2.6% during that time period.
Per person under 65, the average annual spending on health care was $4,255 — that’s a combination of what people and their insurance companies paid.
Between 2009 and 2010, it rose 4.5% for Americans under 18. The trend has been upwards for children since 2007, when the average annual expenditure for this group was $1,790, compared to $2,123.
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