Essays on Health, Health Care Utilization, and Public Insurance

Timothy Andrew Bersak, Clemson University


Inadequate prenatal care has long been associated with low birth weight as well as adverse health and economic outcomes. As such, public policy and public health interventions have focused on increasing access to prenatal care with the goal of increasing birth weight. Despite this focus, research has generally found little con-clusive evidence supporting a causal relationship between increased access to prenatal care and substantial gains in birth weight. A small but growing body of work suggests prenatal care may improve future health outcomes independently of birth weight by directly influencing a mother’s health or how she interacts with the health care sys-tem. In the first chapter of my dissertation, I use unique data combining all Medicaid financed births with all subsequent Medicaid claims in South Carolina between 2001 and 2012, to find that prenatal care increases the probability of an infant receiving routine well-child care and decreases the probability of requiring inpatient care within the first year of life. In spite of these findings, my results suggest that prenatal care has only a small, marginally significant impact on an infant’s birth weight I find that a portion of the causal mechanism through which prenatal care acts is by providing health knowledge and that prenatal care and formal education are substitutes in the production of health knowledge.

Although the impacts of prenatal care on birth weight and health outcomes at birth have been extensively studied, little is known about the long term impacts of prenatal care on prospective measures of health. In the second chapter of my dissertation, I restrict my data to include all Medicaid financed births between 2001 and 2007 and find that a mother’s utilization of prenatal care increases the probability of her child receiving treatment for an asthma-related diagnosis. Using a count model that allows for unobserved heterogeneity at the individual level, I find evidence that a mother’s usage of prenatal care increases the number of times her child receives primary care and does not impact the frequency with which resource intensive care is utilized for asthma-related conditions. These results suggest that prenatal care may be more likely to impact the prospective management, rather than the underlying presence or severity, of chronic health conditions.