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The Technology of Birth: Health Insurance, Medical Interventions, and Infant Health

  • Janet Currie
  • Jonathan Gruber

Two key issues for public insurance policy are the effect of insurance status on medical treatment, and the implications of insurance-induced treat- ment differentials for health outcomes. We address these issues in the context of the treatment of childbirth, using Vital Statistics data on every birth in the U.S. over the 1987-1992 period. The effects of insurance status on treat- ment and outcomes are identified using the tremendous variation in eligibility for public insurance coverage under the Medicaid program over this period. Among teen mothers and high school dropouts, who were largely uninsured before being made eligible for Medicaid, eligibility for this program was associated with significant increases in the use of a variety of obstetric procedures. On average, this more intensive treatment was associated with only marginal changes in the health of infants, as measured by neonatal mortality. But the effect of eligibility on neonatal mortality is sizeable among children born to mothers whose closest hospital had a Neonatal Intensive Care Unit, suggest- ing that insurance-induced increases in use of `high tech' treatments can have real effects on outcomes. Among women with more education there is a counter- vailing effect on procedure use. Most of these women had private insurance before becoming Medicaid-eligible, and some may have been 'crowded out' onto the public program. These women moved from more generous to less generous insurance coverage of pregnancy and neonatal care. This movement was accompanied by reductions in procedure use without any discernable change in neonatal mortality.

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Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 5985.

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Date of creation: Apr 1997
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Handle: RePEc:nbr:nberwo:5985
Note: CH HC LS PE
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  1. Janet Currie & Jonathan Gruber & Michael Fischer, 1994. "Physician Payments and Infant Mortality: Evidence from Medicaid Fee Policy," NBER Working Papers 4930, National Bureau of Economic Research, Inc.
  2. Jonathan Gruber & Maria Owings, 1996. "Physician Financial Incentives and Cesarean Section Delivery," RAND Journal of Economics, The RAND Corporation, vol. 27(1), pages 99-123, Spring.
  3. Currie, J. & Thomas, D., 1995. "Medical Care for Children, Public Insurance, Private Insurance, and Racial Differences in Utilization," Papers 95-08, RAND - Reprint Series.
  4. David M. Cutler & Mark McClellan, 1996. "The Determinants of Technological Change in Heart Attack Treatment," NBER Working Papers 5751, National Bureau of Economic Research, Inc.
  5. McGuire, Thomas G. & Pauly, Mark V., 1991. "Physician response to fee changes with multiple payers," Journal of Health Economics, Elsevier, vol. 10(4), pages 385-410.
  6. Dranove, David, 1988. "Pricing by non-profit institutions : The case of hospital cost-shifting," Journal of Health Economics, Elsevier, vol. 7(1), pages 47-57, March.
  7. Jonathan Gruber & Kathleen Adams & Joseph P. Newhouse, 1997. "Physician Fee Policy and Medicaid Program Costs," Journal of Human Resources, University of Wisconsin Press, vol. 32(4), pages 611-634.
  8. Gruber, Jonathan, 1994. "The effect of competitive pressure on charity: Hospital responses to price shopping in California," Journal of Health Economics, Elsevier, vol. 13(2), pages 183-211, July.
  9. Janet Currie, 1995. "Do Children of Immigrants Make Differential Use of Public Health Insurance?," NBER Working Papers 5388, National Bureau of Economic Research, Inc.
  10. Currie, Janet & Gruber, Jonathan, 1996. "Saving Babies: The Efficacy and Cost of Recent Changes in the Medicaid Eligibility of Pregnant Women," Journal of Political Economy, University of Chicago Press, vol. 104(6), pages 1263-96, December.
  11. David M. Cutler & Jonathan Gruber, 1995. "Does Public Insurance Crowd Out Private Insurance?," NBER Working Papers 5082, National Bureau of Economic Research, Inc.
  12. Thomas G. McGuire & Mark V. Pauly, 1991. "Physician Response to Fee Changes with Multiple Payers," Papers 0015, Boston University - Industry Studies Programme.
  13. Currie, Janet & Gruber, Jonathan, 1996. "Health Insurance Eligibility, Utilization of Medical Care, and Child Health," The Quarterly Journal of Economics, MIT Press, vol. 111(2), pages 431-66, May.
  14. Robert Hutchens & George Jakubson & Saul Schwartz, 1989. "AFDC and the Formation of Subfamilies," Journal of Human Resources, University of Wisconsin Press, vol. 24(4), pages 599-628.
  15. Feldstein, Martin S, 1971. "Hospital Cost Inflation: A Study of Nonprofit Price Dynamics," American Economic Review, American Economic Association, vol. 61(5), pages 853-72, December.
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