of a breadwinner and those of family members who depend economically on the breadwinner. In the example described above, the differing coverage status of child and parent may translate into different experiences with the health care system, and different consequences of being uninsured for families with at least one uninsured member, than if both child and parent were covered by public insurance. Likewise, parents’ knowledge of both their children’s and their own eligibility for insurance and their beliefs about the value of coverage may affect whether they enroll themselves and their children. Their knowledge of and beliefs about health care and the availability of services may influence whether they seek care for themselves and their children. The availability and costs of coverage at the community-wide level (lower left box) may influence aggregate enrollment and use of health care in the community.

  • Within the box labeled “health care,” Figure A.2 merges the three categories listed in Figure A.1 (i.e., personal health practices, utilization of health services, processes of services delivery) into two categories that highlight the influence of a parent or family breadwinner’s decision making on the process of obtaining access to health care. The quality, quantity and continuity of the services obtained can affect the box labeled health outcomes for families in the right panel on consequences as well as the community level in the box effects on communities.

  • In Figure A.2, the box labeled economic and health outcomes for family members is roughly equivalent to the box in Figure A.1 labeled effects on families. These consequences include effects on family resources (e.g., current and anticipated future income, economic status, long-term asset accumulation), some of the family’s characteristics (e.g., decisions about marital status and childbearing), and the health of all family members (e.g., health status, family stress and well-being, childhood development). These consequences may have different effects on the family as a unit from those on individual members.

  • The “effects on communities box” in Figure A.2 reflects the influence on communities of the aggregate efforts of families to obtain access to health care. A community’s uninsured rate may influence the configuration of services, providers, and institutions and their costs and revenues. The uninsured rate in the community also may influence the quality of care that providers and institutions deliver, the health care needs of its residents, and their use of care. These community-level effects will be examined in detail in the next report of the Committee.

To tailor the conceptual framework for use in assessing the literature on health outcomes for pregnant women and newborns (in Chapter 6), Figure 6.1 reflects the specific processes and outcomes studied in the literature reviewed. Figure 6.1 emphasizes the role of health insurance for pregnant women in obtaining access to health services and enumerates specific health outcomes for both women and their newborn infants that may be consequences of the mother having been uninsured. It makes linkages between the process of health services delivery and the care received to decisions of providers of care that reflect health insurance status.



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