Hospital Delivery Charges Significantly Higher When Babies Conceived Through Assisted Reproductive Technologies

A new study published in the Journal of Perinatology [1] online has found that from 2009-2011 in California, hospital delivery charges associated with babies born through assisted reproductive technologies (ART) or artificial insemination (AI) were significantly higher than charges for babies born through natural conception ­­–– in some cases exceeding $1.2 million per infant.

The retrospective study was based on 2009-2011 data from the California Office of Statewide Health Planning and Development and conducted by researchers from the Loma Linda University School of Medicine.

In 2011, statewide average hospital charges for maternity care for women who delivered ART/AI infants were almost fifty percent higher than fees for non-ART infants born late preterm or at term­­––$35,768 compared to $18,654. The higher charges are linked to a 24- to 27-fold increase across California of multiple births, and significantly higher rates of preterm births, lower birth weights, fetal anomalies and stillbirth, among infants born through ART/AI. In 2009, there were 5,710 ART/AI live births in California and 1,718 of these births -- or 30.1 percent –– were multiple births consisting of twins, triplets or more.[2]

Nationally in 2005, the Institute of Medicine estimated economic burden associated with all preterm births in the United States was $26 billion ($51,600 per infant born preterm). [3] In 2010, according to the CDC, “ART infants born preterm accounted for approximately 4.0 percent of all preterm births in the United States, a total economic burden likely to far exceed the earlier estimated costs of one billion.”[4] Of all ART infants born that year, the CDC reports that 46.4 percent were multiples, compared to only three percent of multiples among naturally conceived infants.

See Part 1: Stillbirths and Infant Health Risks Higher in California's Artificially Conceived Infants

In one fee assessment case study highlighted in the Journal of Perinatology article, researchers at Loma Linda University’s Children’s Hospital compared delivery charges of women who received ART/AI from the hospital’s fertility program or other fertility centers in Southern California to women who conceived naturally.

“We found that hospital fees for ART/AI twin births were 59 times higher than charges for single births, and physician charges were 62 times higher,” Dr. Mitchell Goldstein of the Department of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine, who co-authored the report, said in an interview. “Hospital fees for triplet births were 263 times higher than those for singleton births in the normal nursery and physician charges were 187 times higher. In some cases, single ART/AI infant care charges exceed $1.2 million.”

As I noted in my previous post about this study, throughout the state, preterm labor and risks associated with cesarean section were four times higher for women who underwent ART/AI, and their length of stay in hospital was twice as long. The study states that the higher costs of perinatal care for ART/AI mothers are linked to their frequent admission to hospital for “preterm labor, prolonged hospitalization for antepartum testing, bed rest, medication to suppress preterm labor, and the increased rate of operative deliveries.”

In a November 2013 report published in the American Journal of Obstetrics and Gynecology, Merck & Co. found the average charges of all multiple births, including ART/AI, in the United States to be 20 times higher than singleton births. [5] Examining data from nearly 438,000 births by women aged 19 to 45 between January 2005 and September 2010 researchers found that 97 percent were single births that incurred hospital charges on average of $21,000. Almost three percent of births were twins that cost roughly $105,000 and 0.13 percent were triplet births or more that cost more than $400,000. These costs included medical expenses during the 27 weeks before and up to 30 days after delivery. Nationally, the Institute of Medicine estimates that the average daily charges for NICU care is roughly $3,000, [6] but fees vary and increase significantly depending on the extent of interventions required. 

Only 15 U.S. states, including California, mandate that private health insurance programs cover full or partial ART or AI services. [7] According to the Journal of Perinatology study, to date, there has not yet been an estimate of either the total costs incurred­­ or saved when insurance coverage has been made available. These unknowns carry considerable weight for states like California that in the future may consider covering ART/AI through Medi-Cal, the state insurance program.

In some European and other countries where ART/AI services are included under national health insurance schemes, the use of elective single embryo transfers is significantly increased, resulting in fewer premature, low birth weight infants. [8] Since August of 2010, for example, Quebec’s public health system has been covering the costs of up to three stimulated or six un-stimulated ART cycles. As a result, the Quebec government has been able to limit the number of embryos that can be transferred per cycle, and clinics are actively encouraged to promote single embryo transfer. [9] 

But in the United States where there are virtually no regulations in place, the responsibility falls to the clinics to protect women and infant’s health by transferring fewer embryos. This approach, overall, has not boded well for many families that experience multiple preterm births, stillbirth or neonatal death.

In just one 18-month period at Loma Linda Children’s Hospital from 2012-2013, for example, a total of 92 ART/AI infants were born, including 10 very premature infants that died on the first day and four more that died later. Of the surviving 78 ART/AI singleton infants, twins and triplets, 74 percent­––or 61 infants––were admitted to the Neonatal Intensive Care Unit (NICU) with a 38-day average length of stay and a range of anywhere from three to 138 days.

“Our findings suggest that prior to inclusion of ART or AI services under state health insurance programs, there must be enforcement of existing professional guidelines focused on elective single embryo transfer procedures,” said Goldstein, the co-author of the Journal of Perinatology article. “In some instances, families affected by adverse pregnancy outcomes and infant deaths are not sufficiently warned of the health or fiscal risks of multiple embryo transfers. Their full understanding of the risks they face by agreeing to multiple embryo transfers must be part of insurance policies and informed consent procedures.”

Miriam Zoll is an independent journalist and the author of the new book, Cracked Open: Liberty, Fertility and the Pursuit of High-Tech Babies (Interlink-2013).