
                         Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: WEDNESDAY, July 7, 1993                   TAG: 9307070042
SECTION: NATIONAL/INTERNATIONAL                    PAGE: A-9   EDITION: METRO 
SOURCE: Associated Press
DATELINE: CHICAGO                                LENGTH: Medium

INSURANCE MIGHT NOT BE CURE-ALL FOR POOR PREGNANT WOMEN

Giving poor pregnant women health insurance might not improve their health and might increase the percentage undergoing Caesarean sections, a study found.

Researchers studied mothers who had babies in Massachusetts hospitals in 1984 and 1987, before and after the state enacted its Healthy Start program in 1985. Healthy Start covers uninsured pregnant women ineligible for Medicaid because their incomes are slightly too high.

The study measured maternal health by looking at pregnancy-related high blood pressure, premature detachment of the placenta and a mother's hospital stay at least one day longer than her baby's.

The study compared uninsured women and women with private insurance and found that, in 1984, uninsured women had higher complication rates - 5.5 percent vs. 5.1 percent - and lower rates of Caesarean sections - 17.2 percent vs. 23.0 percent.

In 1987, the study compared Healthy Start mothers and privately insured mothers. Complication rates remained unchanged, but Caesarean rates had risen to 22.4 percent for Healthy Start mothers and 25.9 percent for the privately insured women.

Researchers said the drop of 2.3 percentage points in the difference in Caesarean rates for uninsured and insured women suggests that the method of payment helps determine whether or not they undergo Caesareans.

The researchers, led by Dr. Jennifer S. Haas of Harvard-affiliated Brigham and Women's Hospital, reported their findings in today's Journal of the American Medical Association.

The data did not reveal whether the Healthy Start women needed more Caesareans, or whether the higher rate was excessive.

No more than 12 percent of all births should be Caesarean, consumer health advocates say.

Haas said Tuesday that Healthy Start needs further study and noted that the program was only a year old in her study.

The apparent failure of Healthy Start to improve the medical status of poor pregnant women from 1984 to 1987 could indicate that insurance alone isn't enough, she said. Other problems, such as lack of transportation or day care might also play a part, she said.

by CNB