Too Many Sperm Being Injected in Rhode Island

Anecdotal evidence of the unintended consequences of insurance mandates and bureaucratically-set healthcare pricing, courtesy of the Associated Press

Fertility clinics are overusing a laboratory technique and costing infertile couples and some insurers hundreds of extra dollars, a new study suggests.
At issue is a procedure that injects a single sperm into an egg. The method is considered the best option for couples in which the man has defective sperm or extremely low sperm counts.
But many clinics are using it for other infertile couples, even though it often doesn’t work as well as the standard lab dish method, according to a study in Thursday’s New England Journal of Medicine.
Sperm injection adds about $1,500 to the $12,400 average cost of an in vitro fertilization treatment cycle, the authors said.
“This paper is particularly troubling because we’ve got a major shift in practice that isn’t evidence driven. The paper suggests it may be driven by money,” said Arthur Caplan, director of the University of Pennsylvania’s Center for Bioethics and a contributing writer for’s Breaking Bioethics column….
The research team reviewed a decade of results that hundreds of fertility clinics reported to the federal government. In 2004, about 58 percent of treatment attempts included sperm injection — up from 11 percent in 1995.
But the proportion of couples who have trouble conceiving because of the man’s sperm has stayed constant, at around 34 percent. This suggests that the sperm-injection technique is being urged on many couples who do not need it and might be better off with traditional lab dish, or in vitro, fertilization, Caplan said.
Sperm injection does not increase overall success rates for healthy births. The researchers found that among infertility treatment attempts with successful egg retrievals in 2004, about 31 percent of those involving sperm injection resulted in a live birth. The percentage was higher — 33 percent — for those that did not use the sperm injection….
They also noted that sperm-injection rates were higher in three states — Illinois, Massachusetts and Rhode Island — that mandate coverage of the technique than in states without such a requirement.
Now, I know there are some critics of the current healthcare system will say this is clearly a result of the evils of for-profit medicine, but that argument doesn’t fly here.
Prices for medical procedures in America today are set by a mixture of private and public insurance bureaucracies. (And if you don’t like the price specified by your insurer, too bad; you have little opportunity to go elsewhere, because of our employer-based healthcare system). Since insurance companies set the reimbursement rates, it’s doubtful that doctors can be blamed for conspiring to establish a bigger profit margin for the injection versus the lab dish procedure. And since the insurers don’t provide the actual service, they can’t be making more money by encouraging higher-priced treatments.
That leaves at least two explanations, in the absence of evidence of medical necessity, for the growing preference for injection treatments…
  1. There are different profit margins for the two procedures, resulting from the fact that bureaucratically established prices have not responded efficiently or rationally to the true costs of providing treatments, and some doctors are indeed getting greedy.
  2. Alternatively, note that the AP story states only that the price of the injection treatment is higher, not that the profit margin is higher. The increase in injections could also result from the fact that some patients figure the higher-cost treatment must be the better treatment, and since they’re paying the same amount for either treatment (assuming the price of both treatments exceed their deductible), that’s the treatment they choose.
Either way, what reason is there to believe that a situation like this will improve if health insurance becomes more stringently controlled by government bureaucracy?

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16 years ago

Warning: that headline’s gonna bring out the 10-year-old in all of us.

16 years ago

This is what happens when the consumer is insulated from price. We’ve become a country in which most people effectively have “Pre-Paid” healthcare. Only about 14 cents out of each dollar spent on healthcare comes directly from someone’s pocket. Healthcare in the U.S. is kind of like pre-paying for an all-you-can-eat buffet.You are bound to grab an extra lobster and leave half on the plate. Until we reconnect people to the real cost of healthcare, we will continue to have rapidly escalating cost and stunted quality of service.

John Howard
16 years ago

Wow, so in Massachusetts, where it is now mandatory for every adult to buy health insurance, we are paying for people’s fertility treatments? How is that? It’s not a health care issue, there is no one getting sick and dying. I bet we have to pay for single women, and possibly surrogate mothers, too.
What do you think of Gov. Carcieri vetoing the mandated coverage for unmarried people? Interesting how it relates to the conversation we were having back in June, where i was saying that marriage gives a couple the right to procreate, and that same-sex couples should not be given the right to procreate due to the extreme risks to the child and the harm to humanity it would cause. So I welcomed the Gov’s veto, which gets people thinking. Note that if RI had gay marriage, you’d be paying for lots of IVF cycles. Soon, without an egg and sperm law, we’ll all be paying for same-sex conception too, because they claim it is a “right” for it to be “safe and affordable”. We have to stand up and say that it isn’t a right.

16 years ago

“Until we reconnect people to the real cost of healthcare, we will continue to have rapidly escalating cost and stunted quality of service.”
You were referring to the US, SeanO, but your comment especially applies to public sector insurance coverage in Rhode Island, where co-pays and co-shares of premium were non-existant until very recently and even now, where they have been gingerly brought into some (not all) contracts, can only be described as token.
This has lead to disproportionately high health insurance costs. According to this RIPolicy Analysis column, for example, in 2004, “Rhode Island’s health care utilization rate (according to Blue Cross’ own SHAPE study) is 43% higher than the national average.” The State of Rhode Island, of course, self insures health insurance, so those disproportionately higher costs are paid directly by tax payers. Concurrently, Ed Achorn made the point that Frank Montanaro and Blue Cross love no-co-pay/no-co-share coverage because they can jack up rates without a lot of customers squawking.
It’s remarkable how discerning an insured becomes about the necessity of treatment when even a very modest amount of the cost must come out of pocket.

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