Does Medicaid coverage change the prenatal health behaviors of pregnant women?

Even though the use of prenatal care has increased as Medicaid coverage has expanded during the last two decades, infant health is not improving as expected. Between 1990 and 2010, the share of births in the US covered by Medicaid increased from 28 percent to 44 percent. Lawmakers expanded Medicaid coverage to make prenatal care more accessible to disadvantaged pregnant women. In turn, this expansion should have improved infant health. However, the expansion produced unexpected results. Women who gain health insurance may not necessarily behave in a way that benefits their own and their infants’ health.

Economic theory suggests three main effects of gaining health insurance coverage on health behaviors. First, gaining insurance increases risky behaviors during pregnancy. Insurance reduces the price of care, and thus the costs of illness. What’s more, since the government provides insurance, pregnant women no longer have to purchase their own insurance. However, women may buy more risky goods with the saved money, like cigarettes, instead of goods improving infant health, like prenatal and perinatal nutrition. Last, since Medicaid coverage increases women’s contact with health providers, women may improve their health behavior as a consequence of new medical appointments.

Dave et al. examine the above impacts of Medicaid eligibility expansions on the prenatal behaviors and health indicators of pregnant women. Researchers find some suggestive evidence of increased risky behaviors. Expansion results in more cases of gestational diabetes. The increase may partly reflect changes in women’s behavioral pathways. Estimates from their study indicate that expansions in Medicaid eligibility lead to more harmful purchases. Women covered by the Medicaid expansion smoke more and gain less weight during pregnancy. Lastly, there is no evidence suggesting that women adopt healthier behaviors resulting from greater contact with health care providers. In other words, Medicaid expansion leads to negative consumption but does not improve women’s healthy behaviors.

Additionally, their study identifies a heterogeneous effect of the Medicaid coverage expansion. Among the population they study, the lowest-educated, single mothers have the highest Medicaid take-up rates. Medicaid coverage affects these mothers more. The lowest-educated, single mothers smoke more, relative to other mothers in general.

The study provides convincing empirical evidence of why Medicaid expansions haven’t resulted in substantial improvements in infant health. It also shows that Medicaid eligibility expansions may have unintended consequences. Mothers may reduce prevention efforts and increase riskier and less healthy behaviors. These results highlight the importance of providing incentives to maintain prevention efforts, for instance by encouraging visits to the doctor, removing cost-sharing for preventive care, or capitalizing on the patient-physician contact, to probe and encourage healthy behaviors.

Article Source: Does Medicaid coverage for pregnant women affect prenatal health behaviors? Dave et al., National Bureau of Economic Research, Working Paper # 21049, March 2015.

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