The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #64890

Linda Rudolph, MD, MPH¹, Renyi Liu, MA¹, and Wes Ingram, PhD². (1) Medi-Cal Managed Care Division, California Department of Health Services, 714 P Street, Rm 950, Sacramento, CA 95814, 916.651.9409, lrudolph@dhs.ca.gov, (2) Payment System Division, California Department of Health Services, California Department of Health Services, 3130 Kilgore Road, Suite 101, Rancho Cordova, CA 95670

This study evaluates the adequacy of utilization of prenatal care services received by California women who had a single live birth in 1999. The study seeks to investigate disparities in the quality and accessibility of the prenatal care services provided to Medi-Cal women versus privately insured women, and between the Medi-Cal women enrolled in Fee-for-service (FFS) versus Managed Care (MC). Adequacy of prenatal care utilization rates in women enrolled in different Medi-Cal MC health models are also assessed.

Data was extracted from the 1999 California Birth Certificate file and the 1998-99 Medi-Cal Eligibility Data System. The study sample included 428,079. The Kotelchuck Adequacy of Prenatal Care Utilization (APNCU) index was used to measure prenatal utilization rates. After controlling for maternal age, race, education, language, marital status, number of previous live births, and number of Medi-Cal providers per square mile in county of residence, we found Medi-Cal women were less likely to report adequate pre-natal care compared to privately insured women (odds ratio: 0.898). Medi-Cal women enrolled in MC program had 16.8 percent higher APNCU than FFS women. Among the Medi-Cal MC health models, the Commercial Plan (CP) model had higher rates of adequate prenatal care utilization; the odds ratios for LC, COHS and GMC compared to CP were 0.775, 0.809, and 0.892, respectively. Women who were older, married, with higher education, and with fewer previously born children were more likely to have adequate prenatal care utilization, after adjustment for all other factors. Higher density of providers per square mile also increased adequacy rates. The effects of mothers’ races and languages on APNCU were mixed in different logistic models.

While the MC program appears to improve prenatal care utilization for Medi-Cal women, Medi-Cal women enrollees are warranted. Medi-Cal MC health plans should be encouraged to implement effective interventions in addressing attitudinal and other barriers to adequate prenatal care utilization. The FFS Medi-Cal program should also explore methods to improve prenatal care utilization rates among its beneficiaries.

Learning Objectives:

• At the conclusion of the session, the participant in this session will be able to learn how disparities in the quality and accessibility of the prenatal care services vary between Medi-Cal women versus privately insured women, and between the Medi-Cal women enrolled in Fee-for-service versus Managed Care programs.

Keywords: Health Disparities, Prenatal Care

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: California Department of Health Services
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.