Managed care, well established as the predominant method of health care financing and delivery in the United States, is credited for cost containment and challenged as a possible threat to patient-centered care. Assessments of how managed care is experienced by maternity care providers have been lacking. This paper discusses the perceptions of certified nurse-midwives (CNMs), based on a national survey, on the impact of managed care on their ability to practice midwifery. Methods: The survey included closed-ended questions about the practice and clients of nurse-midwives and open-ended questions about their experiences in the changing health care environment. Surveys were mailed to 6,365 certified nurse-midwives residing in the U.S. in 1997; 2,530 (40%) returned surveys; of these 2,405 were available for analysis. Qualitative analysis was conducted using QSR NUD*IST software. Results: More than 1,340 CNMs reported serving clients covered by private or Medicaid managed care plans. One-third of the total respondents (N=721) discussed the impact of managed care and changing insurance policies in the qualitative portion of the questionnaire. Their experiences were grouped into five areas: a)the ability to practice at all in the managed care environment; b)the ability to serve certain client populations; c)reimbursement and administrative issues; d)the style of practice of the midwife, and e)changes in the services available to clients. The paper explores each of these areas in detail and discusses implications for professional education and the development of health care policies.
Learning Objectives: Learning Objectives: At the conclusion of this session the participant will be able to: 1. List five factors identified by nurse-midwives that impact their practice as a result of changes in health care organization and financing. 2. Describe the perceptions of nurse-midwives of the impact of managed care on their ability to provide care for the Medicaid population. 3. Discuss the implications of changes in health care organization and financing on the provision of woman-centered care in the future
Keywords: Access and Services, Managed Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.