Public attitudes in the United States toward insurance coverage for in vitro fertilization and the provision of infertility services to lower income patients

Jacqueline R Ho; Lusine Aghajanova; Evelyn Mok-Lin; Jacquelyn R Hoffman; James F Smith; Christopher N Herndon

doi:10.1016/j.xfre.2021.09.002

Public attitudes in the United States toward insurance coverage for in vitro fertilization and the provision of infertility services to lower income patients

F S Rep. 2021 Sep 20;3(2 Suppl):122-129. doi: 10.1016/j.xfre.2021.09.002. eCollection 2022 May.

Authors

Jacqueline R Ho¹, Lusine Aghajanova², Evelyn Mok-Lin³, Jacquelyn R Hoffman⁴, James F Smith^{5

6}, Christopher N Herndon⁷

Affiliations

¹ Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, University of Southern California, Los Angeles, California.
² Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Stanford University, Palo Alto, California.
³ Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, California.
⁴ University of Arizona School of Medicine, Tucson, Arizona.
⁵ Department of Urology, University of California, San Francisco, California.
⁶ Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California.
⁷ Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, University of Washington, Seattle.

Abstract

Objective: To assess attitudes and factors that influence public opinion in the general US population toward insurance coverage and provision of infertility care to lower income patients.

Design: Cross-sectional survey.

Setting: Online.

Patients: A nationally representative sample of US residents.

Interventions: Questionnaire with multiple choice and open response questions.

Main outcome measures: Public attitudes toward in vitro fertilization and infertility care coverage for lower income patients.

Results: A total of 1,027 (90.2%) participants completed the survey, among whom 620 (60.4%) had private insurance, 275 (26.8%) had Medicare/Medicaid, and 56 (5.5%) were uninsured. The majority (916, 89.2%) did not consider infertility a disease. Over half of the respondents (568, 55.3%) supported private insurance coverage of infertility services, including for in vitro fertilization. Most respondents, 735 (71.6%) believed that the prevalence and psychosocial impact of infertility were equal among the lower and higher income people. The majority of respondents with an opinion (512, 67.6%) believed that doctors should provide infertility treatments regardless of the income level of the patients. Of supporters, 40.1% believed in the right to have a family regardless of income, and 38.2% believed that doctors had a social responsibility to provide infertility services. After adjusting for covariates, age <45 years, noncollege graduates, desiring more children, believing that infertility was a disease, and residence in the Northeast region remained significant predictors for support of private insurance coverage.

Conclusions: Public perception of infertility as a disease is one of the strongest predictors of support for insurance coverage for infertility services, underscoring the need for enhanced advocacy and education in the general public.

Keywords: Access to care; IVF; infertility; insurance; public opinion.