The Effect of Health Coverage on Use of Cesarean Section-Reply

Jennifer S. Haas, MD, MSPH; I. Steven Udvarhelyi, MD, MS; Arnold M. Epstein, MD, MA
JAMA. 1993;270(20):2435. doi:10.1001/jama.1993.03510200040022.
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In Reply.  —We agree with Dr Waszak that cesarean sections are frequently performed for fetal indications. Although our article reports on the effect of coverage for uninsured pregnant women on maternal health status and the use of cesarean section, we had previously reported that expanded health coverage was not associated with improved rates of low birth weight or prematurity.1We recognize that our data do not permit us to examine the appropriateness of the observed increase in cesarean sections. Nevertheless, our article adds to a growing body of literature that suggests that insurance status may be a determinant of cesarean section use independent of clinical circumstance.2-4 Further study will be needed to examine prospectively the appropriateness of cesarean section use.Prior studies on the impact of expanded health coverage for low-income pregnant woman have focused solely on infant health outcomes. Our study was intended to be an initial


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