of delivery than do privately insured women but have shorter hospital stays despite more maternal complications.
Evaluations of expansions in health insurance coverage for children and pregnant women indicate that health outcomes improve with coverage. Children’s access to and utilization of appropriate health care, a positive outcome in itself, improves with higher rates of insurance coverage. In examining population-wide improvements in birthweight and prematurity due to public insurance expansions, some states found no improvement while others identified progress for selected groups (e.g., white women and black teenagers). Attributing improvements in infant mortality to insurance expansions is complicated by co-occurring improvements in neonatalogy. The population effect of public insurance eligibility expansions on utilization and health outcomes is less than some experts would predict based on the substantial number of pregnant women who are eligible. However, a significant number of eligible women do not enter prenatal care in the first trimester or enroll at all.
This chapter has reviewed the research addressing the impact of insurance status on access to health care, its use, and ultimately, health outcomes for children, pregnant women, and newborns. Although having insurance makes a difference, simply making insurance available may not be enough to improve health care and health outcomes for all of the uninsured. Some high-risk groups may require additional services (e.g., educational interventions, targeted case management) if they are to obtain good preventive and routine care.