Dissertations, Theses, and Capstone Projects

Date of Degree


Document Type


Degree Name





Sanders Korenman

Committee Members

Sherry Glied

Michael Grossman

Dahlia Remler

Subject Categories



National measures of infant health in the 1990s were flat, but rates of low birth weight and preterm birth among blacks, especially in center cities, improved. Health gains were especially marked in Washington, DC. Analysis at the metropolitan area level reveals that center city-suburban gaps in black infant health declined. The first two chapters of this dissertation use the 1990-2001 National Center for Health Statistics (NCHS) Natality Files to examine improvements in infant health among African-Americans, first, in Washington, DC, and second, in 37 metropolitan areas with large black populations.

Although Washington, DC also experienced substantial, above-average reductions in its non-marital and teen birth ratios, changes in the sociodemographic profile (age, marital status, education, parity) of mothers in the District of Columbia contributed little, if anything, to black infant health gains in the 1990s. Instead, a steep decline in prenatal smoking is the most important, identifiable cause of improved infant health, though we cannot distinguish between the effects of declines in measured tobacco use and unmeasured crack use. These findings are applicable to black trends in center city and suburban infant health and spatial health disparities in a broad sample of metropolitan areas, as well. Decomposition analysis using 1990 and 2000 Census data reveals that changes in age-specific fertility rates and within-age rates of low birth weight and preterm birth explain more of the change in spatial inequality than changes in age-related population composition.

Chapter 3 departs from the area of infant health, focusing instead on methodological issues related to estimating the costs of expanding Medicaid through increased eligibility or simplification of enrollment and recertification procedures. Many estimates extrapolate from the per-enrollee costs of current Medicaid beneficiaries. We use month-to-month health insurance transitions, expenditures, and service utilization patterns for adults in the 1996-2003 Medical Expenditure Panel Survey (MEPS) to show that individuals who enroll in Medicaid and maintain coverage today have greater health needs than those with unstable or no Medicaid coverage. These results suggest that ignoring the adverse selection of current Medicaid enrollees will lead to overestimates of the per-enrollee costs of expanding eligibility or increasing take-up.


Digital reproduction from the UMI microform.

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