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Health Insurance is a Family Matter
6
Health-Related Outcomes for Children, Pregnant Women, and Newborns
This chapter examines clinical and epidemiological evidence about the effects of health insurance status on the health of children, pregnant women, and newborns.1 It extends the assessment of health outcomes that the Committee presented in Care Without Coverage to pediatric and pregnancy-related care and outcomes. It places this analysis within the broader context of family interests, behavior, and constraints of this report because, as demonstrated in the previous chapter, children’s access to and use of health care is highly dependent on their parents’ opportunities and actions. The financially constrained patterns of use by uninsured families, as documented in Chapter 4, can affect the overall health and development of their members, particularly of children. Table 6.1 summarizes the health insurance status of American children by age, race and ethnicity, and family income.
The Committee reviewed studies that compare the access to and use of health care services by insured and uninsured children, pregnant women, and newborns as well as research that relates their insurance status to health outcomes.2 Only
1
Many studies classify people age 18 and under as children, conforming to the federal Medicaid eligibility standard definition of children; others, however, are based on national surveys that classify people age 17 and under as children. The American Academy of Pediatrics considers people up to age 21 children.
2
The review draws on studies identified in a MEDLINE search of the English language literature published between 1985 and September 2001. The search terms included “insurance status,” “insurance, longitudinal,” “insurance, cohort,” “uninsured, longitudinal,” “uninsured, cohort,” “payer status,” “payer source,” “medically indigent,” and “uncompensated care.” Studies with fewer than 250 participants, those with unadjusted results, and those from a single institution were excluded, unless broader studies of a particular outcome were unavailable or limited. In addition, more recent
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