BACKGROUND: Insurance expansions and service delivery system expansions are alternative policy instruments used to try to improve birth outcomes for low-income women. OBJECTIVES: The objective of this research is to investigate the effect of expansions of public insurance on access and birth outcomes for pregnant women and the role of different delivery systems in these outcomes. MATERIALS AND METHODS: The experience in Florida during the years 1989-1994 is studied. Data are from linked birth certificates, hospital discharge data, Medicaid eligibility and claims files, and county health department records. Use of prenatal care and birthweight for low-income women is compared under different financing for prenatal care and for those using different delivery systems. Several approaches to control for self-selection are adopted, and similar results are obtained with each. RESULTS: Women enrolled in Medicaid have more prenatal care visits than the uninsured. Outcomes for those on Medicaid and the uninsured are significantly better if they receive care in the public health system than if they receive care in the private system-including private offices, clinics, and HMOs. Over time, the gap in outcomes between those in the public system and those receiving prenatal care from private physicians has diminished. CONCLUSIONS: Public insurance improves access to services, but the delivery system is a key factor in improving outcomes.
BACKGROUND: Insurance expansions and service delivery system expansions are alternative policy instruments used to try to improve birth outcomes for low-income women. OBJECTIVES: The objective of this research is to investigate the effect of expansions of public insurance on access and birth outcomes for pregnant women and the role of different delivery systems in these outcomes. MATERIALS AND METHODS: The experience in Florida during the years 1989-1994 is studied. Data are from linked birth certificates, hospital discharge data, Medicaid eligibility and claims files, and county health department records. Use of prenatal care and birthweight for low-income women is compared under different financing for prenatal care and for those using different delivery systems. Several approaches to control for self-selection are adopted, and similar results are obtained with each. RESULTS:Women enrolled in Medicaid have more prenatal care visits than the uninsured. Outcomes for those on Medicaid and the uninsured are significantly better if they receive care in the public health system than if they receive care in the private system-including private offices, clinics, and HMOs. Over time, the gap in outcomes between those in the public system and those receiving prenatal care from private physicians has diminished. CONCLUSIONS: Public insurance improves access to services, but the delivery system is a key factor in improving outcomes.
Authors: Emmanuel A Anum; Sheldon M Retchin; Sheryl L Garland; Jerome F Strauss Journal: J Womens Health (Larchmt) Date: 2010-09-11 Impact factor: 2.681
Authors: Min Wu; Linda L Lagasse; Trecia A Wouldes; Amelia M Arria; Tara Wilcox; Chris Derauf; Elana Newman; Rizwan Shah; Lynne M Smith; Charles R Neal; Marilyn A Huestis; Sheri Dellagrotta; Barry M Lester Journal: Matern Child Health J Date: 2013-04
Authors: George E Fryer; Larry A Green; Susan M Dovey; Barbara P Yawn; Robert L Phillips; David Lanier Journal: Ann Fam Med Date: 2003 Jul-Aug Impact factor: 5.166
Authors: Kathryn Taylor; Sarah Compton; Giselle E Kolenic; John Scott; Nora Becker; Vanessa K Dalton; Michelle H Moniz Journal: JAMA Netw Open Date: 2021-10-01