 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
E. Kathleen Adams, PhD, Rollins School of Public Health, Emory University, 1518 Clifton Road, N.E., Atlanta, GA 30322, 404-727-9370, eadam01@sph.emory.edu, Norma I. Gavin, PhD, Health, Social and Economics Research, Research Triangle Institute, P.O. Box 12194, Research Triangle Park, NC 27709, and M. Beth Benedict, DrPH, JD, Office of Research, Development, and Information, Centers for Medicare and Medicaid Services, 7500 Security Blvd., Mail Stop: c3-19-07, Baltimore, MD 21244-1850.
Introduction: While Medicaid eligibility for low-income expanded through the 90’s stark differences in access to early/adequate prenatal care and birth outcomes across racial/ethnic groups remain.
Objectives: To examine differences in geographic dimensions of provider supply, usual source of care and effects of provider supply on preventive care among pregnant women with similar income levels and insurance coverage by race/ethnicity.
Method: Medicaid administrative data on pregnant women enrolled in Medicaid sometime during their pregnancy/delivery in 1995 in Florida (52,336), Georgia (51,247), Texas in 1997 (81,589), and New Jersey (32,455) were used to construct person-based files on utilization during pregnancy/delivery. County level data on physician/hospital supply, HMO penetration and service need as reflected by poverty were appended. Multivariate logit models controlling for demographics, enrollment characteristics and medical risk factors were estimated on: 1) early prenatal care; 2) early/adequate prenatal care (in GA and TX); and 3) prenatal care vitamins. Tests on the equivalence of models and individual coefficients across race were completed.
Results: Black non-Hispanic and Hispanic pregnant Medicaid women live in more urbanized areas with greater provider supply. Yet, in Florida and Texas, black non-Hispanics and in Florida, Hispanics were less likely to have an office as their usual source of prenatal care. In multivariate models, the effect of being in an urbanized area on use did not differ across racial groups except in Georgia where blacks had lower odds of early/adequate prenatal care. A greater supply of Obstetrical/Gynecologists (Ob/Gyns) differentially increased utilization primarily for Hispanics. A greater supply of foreign medical graduates differentially increased the odds of early prenatal care for Hispanics in Florida and early/adequate prenatal care for black non-Hispanics in Texas. Greater HMO penetration often had a negative effect but increased the odds of early/adequate prenatal care for Hispanics in Texas. While higher poverty levels were generally associated with lower odds of early or adequate prenatal care, Florida Medicaid women in these areas had higher odds of prenatal vitamins and these were even higher for Hispanics.
Conclusions: Disproportionate location of minority pregnant women on Medicaid in urban areas did not enhance their access to prenatal care. Furthermore, living in areas with more Ob/Gyns did not increase access for black women. A greater supply of foreign medical graduates, more likely to participate in Medicaid, increased access for minorities in some states. Higher poverty levels in areas in which minorities live further exacerbated access issues.
Learning Objectives:
Keywords: Access, Preventive Medicine
Presenting author's disclosure statement:
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.