INFERTILITY SERVICES IN A MANAGED CARE ENVIRONMENT

Managed care schemes are replacing traditional fee-for-service reimbur sement to physicians and hospitals in the United States. Managed care schemes take the form of discounted fee-for-service, utilization revie w, global fee reimbursement, and capitated reimbursement schemes with funds to be distributed among providers. Reimbursement for infertifity services has been excluded from many managed care plans as infertilit y is viewed as a social condition, not a medical condition, and covera ge for infertility diagnosis and treatment is viewed as unnecessary in the bundle of services offered by insurers and other managed care org anizations. However, some states mandate infertility coverage and some managed care organizations realize that provision of care for inferti le couples makes their product more attractive. Large managed care org anizations such as Blue Cross/Blue Shield of Illinois and some entrepr eneurial organizations are developing managed care plans that incorpor ate infertility services. Comprehensive services including in-vitro fe rtilization - can be offered at a lower cost than traditional fee-for- service care. Newer technologies such as in-vitro fertilization are re placing fallopian tube surgery and surgical treatment for male inferti lity. These can be implemented at a lower cost and with better outcome for infertile couples than traditional services.