208146 Medicaid managed care versus fee-for-service: Access and geographic barriers to prenatal care remain

Monday, November 9, 2009: 3:00 PM

Stephen Borders, PhD , School of Nonprofit and Public Administration, Grand Valley State University, Grand Rapids, MI
Craig H. Blakely, PhD , Department of Health Policy and Management, School of Rural Public Health, College Station, TX
Chuck Huber, PhD , Epidemiology & Biostatistics, Texas A&M HSC School of Rural Public Health, College Station, TX
Ramdas Menon, PhD , Center for Health Statistics, Texas Department of State Health Services, Austin, TX
Medicaid managed care (MMC) has become the dominant form of health care delivery, covering nearly 60% of Medicaid enrollees nationally. Yet, little conclusive evidence exists that indicates managed care either increases or decreases the number or use of preventive health services relative to Medicaid fee-for-service (FFS). This study compared prenatal care access among women in a five county MMC program home to the Beaumont-Port Arthur Metropolitan Statistical Area (MSA) and a similar Medicaid FFS area home to the Killen-Temple-Ft. Hood MSA. Using Texas Medicaid births records between 2000 and 2004, we assessed the adequacy of prenatal care as measured by the Kessner Index, timing of first prenatal care visit, number of prenatal care visits, and low birth weight rates. MMC mothers were more likely to receive adequate prenatal care (69.6% versus 50.9%, p<0.001) and to have received prenatal care from a private physician (75.87% versus 54.6%, p<0.001). All results remain significant after adjusting for mother's smoking, drinking or age <19 years as well as the setting of prenatal care. Despite having better access to care, MMC mothers were more likely to have low birth weight babies (<2500 grams) than those enrolled in FFS (8.3% versus 7.7%, p<0.005). Using geographic information systems (GIS), we also analyzed the spatial aspects of prenatal care access. Access barriers remain and deficiencies in prenatal care utilization are concentrated in specific areas and subpopulations. The findings indicate the importance in assessing potential policy and program options for reducing disparities in prenatal care access.

Learning Objectives:
1. Identify key factors associated with low prenatal care utilization in Medicaid managed care. 2. Describe how GIS and vital records data can be used to identify mothers at risk of low prenatal care utilization. 3. List how to apply GIS techniques to find solutions to public health problems and craft more effective policy.

Keywords: Access to Health Care, Prenatal Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have published a number of articles and technical reports in the area of access to health care services in Medicaid managed care.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.