https://researchopenworld.com/competitive-pressures-and-multiple-births-in-infertility-treatment/#

Abstract

Background : With the increase in fertility problems and delayed childbearing, demand for infertility treatments has been rising . Today, in vitro fertilization (IVF) is the most successful infertility treatment but it is costly. To meet rising demand for infertility treatment many markets have seen an increased entry of infertility clinics. Concerns have been raised of the effect of high per-treatment cost and rising competitive pressures on the outcomes of infertility treatments. The objective of this study is to examine the relationship between competitive pressures and prices charged by clinics for in vitro fertilization treatments as well as the effect of prices and competition on multiple gestations. Method : This is a retrospective analysis of 2012-2014 clinic-level data in the United States. This study collects in vitro fertilization prices and combines the price data with the ART Fertility Clinic Success Rates Reports published by the Centers for Disease Control and Prevention (CDC). The Herfindahl– Hirschman Index (HHI) is a widely-used measure of competition within a market. Regression analysis is used to estimate the relationship between HHI and price variables. The effect of prices and competitive pressures on multiple gestations is estimated. Results : Multivariate regression results show that competitive pressures do decrease prices charged by IVF clinics (p-value<0.1). IVF refund programs that reimburse couples for multiple failures are more likely to be offered in more concentrated markets (p-value<0.05) and larger clinics (p-value<0.01). Lower prices translate into lower multiple rates for younger women Controlling for prices, competitive pressures decrease multiple rates for younger women (below 35 years of age) but increase multiple rates for older women (above 40 years of age) (p-value<0.1). Conclusions : Lower IVF prices translate into better quality as measured by the rates of multiples for younger women undergoing infertility treatments. Effect of competitive pressures on quality of care is ambiguous especially after we control for treatment cost. For older women such pressures may lead to more embryo transferred and higher rates of multiples. Further research is needed to identify the relationship between competition and quality of medical care in infertility and other markets.