Newcomer WE, Cox RL; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented By: Wendy E. Newcomer, PH.D., R.N., M.P.H., Assistant Professor, University of Maryland, School of Nursing, 655 W. Lombard St., Baltimore, MD 21201. Tel: (W) 410-706-3449 (H) 410-662-0905; Fax: 410-706-0253; E-mail: newcomer@son.umaryland.edu.
Research Objective: Was there a difference in the satisfaction with prenatal care, utilization of prenatal care, content of care and perceived barriers to care among Maryland women enrolled in Medicaid managed care compared to women enrolled in other managed care plans?Study Design: A descriptive/comparative study design was used. The conceptual framework was Donabedian's quality assessment framework. Women, recruited after delivery in 4 different regions of Maryland, completed a survey and consented to a medical record review. The survey instrument included the Consumer Assessment of Health Plans Survey (CAHPSTM), items assessing the intendedness of pregnancy, characteristics of the mother, and infant care, and the "A Better Start" (ABS) survey instrument to measure perceptions of barriers to prenatal care. The review of the medical record assessed the utilization of prenatal care measured by the Adequacy of Prenatal Care Utilization Index and the content of prenatal care services measured by the Content and Quality of Prenatal Care Measure (CQPM). Group differences were examined using bivariate analysis techniques. Regression analyses were used to explore study outcomes that differed significantly by insurer.Population Studied: Maryland women in managed care plans who received prenatal care in 1998 and 1999.Principal Findings: Of the 314 (76.2% response rate) women in the sample 163 (52%) had Medicaid managed care and 151 (48%) had a commercial managed care plan as their insurer. The groups differed significantly on most demographic variables however, there was no significant difference in overall satisfaction with their prenatal care provider or health insurance plan. Women in Medicaid managed care were more likely to not have one person they considered their prenatal care provider (OR = 0.03). Respondents in the Medicaid managed care group were less able to get the care they thought they needed (p<.001) and more dissatisfied with paperwork and handling of approvals and payments (p<.001). The Medicaid managed care group had markedly less utilization of prenatal care. Those with commercial managed care were 10 times more likely to enter care earlier and 6 times more likely to receive an adequate number of visits. The number one perceived barrier for both groups was no health insurance followed by no child care or transportation. The content of care did not differ between the Medicaid or commercial managed care groups. Although not a focus of this study, 70% of women in the Medicaid managed care group did not intend their current pregnancy compared to 30% in the commercial managed care group.Conclusions: Although some of the study findings were reassuring, there were other findings that identified areas of concern. The ability to get needed care and have one person who is the prenatal care provider, and the intendedness of pregnancy are key to improving perinatal outcomes.Implications for Policy, Delivery or Practice: As health care systems undergo reorganization in structure and financing it is important to monitor the care received by vulnerable populations. This study is a first step toward comparing the experiences of pregnant women in Medicaid and commercial managed care health plans in Maryland. Primary Funding Source: The Maryland Commission on Infant Mortality Prevention
Publication Types:
Keywords:
- Child
- Data Collection
- Female
- Health Services Needs and Demand
- Humans
- Infant
- Insurance Carriers
- Insurance, Health
- Managed Care Programs
- Maryland
- Medicaid
- Outcome Assessment (Health Care)
- Population Groups
- Pregnancy
- Prenatal Care
- economics
- utilization
- hsrmtgs
Other ID:
UI: 102272528
From Meeting Abstracts