This research attempts to close an important gap in health economics regarding the efficacy of prenatal care and policies designed to improve access to that care, such as Medicaid. We argue that a key beneficiary-- the mother-- has been left completely out of the analysis. If prenatal care significantly improves the health of the mother, then concluding that prenatal care is 'ineffective' or that the Medicaid expansions are a 'failure' is premature. This paper seeks to rectify the oversight by estimating the impact of prenatal care on maternal health and the associated cost savings. We first set up a joint maternal-infant health production framework that informs our empirical analysis. Using data from the National Maternal and Infant Health Survey, we estimate the effects of prenatal care on several different measures of maternal health such as body weight status and excessive hospitalizations. Our results suggest that receiving timely and adequate prenatal care may increase the probability of maintaining a healthy weight after the birth and, perhaps for blacks, of avoiding a lengthy hospitalization after the delivery. Given the costs to society of obesity and hospitalization, these are benefits worth exploring before making conclusions about the effectiveness of prenatal care-- and Medicaid.

We compared the graft survival and accumulative costs associated with sepsis and pneumonia pre-and post-transplantation. We analyzed 44 916 first kidney transplants from 1995 to 2001 USRDS where Medicare was the primary payer. We drew five cohorts for each disease from the baseline population: patients who had a disease onset in the first or second years pre-transplantation (cohorts 1 and 2) or post-transplantation (cohorts 3 and 4) and patients who were disease-free (cohort 5). For each cohort, we calculated graft survival and average accumulated Medicare payments (AAMPs) for the two pre-and post-transplantation years. Graft survival: new-onset sepsis and pneumonia both significantly (p<0.01) lowered graft survival during the year of onset. AAMPs: the AAMPs incurred by sepsis-(pneumonia-) free patients during the first and second years post-transplantation were $50 000 and 13 000 ($51 100 and 13 500), respectively. Patients with a sepsis (pneumonia) onset post-transplantation cost on average $48 400 ($38 400) extra (p<0.01). Episodes of sepsis and pneumonia have a strong and independent impact on graft survival and costs.

Although tacrolimus is being used with increasing frequency, analyses of the USRDS data show no net advantage in the ultimate transplantation outcome, graft survival. Given the higher acquisition price of tacrolimus compared to CsA and the similar risk of graft failure, further studies should be conducted to define those patient groups for which tacrolimus might be cost-effective.

During the conflict in Vietnam, married men with dependents could obtain a deferment from the draft. In 1965, following President Johnson's Executive Order 11241 and a subsequent Selective Service System announcement, the particulars of this policy changed substantially in a way which provided strong incentives for childless American couples to conceive a first-born child. This study examines the effects of the intervention on the decision to start a family. In my empirical analysis, I use data from the Vital Statistics for the period 1963-1968 and employ a difference-in-differences methodology. The estimated magnitude of the effect is substantial.

No abstract