A limited benefit-cost analysis of prenatal care controlling for self-selection.
Item
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Title
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A limited benefit-cost analysis of prenatal care controlling for self-selection.
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Identifier
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AAI9605608
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identifier
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9605608
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Creator
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Joyce, Geoffrey Fulton.
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Contributor
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Adviser: Michael Grossman
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Date
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1995
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Language
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English
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Publisher
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City University of New York.
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Subject
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Economics, General | Health Sciences, Public Health
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Abstract
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This study is a limited benefit-cost analysis of prenatal care. The dataset consists of vital statistic records linked to discharge abstracts of delivery and postnatal care for more than 47,000 mother/infant pairs. The sample consists of low income women predominantly covered by Medicaid who delivered at municipal hospitals in New York City between 1990-1992. I estimate the total effect of prenatal care on infant costs and hospital length of stay as well as the direct effects of care not operating through birth weight. Prenatal care is measured by a modified version of the Kotelchuck index. The index is amended by adding a fifth category for women who receive no care prior to delivery. The new index highlights the role of selection bias in the decision to seek care and yields dramatically different estimates of the effectiveness of care than the Kessner index.;I find the direct effects of care on infant costs are negligible when estimated by OLS. However, estimation by instrumental variable techniques and sample selection methodologies yield large and significant effects among blacks and Hispanics. Infants born to black and Hispanic women receiving no prenatal care have considerably higher costs and extended stays relative to mothers who receive adequate prenatal care. The effect of care remains positive and significant controlling for birth weight. Furthermore, I find strong evidence of adverse selection in the decision to seek care among women who receive the most intense prenatal services as well as those who abstain from care. The marginal benefits of providing additional care are largest for women who receive no prenatal services, but are positive and significant for women receiving inadequate or intermediate levels of care. This contrasts with previous work which finds small marginal benefits beyond a threshold level of services.
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Type
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dissertation
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Source
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PQT Legacy CUNY.xlsx
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degree
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Ph.D.
