Adequate prenatal care: A geospatial examination of economic and non-economic barriers to utilization in Medicaid managed care

Adequate prenatal care is often a prerequisite to a healthy baby. In an effort to address access problems while reducing costs, Medicaid managed care (MMC) has grown to become the dominant form of health care delivery, covering nearly 60% of Medicaid enrollees nationally. Despite the promises of MMC, specific subpopulations in Texas continue to receive inadequate prenatal care more than a decade after implementation. Yet access to adequate prenatal care is complicated by a number of socioeconomic factors related to the parents. These factors include education, ethnicity, insurance type, proximity to care (urban/rural), and age. Using geographic information systems (GIS), this study analyzed the spatial aspects of inadequate prenatal care access in the Travis (County) MMC service area, a seven county MMC program home to Austin, TX. Using vital statistics data on Medicaid births recorded in the Travis MMC service area between 2000 and 2004, a logistic regression model was employed to determine the significance of various independent variables associated with inadequate prenatal care access as measured by the Kessner Index. The data provide evidence that the proliferation of MMC does not assure adequate prenatal care use. An examination of the spatial distribution and relative severity of each predictor variable uncovered a number of proximal relationships. The study findings indicate deficiencies in prenatal care utilization concentrated in specific areas and subpopulations. Thus, the findings indicate the importance in assessing potential policy and program options for reducing differentials in prenatal care use to distinguish between economic and noneconomic barriers to utilization.