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Medicaid Eligibility, Prenatal Care, and the Outcome of Pregnancy

Timothy J. Moore, MD, MS
JAMA. 1991;265(8):974. doi:10.1001/jama.1991.03460080044015.
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To the Editor. —  I read the recent article by Piper et al1 and the accompanying editorial by Guyer2 with much interest. Those of us who work in community health centers across the country have seen that financial barriers to prenatal services are not the primary reason a poorer prenatal outcome is observed in these underserved populations. While working in the community health center in Pueblo, Colo, a survey of teenage prenatal patients was done to evaluate the reason they delayed entry into care. Only 5% indentified finances as a barrier, while unknown resources, inconvenient time, and not understanding the importance of early care were named as reasons by 80% of the patients.In most communities, the health care system is so fragmented and disjointed that the providers cannot understand how the system works, much less the patients who need the services most! The multiple-funding sources each cover


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