Insured Women's Access to Infertility Care: How 'Fair' Is It Even With Family Healthcare Insurance?

Journal of Multicultural Nursing & Health, Fall 2003 by Griffin, Martha

Hann (1991) outlined his overall findings in a study that was commissioned by the Dutch Government to answer the question of whether the advanced reproductive technologies should be part of their overall social insurance package based on: medical outcome concerns; financial concerns and psychosocial concerns. The Dutch study was one of the first and to date the only comprehensive initiative that explicitly linked the decision about reimbursement based on these three concerns. Hann concluded that public debate about reimbursement should not hide behind economic concern because cost-effectiveness arguments have been proven invalid. Thus, he further states that objections to reimbursement for infertility treatments be addressed honestly in the public arena to expose invalid value judgments that affect health policy (Hann, 1991).

Approximately two-thirds of childbearing age women are covered by private health insurance plans. A survey conducted by the Alan Guttmacher Institute (1994) found that comprehensive infertility care was excluded in 86% of all private sector insurance plans. Consequently, the private health insurance structure itself becomes a conduit or a barrier in accessing health care in general, and specifically care for the treatment of infertility. Historically this fact has been evidenced in other sub-groups of patients: women; cancer patients; AIDS patients and those with mental illness (Starr, 1982; Cassidy, 1988; Mechanic, 1993; Andersen, 1995).

It has been shown that women experience impediments to comprehensive health care in many forms. This fact is especially true around issues of reproduction (Clancy & Massion, 1992). Comprehensive maternity care was not an insurable condition until the Federal Government enacted the Pregnancy Anti-discrimination Law (1978).

Impaired fertility impacts 5.3 million people. However, this disease and its treatments have not been given the credibility that other major diseases and diagnostic treatments have been given over the past three decades. The more recent techniques for treating infertility such as invitro fertilization (IVF), gamete intra-fallopian transfer (GIFT), zygote intra-fallopian transfer (ZIFT) and inter-cytoplasmic sperm injection (ICSI) are all non-experimental frequently indicated treatments for the disease of infertility. They have collectively resulted in thousands of live births to infertile couple's nationwide and worldwide (Olivennes, Kerbrat, Rufat, Blanchet, Fanchin & Frydman, 1997; VanBladen& Gerritis, 2001). The overall success rate for these advanced procedures in terms of live delivery per initiated cycle has nearly tripled, from an estimated 5.4% in 1985 to 16.8% in 1993 (VanVoorhis et al., 1995; Ginsburg, 1996). Additionally, as with many other therapeutic treatments, assisted reproductive techniques become relatively cost effective once the success rate reaches 10% (Hann, 1991).

There exist, within any given year in the United States, approximately 55 million women of childbearing years (15 - 44). Further, 5.3 million of these women will experience infertility. However, only 2.3 million women will receive any treatment for their infertility. Reportedly, of the 2.3 million who do receive treatment, only 2% or 46,000 of these women have reported using any of the advanced assisted reproductive techniques (Preger, 1990; Wilcox & Mosher, 1993). Additionally, it has been shown that 41% of recommended treatment is never carried out. Evidence suggests that this is true even when the outcomes of such treatments have a high degree of associated success (Ginsburg, 1996).