Uninsured Babies Get Reduced Care : Medicine: Seriously ill newborns with no coverage receive fewer tests than those who are insured, researchers find.


A study of seriously ill newborn babies in California has found “a consistent pattern” of uninsured newborns receiving fewer medical tests and procedures than those covered by insurance, even when their medical problems were comparable.

Moreover, the uninsured babies were discharged from the hospital after an average stay of 13.2 days, while privately insured babies stayed an average of 15.7 days. Sick newborns insured by the state’s Medi-Cal insurance program for the poor, which pays significantly less than private insurers, stayed an average of 14.8 days.

The findings, by researchers at UC San Francisco, are reported in today’s Journal of the American Medical Assn. Although many studies have documented difficulties encountered by the uninsured in obtaining basic outpatient medical care, the UC San Francisco study suggests that the lack of health-care coverage also affects the quality of hospital care.

“I think that we are now seeing that uninsured patients in hospitals are getting less care,” said E. Richard Brown, a professor of public health at UCLA who has authored studies on the growing number of uninsured Californians and the barriers to their receiving health care.


The effect of early discharge and reduced hospital services, Brown said, is that uninsured babies probably leave the hospital “at higher risk . . . because their medical conditions may not be as stable as a privately insured baby at the time of discharge.”

The UC San Francisco team did not document the health of these babies once they left the hospital, according to Dr. Paula Braveman, lead author on the study, undertaken with colleagues from the UC San Francisco Department of Family and Community Medicine. But the disparity in treatment, Braveman wrote in JAMA, represents “evidence of serious inequity and suggests the need for intensive and systematic public surveillance of the pressures on institutions, providers and patients under current health-care financing systems.”

The study was based on a survey of 23,810 sick newborns who stayed six or more days during 1987 at acute care hospitals in California.

Researchers ruled out discrimination on the basis of race or ethnicity, or other factors specific to the infant. The pattern of more medical services for privately insured newborns did not vary among nonprofit, for-profit and public hospitals, although the gap was slightly wider at for-profit hospitals.


The study grew out of a 1989 survey, also by Braveman and UC San Francisco colleagues, showing that babies born to uninsured mothers in the San Francisco area were more likely to have serious medical problems than babies of insured mothers, who presumably were under regular medical supervision during their pregnancies.

Nevertheless, she says she was surprised by what she found in her latest study.

“The feeling among most people, and I include myself, was that once (patients) got in the hospital, they got good care even if they didn’t have insurance,” Braveman said. She added that this expectation was particularly true regarding sick newborns.

Braveman and co-authors Susan Egerter, Trude Bennett and Jonathan Showstack compared babies insured by private indemnity or prepaid HMO insurance plans against babies covered by the state’s Medi-Cal program and those without insurance.


In general, babies covered by Medi-Cal, which pays hospitals considerably less than private insurers, received “an intermediate level of services"--more than the uninsured but significantly less than the privately insured babies. The level of service was measured by the amount the patient’s family was charged for each stay.

For example, average total charges for each uninsured baby were $4,485, or 28% less than for comparable privately insured babies. Medi-Cal-insured babies received 18% less in hospital care, reflected in charges $2,444 lower than the average billed to privately insured patients.

Newborns covered by prepaid plans and those with indemnity insurance showed no significant differences in care or length of stay. Indemnity plans pay per procedure; prepaid plans generally pay a negotiated sum on the basis of the patient’s diagnosis, thus discouraging expenditures on unnecessary tests and procedures.

The researchers found the greatest disparities in care at for-profit hospitals. Total charges for the uninsured were 39% lower at for-profit hospitals, compared to 34% at county hospitals and 28% at nonprofit facilities.