Background
Infertility and its treatment
Funding arrangement for fertility treatment
Methods
Data sources
Cycle type | Before January 2010 | After January 2010 |
---|---|---|
(pre EMSNCap policy) | (post EMSNCap policy) | |
Fresh Cycle (uniquely identified by items 13200 and 13201) | 13209, 13200, 13212, 13215, 13221, 13251 | 13209, 13200, 13212, 13201, 13215, 13251 |
Frozen Cycle (uniquely identified by item 13218) | 13209, 13218 | 13209,13215,13218 |
IUI Cycle (identified by item 13203) | 13209, 13203, 13221 | 13209, 13203, 13221 |
Empirical analysis
The effect of the EMSNCap policy on women in different age categories
Anticipatory behaviour
Distribution of the number of cycles in each year
Medicare benefit savings and number of cycles not performed due to policy
Results
Descriptive statistics
Age specific groups, provider fees, Medicare benefits and out-of-pocket costs
2007 Q1 to 2009 Q4 | 2010 Q1 to 2011Q2 | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Pre EMSNCap | Post EMSNCap | |||||||||
Fresh Cycles
| Obs | Mean | SD | Min | Max | Obs | Mean | SD | Min | Max |
No of Patients | 84 | 1166 | 265 | 781 | 2130 | 35 | 1117 | 237 | 750 | 1831 |
Number of Cycles | 84 | 1249 | 278 | 810 | 2241 | 35 | 1137 | 237 | 751 | 1856 |
Average provider fees | 84 | 7393 | 475 | 6182 | 8187 | 42 | 7664 | 172 | 7355 | 8014 |
Average Medicare benefits | 84 | 5333 | 548 | 4101 | 6244 | 42 | 5016 | 189 | 4744 | 5421 |
Average out-of- pockets | 84 | 2059 | 188 | 1671 | 2551 | 42 | 2648 | 82 | 2525 | 2909 |
Frozen Cycles
| Obs | Mean | SD | Min | Max | Obs | Mean | SD | Min | Max |
No of Patients | 84 | 594 | 147 | 337 | 1074 | 35 | 654 | 140 | 428 | 1040 |
Number of Services | 84 | 696 | 178 | 383 | 1248 | 35 | 772 | 171 | 496 | 1255 |
Average Fees | 84 | 2097 | 106 | 1827 | 2373 | 42 | 2367 | 89 | 2208 | 2731 |
Average Benefits | 84 | 1447 | 153 | 1121 | 1756 | 42 | 1323 | 71 | 1210 | 1427 |
Average OOP | 84 | 650 | 94 | 483 | 858 | 42 | 1044 | 95 | 935 | 1317 |
IUI Cycles
| Obs | Mean | SD | Min | Max | Obs | Mean | SD | Min | Max |
No of Patients | 84 | 264 | 155 | 84 | 674 | 35 | 265 | 136 | 119 | 641 |
Number of Services | 84 | 394 | 229 | 127 | 1015 | 35 | 370 | 193 | 158 | 923 |
Average Fees | 84 | 1381 | 159 | 1102 | 1786 | 42 | 1195 | 66 | 1064 | 1386 |
Average Benefits | 84 | 1007 | 151 | 731 | 1372 | 42 | 542 | 21 | 505 | 580 |
Average OOP | 84 | 374 | 59 | 292 | 547 | 42 | 653 | 62 | 546 | 849 |
Econometric results
Access to fresh cycles by age
Base model and lag | With anticipatory behaviour and lag | |||||||
---|---|---|---|---|---|---|---|---|
all age
|
all age
| |||||||
Variable
|
Age ≤ 33
|
34 ≤ Age ≥ 39
|
Age ≥ 40
|
groups
|
Age ≤ 33
|
34 ≤ Age ≥ 39
|
Age ≥ 40
|
groups
|
EMSNCap effect
|
-305.83*
|
-429.52***
|
-497.31***
|
-307.04***
|
-183.17*
|
-275.63***
|
-436.91***
|
-195.24***
|
143.84 | 59.82 | 56.09 | 72.58 | 80.23 | 40.70 | 63.83 | 48.20 | |
Lag of D. Variable | 0.88*** | 0.32** | -0.07 | 0.70*** | 0.95*** | 0.56*** | 0.001 | 0.82*** |
0.13 | 0.10 | 0.10 | 0.11 | 0.06 | 0.07 | 0.12 | 0.06 | |
Season 1 (base) | ||||||||
Season 2 | 335.00** | 132.34** | -21.77 | 123.40** | 230.57*** | 81.25** | -45.02 | 48.77 |
94.08 | 38.29 | 34.23 | 45.64 | 54.22 | 28.25 | 36.58 | 35.29 | |
Season 3 | 345.06** | 158.65*** | -76.69* | 117.40* | 279.29*** | 112.51*** | -95.47** | 66.87 |
96.6512 | 34.5121 | 31.1946 | 47.48 | 62.4833 | 25.8843 | 33.7326 | 38.5072 | |
Season 4 | 62.98 | -18.28 | -236.29*** | -79.41 | -42.13 | -108.45*** | -262.41*** | -159.02*** |
90.82 | 38.17 | 33.58 | 42.29 | 47.57 | 27.11 | 35.10 | 31.69 | |
Time Trend | 26.38* | 35.28*** | 51.50*** | 25.45*** | 14.03 | 20.94** | 45.57*** | 14.29** |
11.98 | 4.10 | 5.70 | 6.30 | 7.77 | 3.61 | 6.59 | 4.32 | |
Constant | -178.31*** | 576.37*** | 963.39*** | 183.49 | -122.03 | 416.99*** | 934.94*** | 168.30* |
126.19 | 107.59 | 95.43 | 110.00 | 103.93 | 71.97 | 100.54 | 75.76 | |
N | 32 | 48 | 32 | 112 | 32 | 48 | 32 | 112 |
df | 6 | 6 | 6 | 6 | 6 | 6 | 6 | 6 |
R squared | 0.85 | 0.81 | 0.89 | 0.71 | 0.94 | 0.88 | 0.89 | 0.81 |
Base model and lag | With anticipatory behaviour and lag | |||||||
---|---|---|---|---|---|---|---|---|
all age
|
all age
| |||||||
Variable
|
Age ≤ 33
|
34 ≤ Age ≥ 39
|
Age ≥ 40
|
groups
|
Age ≤ 33
|
34 ≤ Age ≥ 39
|
Age ≥ 40
|
groups
|
Fresh Cycles
| ||||||||
Number of services | -0.22* | -0.34*** | -0.44*** | -0.25*** | -0.14* | -0.21*** | -0.38*** | -0.16*** |
Number of patients | -0.19* | -0.28*** | -0.32*** | -0.20*** | -0.12* | -0.16*** | -0.28*** | -0.13*** |
Frozen Cycles
| ||||||||
Number of services | -0.11* | -0.07* | -0.09 | -0.09** | -0.06 | -0.08 | 0.07 | -0.04 |
Number of patients | -0.11* | -0.07* | -0.10 | -0.09** | -0.07 | -0.09* | 0.06 | -0.05 |
IUI Cycles
| ||||||||
Number of services | -0.14** | -0.07 | 0.13 | -0.01 | -0.04 | -0.06 | 0.12 | 0.00 |
Number of patients | -0.04 | -0.04 | 0.15 | 0.02 | -0.03 | -0.04 | 0.16* | 0.02 |
Base model and lag | With anticipatory behaviour and lag | |||||||
---|---|---|---|---|---|---|---|---|
all age
|
all age
| |||||||
Variable
|
Age ≤ 33
|
34 ≤ Age ≥ 39
|
Age ≥ 40
|
groups
|
Age ≤ 33
|
34 ≤ Age ≥ 39
|
Age ≥ 40
|
groups
|
EMSNCap effect
| -259.55 | -342.52*** | -330.17*** | -232.62*** | -155.83* | -201.41*** | -291.93*** | -141.46** |
126.39 | 51.06 | 44.67 | 62.61 | 74.49 | 33.61 | 52.81 | 42.22 | |
Lag of D. Variable | 0.90*** | 0.33** | -0.10 | 0.77*** | 0.96*** | 0.60*** | -0.04 | 0.86*** |
0.12 | 0.11 | 0.14 | 0.10 | 0.06 | 0.08 | 0.16 | 0.06 | |
Season 1 (base) | ||||||||
Season 2 | 310.06** | 113.54** | -34.50 | 104.95* | 216.99*** | 62.26* | -51.00 | 34.32 |
85.99 | 33.07 | 29.51 | 40.93 | 47.91 | 25.00 | 36.27 | 31.38 | |
Season 3 | 325.46** | 127.08*** | -98.78** | 90.78* | 267.69*** | 80.25** | -112.13** | 44.48 |
88.17 | 31.28 | 28.66 | 43.82 | 59.22 | 23.80 | 33.19 | 35.47 | |
Season 4 | 67.44 | -14.72 | -212.63*** | -68.20 | -23.64 | -102.07*** | -230.53*** | -138.63*** |
81.04 | 35.35 | 31.35 | 37.99 | 44.52 | 25.59 | 33.83 | 28.61 | |
Time Trend | 23.26* | 30.18*** | 42.17*** | 20.51*** | 12.70 | 16.29*** | 38.20*** | 11.13** |
10.66 | 4.53 | 5.69 | 5.67 | 7.32 | 3.29 | 6.76 | 4.01 | |
Constant | -185.66*** | 561.15*** | 917.83*** | 123.85 | -130.18*** | 378.40*** | 896.18*** | 127.05*** |
112.46 | 105.92 | 100.94 | 98.47 | 93.02 | 71.92 | 110.12 | 69.31 | |
N | 32 | 48 | 32 | 112 | 32 | 48 | 32 | 112 |
df | 6 | 6 | 6 | 6 | 6 | 6 | 6 | 6 |
R squared | 0.87 | 0.78 | 0.88 | 0.73 | 0.94 | 0.85 | 0.87 | 0.82 |
Distribution of the number of cycles undertaken in a year
Access to frozen cycles by age
Base model and lag | With anticipatory behaviour and lag | |||||||
---|---|---|---|---|---|---|---|---|
all age
|
all age
| |||||||
Variable
|
Age ≤ 33
|
34 ≤ Age ≥ 39
|
Age ≥ 40
|
groups
|
Age ≤ 33
|
34 ≤ Age ≥ 39
|
Age ≥ 40
|
groups
|
EMSNCap effect
|
-90.14
|
-50.24*
|
-35.17
|
-59.55*
|
-38.81
|
-58.57*
|
55.71
|
-26.62
|
45.76 | 20.56 | 25.85 | 24.07 | 45.34 | 22.29 | 28.44 | 26.25 | |
Lag of D. Variable | 0.97*** | 0.62*** | 0.54* | 0.92*** | 0.97*** | 0.59*** | 0.18 | 0.92*** |
0.07 | 0.13 | 0.21 | 0.06 | 0.06 | 0.13 | 0.18 | 0.05 | |
Season 1 (base) | ||||||||
Season 2 | 79.41* | -81.01** | -108.96*** | -69.09** | 24.84 | -72.15* | -99.61** | -102.30*** |
37.06 | 28.25 | 28.95 | 21.47 | 41.84 | 28.55 | 33.33 | 23.52 | |
Season 3 | 142.93** | -48.96* | -114.18*** | -30.31 | 110.68* | -43.48 | -105.86** | -50.03* |
48.55 | 23.59 | 22.17 | 23.94 | 49.01 | 23.81 | 28.91 | 24.67 | |
Season 4 | -13.55 | -133.59*** | -175.47*** | -127.38*** | -58.60 | -125.68*** | -193.05*** | -155.11*** |
37.56 | 25.04 | 22.98 | 21.83 | 37.75 | 25.33 | 27.67 | 22.09 | |
Time Trend | 7.94 | 7.03*** | 10.11*** | 6.05* | 2.90 | 8.07* | 6.77* | 2.92 |
4.18 | 3.09 | 2.58 | 2.45 | 3.79 | 3.16 | 2.34 | 2.38 | |
Constant | -68.45*** | 308.07*** | 273.69** | 83.05* | -4.29 | 320.05*** | 466.51*** | 127.48*** |
65.82 | 71.06 | 78.96 | 34.55 | 59.81 | 72.13 | 69.14 | 37.82 | |
N | 32 | 48 | 32 | 112 | 32 | 48 | 32 | 112 |
df | 6 | 6 | 6 | 6 | 6 | 6 | 6 | 6 |
R squared | 0.92 | 0.71 | 0.87 | 0.87 | 0.92 | 0.69 | 0.88 | 0.85 |
Base model and lag | With anticipatory behaviour and lag | |||||||
---|---|---|---|---|---|---|---|---|
all age
|
all age
| |||||||
Variable
|
Age ≤ 33
|
34 ≤ Age ≥ 39
|
Age ≥ 40
|
groups
|
Age ≤ 33
|
34 ≤ Age ≥ 39
|
Age ≥ 40
|
groups
|
EMSNCap effect
|
-73.96
|
-46.79*
|
-36.78
|
-53.04*
|
-41.59
|
-56.59***
|
41.87
|
-27.31
|
40.07 | 17.34 | 22.78 | 20.93 | 36.48 | 19.98 | 24.30 | 23.57 | |
Lag of D. Variable | 0.97*** | 0.63*** | 0.51* | 0.91*** | 0.97*** | 0.58*** | 0.24 | 0.90*** |
0.07 | 0.11 | 0.20 | 0.06 | 0.06 | 0.13 | 0.17 | 0.06 | |
Season 1 (base) | ||||||||
Season 2 | 79.51* | -58.75** | -86.95** | -47.08* | 45.19 | -48.91* | -95.54** | -72.65*** |
29.84 | 21.50 | 25.75 | 18.15 | 32.44 | 22.89 | 29.12 | 20.39 | |
Season 3 | 131.32** | -34.06 | -89.68*** | -15.67 | 111.08** | -28.14 | -94.70*** | -30.90 |
39.86 | 18.09 | 19.54 | 20.04 | 38.79 | 18.89 | 25.15 | 21.07 | |
Season 4 | 33.76 | -92.77*** | -139.64*** | -81.78*** | 5.10 | -84.06*** | -166.53*** | -103.17*** |
31.91 | 19.69 | 20.56 | 18.83 | 29.80 | 20.61 | 24.60 | 19.33 | |
Time Trend | 6.72 | 5.96* | 9.12*** | 5.33* | 3.50 | 7.22 | 5.12* | 2.94 |
3.62 | 2.47 | 2.22 | 2.11 | 3.09 | 2.66 | 2.06 | 2.08 | |
Constant | -73.39*** | 249.38*** | 236.99*** | 61.64*** | -35.46*** | 268.82*** | 387.39*** | 99.02** |
55.99 | 57.48 | 66.35 | 31.99 | 49.41 | 62.74 | 59.05 | 35.34 | |
N | 32 | 48 | 32 | 112 | 32 | 48 | 32 | 112 |
df | 6 | 6 | 6 | 6 | 6 | 6 | 6 | 6 |
R squared | 0.92 | 0.71 | 0.84 | 0.85 | 0.92 | 0.67 | 0.86 | 0.83 |
Access to IUI cycles by age
Base model and lag | With anticipatory behaviour and lag | |||||||
---|---|---|---|---|---|---|---|---|
all age
|
all age
| |||||||
Variable
|
Age ≤ 33
|
34 ≤ Age ≥ 39
|
Age ≥ 40
|
groups
|
Age ≤ 33
|
34 ≤ Age ≥ 39
|
Age ≥ 40
|
groups
|
EMSNCap effect
|
-79.21**
|
-22.85
|
21.25*
|
-59.55
|
3.36
|
-9.30
|
18.14
|
-1.43
|
27.87 | 13.25 | 10.88 | 24.07 | 38.94 | 16.75 | 15.93 | 15.81 | |
Lag of D. Variable | -480.27*** | 256.94 | 64.32 | 0.92 | 0.99*** | 0.84*** | 0.14 | 0.97*** |
16.30 | 22.18 | 23.48 | 0.06 | 0.04 | 0.07 | 0.20 | 0.03 | |
Season 1 (base) | ||||||||
Season 2 | 122.57*** | -22.27 | -8.17 | 45.30 | 73.13* | -35.75* | -5.55 | -13.48 |
24.83 | 13.27 | 8.69 | 59.14 | 33.54 | 13.54 | 14.71 | 13.22 | |
Season 3 | 172.65*** | -39.82 | -26.86 | 45.98 | 14.63 | -49.11*** | -24.10 | -42.19*** |
24.91 | 13.04 | 8.86 | 63.19 | 29.16 | 13.30 | 14.96 | 11.54 | |
Season 4 | 61.92** | -110.04** | -63.94*** | -28.21 | -120.60*** | -121.66*** | -61.02*** | -117.94*** |
20.97 | 12.92 | 8.08 | 56.94 | 29.85 | 14.76 | 12.17 | 11.89 | |
Time Trend | -4.42 | 1.16 | 1.20 | -0.83 | -0.80 | -0.27 | 1.43 | -0.23 |
2.82 | 1.70 | 1.23 | 8.28 | 3.90 | 1.85 | 1.59 | 1.62 | |
Constant | 993.48*** | 107.76*** | 155.42*** | 436.08*** | 15.93 | 114.26** | 157.46*** | 54.97** |
33.95 | 34.26 | 12.46 | 94.98 | 48.47 | 36.48 | 27.73 | 18.33 | |
N | 32 | 48 | 32 | 112 | 32 | 48 | 32 | 112 |
df | 6 | 6 | 6 | 6 | 6 | 6 | 6 | 6 |
R squared | 0.98 | 0.84 | 0.82 | 0.85 | 0.95 | 0.83 | 0.70 | 0.96 |
Base model and lag | With anticipatory behaviour and lag | |||||||
---|---|---|---|---|---|---|---|---|
all age
|
all age
| |||||||
Variable
|
Age ≤ 33
|
34 ≤ Age ≥ 39
|
Age ≥ 40
|
groups
|
Age ≤ 33
|
34 ≤ Age ≥ 39
|
Age ≥ 40
|
groups
|
EMSNCap effect
|
-14.44
|
-8.04
|
19.87***
|
-5.30
|
2.16
|
-4.36
|
17.49
|
0.37
|
24.76 | 8.24 | 7.10 | 9.20 | 25.65 | 8.99 | 9.13 | 9.39 | |
Lag of D. Variable | 0.99*** | 0.90*** | 0.25 | 0.98*** | 0.99*** | 0.89*** | 0.27 | 0.97*** |
0.04 | 0.06 | 0.13 | 0.03 | 0.04 | 0.06 | 0.19 | 0.023 | |
Season 1 (base) | ||||||||
Season 2 | 57.51** | -19.46* | -8.81 | -3.79 | 44.76 | -23.11*** | -8.61 | -8.46 |
19.11 | 7.28 | 8.48 | 7.96 | 21.82 | 7.64 | 8.56 | 8.07 | |
Season 3 | 22.82 | -30.52*** | -20.25* | -21.89** | 14.83 | -32.58*** | -20.43** | -24.77** |
19.56 | 7.17 | 8.01 | 7.48 | 20.40 | 7.61 | 8.62 | 7.50 | |
Season 4 | -49.43** | -71.08*** | -40.98*** | -63.29*** | -61.90** | -74.04*** | -40.29*** | -67.68*** |
17.29 | 7.54 | 6.45 | 7.05 | 18.38 | 7.82 | 7.13 | 7.13 | |
Time Trend | 0.90 | 0.45 | 0.88 | 0.38 | -0.61 | 0.09 | 1.01 | -0.14 |
2.40 | 0.10 | 0.83 | 0.93 | 2.38 | 0.96 | 0.89 | 0.95 | |
Constant | -10.06 | 52.81** | 95.94*** | 25.99* | 7.82 | 58.33** | 92.27*** | 32.29** |
27.85 | 17.29 | 9.93 | 10.17 | 29.77 | 17.61 | 16.82 | 10.53 | |
N | 32 | 48 | 32 | 112 | 32 | 48 | 32 | 112 |
df | 6 | 6 | 6 | 6 | 6 | 6 | 6 | 6 |
R squared | 0.96 | 0.89 | 0.85 | 0.97 | 0.96 | 0.88 | 0.81 | 0.97 |
Medicare benefits savings and number of cycles not performed due to policy
Without adjustment for anticipatory behaviour | With adjustment for anticipatory behaviour | ||||
---|---|---|---|---|---|
Average
| |||||
Medicare
| |||||
benefit
|
Total
|
Total
| |||
Fresh Cycles
|
per cycle
|
Cycles
|
savings
|
Cycles
|
savings
|
Predicted benefits and reduction in cycles - without policy: | $6199 | 5451 | $33,790,749 | 4017 | $24,901,383 |
Observed benefits and number of cycles - with policy: | $5108 | 31,504 | $32,341 | ||
Savings due to policy | ($1091) | 31,504 | $34,366,787 | 32,341 | $35,279,845 |
Total savings Fresh Cycles
|
$68,157,536
|
$60,181,228
| |||
Live-birth rate per Fresh Cycle | 21% | 21% | |||
ART live-births not born due to policy | 1145 | 844 | |||
ART Multiple-birth rate | 10.2% | 10.2% | |||
ART infants not born due to policy | 1261 | 930 | |||
Frozen Cycles *
| |||||
Predicted Avr benefits and reduction in cycles without policy: | $1638 | 1409 | $2,307,942 | 1,409 | $2,307,942 |
Actual benefits and number of cycles with policy: | $1348 | 21,276 | 21,276 | ||
Savings due to policy | ($290) | 21,276 | $6,171,063 | 21,276 | $6,171,065 |
Total savings Frozen Cycles
|
$8,479,005
|
$8,479,005
| |||
Live-birth rate per Frozen Cycle | 18% | 18% | |||
ART live-births not born due to policy | 254 | 254 | |||
Multiple-birth rate | 10.2% | 10.2% | |||
ART infants not born due to policy | 279 | 279 | |||
IUI Cycles *
+
| |||||
Predicted Avr benefits and reduction in cycles without policy: | $1270 | ||||
Observed benefits and number of cycles with policy: | $549 | 10,504 | 10,504 | ||
Savings due to policy | ($721) | 10,504 | $7,571,632 | 10,504 | $7,571,632 |
Total savings IUI Cycles
|
$7,571,632
|
$7,571,632
| |||
Total Savings in Medicare benefits
|
$84,208,172
|
$76,231,865
| |||
Total ART infants not born due to policy
|
1540
|
1209
|