TY - JOUR
T1 - Expanding prenatal care to unauthorized immigrant women and the effects on infant health
AU - Swartz, Jonas J.
AU - Hainmueller, Jens
AU - Lawrence, Duncan
AU - Rodriguez, Maria I.
N1 - Publisher Copyright:
© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
PY - 2017
Y1 - 2017
N2 - Objective: To measure the effect of access to prenatal care on unauthorized and low-income, new legal permanent resident immigrant women and their offspring. Methods: We used a difference-in-differences design that leverages the staggered rollout of Emergency Medicaid Plus by county from 2008 to 2013 as a natural experiment to estimate the effect on health service utilization for women and health outcomes for their infants. Regular Medicaid pregnancies were used as an additional control in a triple difference design. Results: Our sample included pregnancies covered by Emergency Medicaid (35,182), Emergency Medicaid Plus (12,510), and Medicaid (166,054). After expansion of access to prenatal care, there was an increase in prenatal visits (7.2 more visits, 95% CI 6.45-7.96), receipt of adequate prenatal care (28% increased rate, CI 26-31), rates of diabetes screening (61% increased rate, CI 56-66), and fetal ultrasonograms (74% increased rate, CI 72-76). Maternal access to prenatal care was also associated with an increased number of well child visits (0.24 more visits, CI 0.07-0.41), increased rates of recommended screenings and vaccines (0.04 increased probability, CI 0.002-0.074), and reduced infant mortality (21.01/1,000, CI 21.42 to 20.60) and rates of extremely low birth weight (less than 1,000 g) (21.33/1,000, CI 22.44 to 20.21). Conclusion: Our results provide evidence of increased utilization and improved health outcomes for unauthorized immigrants and their children who are U.S. citizens after introduction of prenatal care expansion in Oregon. This study contributes to the debate around reauthorization of the Children's Health Insurance Program in 2017.
AB - Objective: To measure the effect of access to prenatal care on unauthorized and low-income, new legal permanent resident immigrant women and their offspring. Methods: We used a difference-in-differences design that leverages the staggered rollout of Emergency Medicaid Plus by county from 2008 to 2013 as a natural experiment to estimate the effect on health service utilization for women and health outcomes for their infants. Regular Medicaid pregnancies were used as an additional control in a triple difference design. Results: Our sample included pregnancies covered by Emergency Medicaid (35,182), Emergency Medicaid Plus (12,510), and Medicaid (166,054). After expansion of access to prenatal care, there was an increase in prenatal visits (7.2 more visits, 95% CI 6.45-7.96), receipt of adequate prenatal care (28% increased rate, CI 26-31), rates of diabetes screening (61% increased rate, CI 56-66), and fetal ultrasonograms (74% increased rate, CI 72-76). Maternal access to prenatal care was also associated with an increased number of well child visits (0.24 more visits, CI 0.07-0.41), increased rates of recommended screenings and vaccines (0.04 increased probability, CI 0.002-0.074), and reduced infant mortality (21.01/1,000, CI 21.42 to 20.60) and rates of extremely low birth weight (less than 1,000 g) (21.33/1,000, CI 22.44 to 20.21). Conclusion: Our results provide evidence of increased utilization and improved health outcomes for unauthorized immigrants and their children who are U.S. citizens after introduction of prenatal care expansion in Oregon. This study contributes to the debate around reauthorization of the Children's Health Insurance Program in 2017.
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U2 - 10.1097/AOG.0000000000002275
DO - 10.1097/AOG.0000000000002275
M3 - Article
C2 - 29016491
AN - SCOPUS:85032629904
SN - 0029-7844
VL - 130
SP - 938
EP - 945
JO - Obstetrics and gynecology
JF - Obstetrics and gynecology
IS - 5
ER -