OBJECTIVES: To examine the relationship between timing of insurance coverage and prenatal care among low-income women. METHODS: Timeliness of prenatal care initiation and adequacy of number of visits were studied for 5027 low-income (<200% of poverty) participants in a larger cross-sectional statewide survey of postpartum women in California, 1994-1995. RESULTS: Although only 2% of low-income women remained uninsured throughout pregnancy, 26% of women whose principal prenatal payer was Medi-Cal were uninsured during the first trimester. Rates of untimely care were highest (65% or higher) among women who were uninsured throughout pregnancy or whose Medi-Cal or private coverage began after the first trimester, and lowest (about 10%) for women who obtained coverage during the first trimester. Women who first obtained Medi-Cal coverage during pregnancy appeared to be at low risk of having too few visits after initiating care. Findings were similar after control for sociodemographic charactistics and other potential barriers to care. CONCLUSIONS: Although most low-income women had coverage at some point during pregnancy, one in five lacked coverage during the first trimester when care initiation is recommended. These findings suggest the importance of considering the timing of prenatal coverage in studies of the relationship between coverage and care use among low-income women. Earlier studies that have relied solely on principal payer information, without data on when coverage began, may have led to inaccurate inferences about the importance of inability to pay as a barrier to prenatal care.
Learning Objectives: At the conclusion of the session, the participant will be able to: 1. Describe how timing of insurance coverage during pregnancy is associated with timeliness of prenatal care initiation and adequacy of number of prenatal visits among low-income women. 2. Recognize the importance of considering timing as well as type of prenatal insurance coverage when assessing the impact of policies affecting financial access to prenatal care
Keywords: Insurance-Related Barriers, Prenatal Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.