Policy Interventions when Medical Treatment Dynamics Matter: The Case of In Vitro Fertilization

Abstract      

Decision-making dynamics are central to In Vitro Fertilization (IVF), an infertility treatment in which patients make a sequence of choices within and across treatment cycles.  Patients’ strategies are affected by their fertility characteristics, preferences, IVF’s treatment technologies, and information gradually revealed during a cycle.  Patients may forego treatment because of its expense, or may choose more aggressive treatment to reduce the substantial risk of IVF failure.  Several policy interventions are possible to increase IVF access or encourage patients to take more conservative treatments, which reduce the chance of risky twin or triplet pregnancies.  We evaluate potential policies after estimating a dynamic structural model of patients’ choices within and across IVF treatments.  The policies include insurance mandates, direct limits on or additional prices for aggressive treatment, and introducing improved treatment technologies.  All policies have significant effects on patient choices and outcomes, but vary substantially in their welfare and cost consequences.