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Susan Egerter, PhD, Paula Braveman, MD, MPH and Kristen Marchi, MPH

Susan Egerter and Kristen Marchi are with the Department of Family and Community Medicine, School of Medicine, University of California, San Francisco. Paula Braveman is with the Department of Family and Community Medicine and the Institute for Health Policy Studies, School of Medicine, University of California, San Francisco.

Correspondence: Requests for reprints should be sent to Susan Egerter, PhD, Department of Family and Community Medicine, University of California, San Francisco, Box 0900, San Francisco, CA 94143 (e-mail: hubbell{at}itsa.ucsf.edu).

Objectives. This study examined 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 among 5455 low-income participants in a larger cross-sectional statewide survey of postpartum women in California during 1994–1995.

Results. Although only 2% of women remained uninsured throughout pregnancy, one fifth lacked coverage during the first trimester. Rates of untimely care were highest (64%) among women who were uninsured throughout their pregnancy or whose coverage began after the first trimester; rates were lowest (about 10%) among women who obtained coverage during the first trimester. Women who first obtained Medi-Cal coverage during pregnancy were at low risk of having too few visits.

Conclusions. Timing of prenatal coverage should be considered in research on the relationship between coverage and care use among low-income women. Earlier studies that relied solely on principal payer information, without data on when coverage began, may have led to inaccurate inferences about lack of coverage as a barrier to prenatal care.

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				P. A. Braveman, S. A. Egerter, C. Cubbin, and K. S. Marchi An Approach to Studying Social Disparities in Health and Health Care Am J Public Health, December 1, 2004; 94(12): 2139 - 2148. [Abstract] [Full Text] [PDF]

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