The role of public insurance and the public delivery system in improving birth outcomes for low-income pregnant women.
BACKGROUND
Insurance expansions and service delivery system expansions are alternative policy instruments used to try to improve birth outcomes for low-income women.


OBJECTIVE
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.


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.
Susan Marquis
M
M
RAND, Arlington, Virginia 22202-5050, USA. susanm@rand.org
Long
Stephen H
SH
D001724:Birth Weight; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D005431:Florida; D006297:Health Services Accessibility; D006302:Health Services Research; D006779:Hospitals, Public; D006801:Humans; D007348:Insurance, Health; D008484:Medicaid; D017057:Medically Uninsured; D011203:Poverty; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000191:economics; D011295:Prenatal Care / Q000191:economics / Q000706:statistics & numerical data; D017149:Private Sector; D011787:Quality of Health Care; D012044:Regression Analysis; D012959:Socioeconomic Factors