Advances in fertility treatment have greatly expanded the number of people who can become parents. But treatment is expensive and – in most states – is not covered by health insurance. Patients often pay tens of thousands of dollars out of pocket for in-vitro fertilization and surrogate pregnancies, and face tough decisions about whether to continue treatment when initial attempts fail.
Kaiser Health News (Infertility Patients Finding Creative Financing Help) documents the growing number of options available to fertility patients. Clinics and shared-risk programs provide full or partial refunds for customers who don’t end up with a baby, in exchange for paying somewhat more upfront. These programs look like a good way to hedge against the risk of multiple cycles or failure to conceive. Those offering the programs must like them, since they increase the addressable market and probably boost average revenues per patient.
So on balance I think these programs are good. But it’s worth stepping back to consider that a mediocre Reproductive Endocrinologist can easily make a seven figure income, especially in those states that don’t mandate coverage for fertility treatments. In the 15 states that do mandate coverage insurance companies use their negotiating power to pay more reasonable rates than what any individual could hope to negotiate, and there’s no need for the consumer to participate in shared-risk or similar programs. Insurers also get a break on the price of expensive fertility drugs.
The downside of the mandate is that it increases insurance premiums for everyone, although those increases may be partially offset by reduced costs for neo-natal intensive care (when self-pay patients push for more embryos and end up with twins and triplets).
I live in a mandate state and I’m glad that I do.
David E. Williams is President of the Health Business Group, strategy consultant in technology enabled health care services, pharma, biotech, and medical devices. Formerly with BCG and LEK. MBA (Harvard), BA (Wesleyan).
Williams has written the Health Business Blog every business day since 2005.