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. 2001 Jun;36(2):373–398.

Changes in prenatal care timing and low birth weight by race and socioeconomic status: implications for the Medicaid expansions for pregnant women.

L Dubay 1, T Joyce 1, R Kaestner 1, G M Kenney 1
PMCID: PMC1089229  PMID: 11409818

Abstract

OBJECTIVE: To conduct the first national study that assesses whether the Medicaid expansions for pregnant women, legislated by Congress over a decade ago, met the policy objectives of improved access to care and birth outcomes for poor and near-poor women. DATA SOURCES/STUDY SETTING: Data on 8.1 million births using the 1980, 1986, and 1993 National Natality Files. We use births from all areas of the United States except California, Texas, Washington, and upstate New York. METHODS: We conduct a before and after analysis that compares obstetrical outcomes by race and socioeconomic status for the periods 1980-86 and 1986-93. We examine whether women of low socioeconomic status showed greater improvements in outcomes during the 1986-93 period compared to the 1980-86 period. We analyze two obstetrical outcomes: the rate of late initiation of prenatal care and the rate of low birth weight. DATA COLLECTION: Natality data were aggregated to race, socioeconomic status, age, and parity groups. RESULTS: During the 1986-93 period, rates of late initiation of prenatal care decreased by 6.0 to 7.8 percentage points beyond changes estimated for the 1980-86 period for both white and African American women of low socioeconomic status. For some white women of low socioeconomic status, the rate of low birth weight was reduced by 0.26 to 0.37 percentage points between 1986 and 1993 relative to the earlier period. Other white women of low socioeconomic status and all African American women of low socioeconomic status showed no relative improvement in the rate of low birth weight during the 1986-93 period. CONCLUSIONS: The expansions in Medicaid lead to significant improvements in prenatal care utilization among women of low socioeconomic status. The emerging lesson from the Medicaid expansions, however, is that increased access to primary care is not adequate if the goal is to narrow the gap in newborn health between poor and nonpoor populations.

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Selected References

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  1. Dubay L. C., Kenney G. M., Norton S. A., Cohen B. C. Local responses to expanded Medicaid coverage for pregnant women. Milbank Q. 1995;73(4):535–563. [PubMed] [Google Scholar]
  2. Gruber J. The incidence of mandated maternity benefits. Am Econ Rev. 1994 Jun;84(3):622–641. [PubMed] [Google Scholar]
  3. Haas J. S., Udvarhelyi I. S., Morris C. N., Epstein A. M. The effect of providing health coverage to poor uninsured pregnant women in Massachusetts. JAMA. 1993 Jan 6;269(1):87–91. [PubMed] [Google Scholar]
  4. Joyce T. Impact of augmented prenatal care on birth outcomes of Medicaid recipients in New York City. J Health Econ. 1999 Jan;18(1):31–67. doi: 10.1016/s0167-6296(98)00027-7. [DOI] [PubMed] [Google Scholar]
  5. Joyce T., Kaestner R. State reproductive policies and adolescent pregnancy resolution: the case of parental involvement laws. J Health Econ. 1996 Oct;15(5):579–607. doi: 10.1016/s0167-6296(96)00496-1. [DOI] [PubMed] [Google Scholar]
  6. Kleinman J. C., Kessel S. S. Racial differences in low birth weight. Trends and risk factors. N Engl J Med. 1987 Sep 17;317(12):749–753. doi: 10.1056/NEJM198709173171207. [DOI] [PubMed] [Google Scholar]
  7. Kleinman J. C., Kopstein A. Smoking during pregnancy, 1967-80. Am J Public Health. 1987 Jul;77(7):823–825. doi: 10.2105/ajph.77.7.823. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Kogan M. D., Martin J. A., Alexander G. R., Kotelchuck M., Ventura S. J., Frigoletto F. D. The changing pattern of prenatal care utilization in the United States, 1981-1995, using different prenatal care indices. JAMA. 1998 May 27;279(20):1623–1628. doi: 10.1001/jama.279.20.1623. [DOI] [PubMed] [Google Scholar]
  9. Kotelchuck M. An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health. 1994 Sep;84(9):1414–1420. doi: 10.2105/ajph.84.9.1414. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Long S. H., Marquis M. S. The effects of Florida's Medicaid eligibility expansion for pregnant women. Am J Public Health. 1998 Mar;88(3):371–376. doi: 10.2105/ajph.88.3.371. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Newacheck P. W., Stoddard J. J., Hughes D. C., Pearl M. Health insurance and access to primary care for children. N Engl J Med. 1998 Feb 19;338(8):513–519. doi: 10.1056/NEJM199802193380806. [DOI] [PubMed] [Google Scholar]
  12. Piper J. M., Mitchel E. F., Jr, Ray W. A. Expanded Medicaid coverage for pregnant women to 100 percent of the federal poverty level. Am J Prev Med. 1994 Mar-Apr;10(2):97–102. [PubMed] [Google Scholar]
  13. Piper J. M., Ray W. A., Griffin M. R. Effects of Medicaid eligibility expansion on prenatal care and pregnancy outcome in Tennessee. JAMA. 1990 Nov 7;264(17):2219–2223. [PubMed] [Google Scholar]
  14. Ray W. A., Mitchel E. F., Jr, Piper J. M. Effect of Medicaid expansions on preterm birth. Am J Prev Med. 1997 Jul-Aug;13(4):292–297. [PubMed] [Google Scholar]
  15. Schoendorf K. C., Hogue C. J., Kleinman J. C., Rowley D. Mortality among infants of black as compared with white college-educated parents. N Engl J Med. 1992 Jun 4;326(23):1522–1526. doi: 10.1056/NEJM199206043262303. [DOI] [PubMed] [Google Scholar]
  16. Schwartz R. M., Luby A. M., Scanlon J. W., Kellogg R. J. Effect of surfactant on morbidity, mortality, and resource use in newborn infants weighing 500 to 1500 g. N Engl J Med. 1994 May 26;330(21):1476–1480. doi: 10.1056/NEJM199405263302102. [DOI] [PubMed] [Google Scholar]
  17. Vega W. A., Kolody B., Hwang J., Noble A. Prevalence and magnitude of perinatal substance exposures in California. N Engl J Med. 1993 Sep 16;329(12):850–854. doi: 10.1056/NEJM199309163291207. [DOI] [PubMed] [Google Scholar]
  18. Yazici E. Y., Kaestner R. Medicaid expansions and the crowding out of private health insurance among children. Inquiry. 2000 Spring;37(1):23–32. [PubMed] [Google Scholar]

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