Access to Care, Provider Choice, and the Infant Health Gradient

摘要

Children born to poor parents in the United States are more than twice as likely to die within the first year as those born to higher-income parents (Steven Gortmaker and Paul Wise, 1997). It has long been hypothesized that these differences are due, in part, to unequal access to care. In California in 1990, neonatal mortality rates for Medicaid births were 33 percent larger than for the privately insured and those with Medicaid were also 37 percent more likely to deliver in public hospitals than their privately insured neighbors. Differential use of providers may explain these differences in health if there are large differences across hospitals in the quality of care that affect infant health. The direct effect of hospital quality on health, however, is very difficult to measure (Mark McClel-lan and Douglas Staiger, 1999).