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

Further, it has been shown that many people with infertility may not seek evaluation or complete treatment because of excessive out of pocket expenses, or because insurance coverage is either unavailable or inadequate (Henifin, 1993: Ginsburg, 1996). These situations leave many infertile women with barriers to care they need and want. Therefore, the opportunity to engage in the self-determined life pursuit of a biological family is blocked or impeded.

The national average annual cost per family health care insurance premium is $4,800 (Alan Guttmacher Institute, 1995). This fact would seem to suggest that family coverage would be similar. However, according to the American Society of Reproductive Medicine (Ginsberg, 1997), coverage for infertility diagnosis and treatment ranges from less than 10% in states such as New Mexico and Kentucky, to 71% to 90% in States such as Arkansas and Massachusetts. Further, with regards to insured women, there has been evidence of gender-biased reimbursement policies that hamper entry into the system of health care in the United States (Fuchs & Perreault, 1986; Jenker, 1991; Shattuck & Schwartz, 1991; Epstein, 1997). Many conditions in women, such as eating disorders, chemical dependency, sexual dysfunction, life cycle transitions and reproduction itself, have been either considered not a bona fide health problem or deemed a psychiatric problem separate from primary health care needs.

Although the etiological factors in infertility are spread proportionately between the sexes, overt therapeutic measures are always seen actualized as a pregnancy in the woman. Infertility has seemingly become a contemporary problem. However, the inability to procreate and concern about that inability are documented throughout history (Sandelowski, 1993). Furthermore, attempting to reverse infertility and re-establish fertility that leads to childbirth and family building is prevalent in most cultures (Rosenblatt et al., 1973; Sandelowski, 1993; Marsh & Ronner, 1996).

There has quite literally been a revolution in the techniques and treatments for infertility in the last two decades. Yet, to the population in need, access to these treatments remains elusive, arbitrary or non-existent. Public policy on this health care issue appears to have been influenced more by popularized myths and prejudice rather than by research and science (Milsap, 1996). The newer treatments for infertility with better outcomes at reasonable costs have been labeled either a waste of social resources or an extravagance (Hann, 1991; Hidlebaugh, Thompson & Berger, 1997; Griffin & Panack, 1998).

METHOD

A convenient, nonrandom sample of women (between the ages of 20 and 49 years, had family healthcare insurance, had infertility treatment within the last seven years and were able to read, write and speak English) who had experienced infertility treatment (n=242) participated in the survey completing the Access to Infertility Care Scale. The total sample included 104 women from states that had a comprehensive infertility insurance mandate (Massachusetts, Rhode Island, Illinois) and 138 women from states without a comprehensive infertility insurance mandate (all other states).