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L Dubay

Publications and source records attributed to L Dubay.

17 recordsLinked to original sources
PubMed2001

Medical malpractice liability and its effect on prenatal care utilization and infant health.

In this paper we conduct the first national evaluation of the effect of malpractice liability pressure, as measured by malpractice premiums, on prenatal care utilization and infant health. Our results indicate that a decrease in malpractice premiums that would result from a feasible policy reform would lead to a decrease in the incidence of late prenatal care by between 3.0 and 5.9% for black women and between 2.2 and 4.7% for white women. Although, we found evidence that malpractice liability pressure was associated with greater prenatal care delay and fewer prenatal care visits, we did not find evidence that such pressure negatively affected infant health.

Black or African American↗
PubMed2001

Changes in prenatal care timing and low birth weight by race and socioeconomic status: implications for the Medicaid expansions for pregnant women.

OBJECTIVE: To conduct the first national study that assesses whether the Medicaid expansions for pregnant women, legislated by Congress over a decade ago, met the policy objectives of improved access to care and birth outcomes for poor and near-poor women. DATA SOURCES/STUDY SETTING: Data on 8.1 million births using the 1980, 1986, and 1993 National Natality Files. We use births from all areas of the United States except California, Texas, Washington, and upstate New York. METHODS: We conduct a before and after analysis that compares obstetrical outcomes by race and socioeconomic status for the periods 1980-86 and 1986-93. We examine whether women of low socioeconomic status showed greater improvements in outcomes during the 1986-93 period compared to the 1980-86 period. We analyze two obstetrical outcomes: the rate of late initiation of prenatal care and the rate of low birth weight. DATA COLLECTION: Natality data were aggregated to race, socioeconomic status, age, and parity groups. RESULTS: During the 1986-93 period, rates of late initiation of prenatal care decreased by 6.0 to 7.8 percentage points beyond changes estimated for the 1980-86 period for both white and African American women of low socioeconomic status. For some white women of low socioeconomic status, the rate of low birth weight was reduced by 0.26 to 0.37 percentage points between 1986 and 1993 relative to the earlier period. Other white women of low socioeconomic status and all African American women of low socioeconomic status showed no relative improvement in the rate of low birth weight during the 1986-93 period. CONCLUSIONS: The expansions in Medicaid lead to significant improvements in prenatal care utilization among women of low socioeconomic status. The emerging lesson from the Medicaid expansions, however, is that increased access to primary care is not adequate if the goal is to narrow the gap in newborn health between poor and nonpoor populations.

Adult↗
PubMed2000

Did the Medicaid expansions for children displace private insurance? An analysis using the SIPP.

Using data from the 1990 panel of the Survey of Income and Program Participation (SIPP), we address the question: Did the Medicaid expansions for children cause declines in private coverage? We use a multivariate approach that attributes a displacement effect to declines in private coverage for children targeted by the Medicaid expansions exceeding declines for a comparison group of older low-income children. We find that 23% of the movement from private coverage to Medicaid due to the expansions was attributable to displacement. There is no evidence of displacement among those starting uninsured, leading to an overall displacement effect of 4%.

Adolescent↗
PubMed2000

Assessing SCHIP effects using household survey data: promises and pitfalls.

OBJECTIVES: To describe how household surveys can be used to assess the effects of the new State Children's Health insurance Program (SCHIP) , review methodologic issues associated with household survey data, and propose solutions for dealing with these issues. PRINCIPAL FINDINGS: To estimate the effect of SCHIP, analysis must explicitly recognize and control for the fact that other factors that could affect the outcomes of interest besides the new program will change over the analysis period. In assessing SCHIP's effect, SCHIP-eligible children must be identified using a detailed simulation model. Analyses that use either a simple eligibility model or only examine children with incomes between 100 and 200 percent of poverty will not accurately identify SCHIP-eligible children. Under these circumstances estimates of the effect of SCHIP will be biased downward. In addition analyses must rely on the same survey in the pre- and post- SCHIP periods to obtain reliable estimates. Moreover, the survey must attempt to obtain data on separate SCHIP programs, and analysts must consider the implications of the possible increasing underreporting of public health insurance coverage. Finally, analysts should be cautious about evaluating SCHIP's success before the program is mature. CONCLUSION: While evaluating SCHIP using household surveys has some challenges, if conducted carefully such analyses will provide important in formation on the effect of the SCHIP program that can not be obtained elsewhere.

Child↗
PubMed1999

The impact of malpractice fears on cesarean section rates.

A longstanding issue in the health care industry is whether physicians' malpractice fears lead to defensive medicine. We use national birth certificate data from 1990 through 1992 to conduct a county fixed-effects analysis of the impact of malpractice claims risk on cesarean-section rates and infant health. Malpractice claims risk is measured by obstetricians' malpractice premiums. The study provides evidence that physicians practice defensive medicine in obstetrics but that the impact of increased cesarean sections that results from malpractice fears on total obstetric care costs is small. The study also finds that physicians' defensive response varies with the socioeconomic status of the mother.

Cesarean Section↗
PubMed1993

Explaining urban-rural differences in the use of skilled nursing facility benefit.

Recent closings of rural hospitals, anecdotal evidence of rural elderly persons having difficulty gaining access to health services, and the large and growing number of elderly persons living in rural areas has renewed concern about access to care for the rural elderly. In this study, 1987 Medicare skilled nursing Facility (SNF) bills were used to examine differences in urban and rural use of the SNF benefit. Using multivariate techniques, the analysis found that Medicare enrollees living in rural and large metropolitan areas used the SNF benefit at a rate 20% and 17% higher than enrollees living in small and medium-sized metropolitan areas, respectively. However, in rural areas the swing-bed program plays a major role in assuring access to the SNF benefit. Without the swing-bed program, rural enrollees would use the SNF benefit at a rate comparable to that of enrollees in small and medium-sized metropolitan areas. The importance of the swing-bed program cannot be underscored, because relative to urban enrollees, rural enrollees disproportionately live in nursing home markets that are not amenable to serving Medicare patients.

Aged↗
PubMed1975

New serotypes of Morganella morganii.

On the basis of 8 new O and 11 new H antigens determined in 22 strains, the Morganella morganii antigenic schema was supplemented with 8 serogroups (O35-O42) and 13 serotypes. Four strains belonged to O groups described earlier and 2 strains contained new O antigens in combination with known O antigens. Known H antigens were present in one strain as a single factor and in one strain as combination of two factors. New H antigens were demonstrated in 5 serotypes in combination with known H antigens. Six out of the 22 isolates were classified into O group 35. Two isolates contained different B-type surface antigens; these factors were not related to Escherichia coli B antigens and, unlike the latter, their living suspension gave a higher titre agglutination in OK serum as compared to the boild culture.

Adult↗
PubMedDate not supplied

Health care access and use among low-income children: who fares best?

In this paper we assess how access to care and use of services among low-income children vary by insurance status. Although 40 percent of low-income children rely on private health insurance, little is known about how this coverage compares with Medicaid coverage in meeting their health care needs. We find that Medicaid and privately insured low-income children appear to have fairly comparable access but that Medicaid-covered children are more likely to receive services and to have more visits when they receive care. Expanding public coverage may not be sufficient to ensure that all low-income children have access to comprehensive and high-quality care. It may require improvements in preventive and dental care for children with private coverage, an area in which states have limited influence.

Child↗