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Author: Trenholm, Christopher Allen
Resulting in 1 citation.
1. Trenholm, Christopher Allen
The Impact of Prenatal Medicaid Programs on the Health of Newborns
Ph.D. Dissertation, The University of North Carolina at Chapel Hill, 1997.
Also: http://osu.worldcat.org/title/impact-of-prenatal-medicaid-programs-on-the-health-of-newborns/oclc/038166451
Cohort(s): NLSY79
Publisher: UMI - University Microfilms, Bell and Howell Information and Learning
Keyword(s): Benefits, Insurance; Birth Outcomes; Birthweight; Endogeneity; Health Care; Heterogeneity; Marital Status; Pre-natal Care/Exposure; Pre/post Natal Health Care

This dissertation undertakes a comprehensive examination of how state Medicaid programs affect the health of newborns. Its key innovation is that it isolates the impact of individual Medicaid components on the birth outcome. These components encompass all aspects of Medicaid including coverage, quality, and eligibility. Given the recent explosion in enrollment and the possibility of cuts in federal funding, states are under increasing pressure to provide effective prenatal care to Medicaid recipients. Results from this dissertation provide state policy makers with detailed information on where to focus scarce resources to maximize newborns' health. Using data from the National Longitudinal Survey of Youth (NLSY), the empirical model evaluates the effect of Medicaid program components in a full information maximum likelihood framework. An equation for newborns' birthweight is estimated jointly with equations explaining a woman's health insurance status, her marital status, and her decision to give birth. A discrete-factor specification of unobserved heterogeneity controls for the endogeneity of insurance, marriage, and fertility. The results strongly suggest that reimbursement to ob/gyns for prenatal care and vaginal delivery has a positive effect on birthweight. An increase from $400 to $800 (in 1986 dollars), for example, is predicted to raise birthweights of children on Medicaid by over five ounces. The cost reduction associated with higher birthweights more than offsets the increase in reimbursement costs. Additional results confirm that the recent eligibility expansion has significantly increased the probability that a pregnant woman enrolls in Medicaid. However, there is no evidence that this increase has reduced the probability that a woman is uninsured, suggesting that the expansion has crowded out private insurers. Finally, based on simulations under selected state Medicaid programs, I find significant variation both across states and through time in the ability of these programs to improve birthweights. The most cost-effective programs generally maintain high rates of reimbursement but limit eligibility to avoid crowd-out. Examples include Georgia, Ohio, and Virginia in 1992. Given the variation in these programs, I conclude that future research must focus on the characteristics of state Medicaid programs, rather than assessing their overall effectiveness through aggregate measures such as coverage or eligibility.
Bibliography Citation
Trenholm, Christopher Allen. The Impact of Prenatal Medicaid Programs on the Health of Newborns. Ph.D. Dissertation, The University of North Carolina at Chapel Hill, 1997..