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Impact of Medicaid Managed Care, Race/Ethnicity, and Rural/Urban Residence on Avoidable Maternity Complications: A Five-State Multi-level Analysis
In the mid 1980s, Medicaid expanded pregnancy-related health care coverage. Substantially expanded coverage requirements were implemented in 1991; by 1992, nearly half of all women in the U.S. were eligible for Medicaid coverage for pregnancy-related expenses. Over the past decade, Medicaid managed care (MMC) has grown to be the primary form of service delivery within Medicaid: 57% of Medicaid recipients were enrolled in MMC in 2001, up from 10% in 1991. Effects of the introduction of MMC on pregnancy outcomes are unclear. Managed care may enhance care coordination, improving access and quality, particularly for minorities, however, managed care potentially provides incentives for under-provision of services.
This project will examine differences in access to care for pregnant women enrolled in MMC and Medicaid fee-for-service, and examine differences in the impact of MMC on access among rural and minority persons. To assess differences, we will use an indicator of access to primary and prenatal care. This indicator, the Potentially Avoidable Maternity Complications, uses hospital discharge data to identify pregnancy-related complications that may often be prevented through routine prenatal and primary care.
Publications
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Impact Of Medicaid Managed Care, Race/Ethnicity, and Rural/Urban Residence On Potentially Avoidable Maternity Complications: A Five-State Multi-Level Analysis
Author(s): Sarah B. Laditka, James N. Laditka, Kevin J. Bennett, Janice C. Probst
Date: 12 / 2004
Complications of pregnancy affect the lives of many women and infants. This study examines pregnancy-related complications using Potentially Avoidable Maternity Complications (PAMCs) as an indicator of access. Findings include: 1) Mothers delivering in rural hospitals had lower PAMC risks than those with urban deliveries.; 2) In rural hospitals, African American women had greater PAMC risks than white women.; and 3) In urban hospitals, adjusted PAMC risks were substantially lower for Hispanics and Asians than for whites.
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Racial and Ethnic Disparities in Potentially Avoidable Delivery Complications Among Pregnant Medicaid Beneficiaries in South Carolina
Author(s): Sarah Laditka, James Laditka, Janice C. Probst
Citation: Maternal and Child Health Journal, 10(4), 339-50
Date: 2006
Examined access to health care during pregnancy for mothers insured by Medicaid as well as the risks of potentially avoidable maternity complications among rural and urban hospital deliveries for groups of mothers defined by race or ethnicity. Within groups defined by race or ethnicity, unadjusted rates for potentially avoidable maternity complications did not differ significantly by hospital location. Holding other factors constant, potentially avoidable maternity complications were less common in rural hospitals than in urban hospitals. In rural hospitals, African Americans had notably higher risk for potentially avoidable maternity complications than did non-Hispanic whites. The authors conclude that providers and policymakers should work to reduce the risks of potentially avoidable maternity complications for African American women in rural areas who are insured by Medicaid.
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