Newborn Survival and Health Insurance Have Direct Correlation

A newborn child’s chances of death or serious illness at birth are linked directly to whether its mother has health insurance, according to a new study that finds a dramatic rise in the number of uninsured mothers in California.

The study, said to be the first to document a long-suspected connection between lack of insurance and infant death and illness, found that the percentage of uninsured women giving birth in Northern California rose by 45 percent.

Uninsured babies were 30 percent more likely than insured babies to die or have serious medical problems, the study found. Blacks especially suffered: Uninsured black babies were more than twice as likely as insured blacks – and four times as likely as insured whites – to encounter problems.

“What’s very special about this study, and very sad about it, is that this is the first really large study that shows that lack of health insurance is associated with serious illness and death,” said Dr. Paula Braveman of the University of California, San Francisco, who headed the study, being published today in the New England Journal of Medicine.

In an editorial accompanying the study, two health policy experts contend the findings offer compelling proof of the need for universal health insurance which, they note, exists in every industrialized country except the United States and South Africa.

“To be born poor in this wealthy nation is to face more than one’s fair share of risk and illness,” conclude the authors of the editorial, Dr. Howard H. Hiatt, a professor at Harvard Medical School, and Dr. Donald M. Berwick of Harvard Community Health Plan.

The researchers trace their findings in part to a lack of preventive services and prenatal care among the uninsured. But they also suggest there may be differences in the hospital care given to insured and uninsured mothers and babies.

As for the recent rise in the number of uninsured mothers, the researchers blame population growth and cuts in employee benefits. They also cite the expansion of the service sector of the economy, in which workers historically have received lower medical coverage.

The long-term consequences of the neglect could not be measured, the researchers say.

“These sickly babies that have serious health problems as newborns are at high risk to never fully realize either their full physical development potential or their full intellectual potential,” Braveman said.

In the study, the researchers from the university and the San Francisco Department of Public Health examined records of more than 146,000 hospital births in the eight Northern California counties of San Francisco, Alameda, Contra Costa, San Mateo, Marin, Sonoma, Napa and Solano.

Braveman suggested that her findings are ominous: “If the consequences of lack of insurance are this severe among newborns – a group that is relatively popular politically and relatively inexpensive to provide care for – how much worse might the results be among even more neglected groups?” she asked.