Obstetric care and payment source: do low-risk Medicaid women get less care?

Dobie, Sharon A.; Hart, L. Gary; Fordyce, Meredith A.; Andrilla, C. Holly A.; Rosenblatt, Roger A.

doi:10.2105/ajph.88.1.51

Cited by 17 publications

(12 citation statements)

References 18 publications

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“…In another analysis using these data, there were few differences in the number of prenatal and intrapartum resources used by Medicaid and privately insured women. 26 Nonetheless, the current findings are consistent with a growing body of work showing that Medicaid patients or patients with demographic characteristics associated with Medicaid insurance status, such as being a racial or ethnic minority, are less likely to receive some medical advice, diagnostic tests, and therapeutic interventions than are their privately insured, white counterpartsP-3I This study is limited by several factors. First, our results are based on chart review.…”

Section: Discussionsupporting

confidence: 83%

Influence of Provider Characteristics and Insurance Status on Maternal Serum Alpha-Fetoprotein Screening

et al. 1998

The Journal of the American Board of Family Medicine

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Background:The maternal serum alpha-fetoprotein test (MSAFP) was developed to screen for neural tube defects. Little is known about the adoption of the MSAFP test. This study examines the effect of provider specialty and geographic location and patient insurance status on MSAFP test use in Washington State.Methods: We conducted a retrospective cohort study of MSAFP use in low-risk obstetric patients of five provider groups. MSAFP use was examined for Medicaid and privately insured patients, as well as for the patients of the five provider types.Results: Patients of urban and rural obstetrician-gynecologists were most likely to have MSAFP testing (80.4 percent and 77.0 percent, respectively); patients of urban certified nurse midwives and rural family physicians were least likely to have MSAFP testing (64.2 percent and 62.2 percent, respectively). Patients of certified nurse midwives were more likely to decline MSAFP testing when offered (26.1 percent). Medicaidinsured women were significantly less likely to have MSAFP testing than privately insured women (60.5 percent versus 79.1 percent, P::; 0.05).Conclusions: Providers and patients did not uniformly use MSAFP screening. Efforts should be made to ensure that all patients are adequately informed of screening tests for neural tube defects. (J Am Board Fam Pract 1998;11:357-65.)

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Section: Discussionsupporting

confidence: 83%

Influence of Provider Characteristics and Insurance Status on Maternal Serum Alpha-Fetoprotein Screening

et al. 1998

The Journal of the American Board of Family Medicine

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“…The two groups showed no significant differences in low birth weight or preterm birth rates. 19 Howell et al 20 compared obstetrical care and birth outcomes among four groups of women in California: short-term Medicaid enrollees (enrolled for 0-3 months of pregnancy), longterm Medicaid enrollees (enrolled for 4 or more months of pregnancy), non-Medicaid mothers living in low-income areas, and non-Medicaid mothers residing in high-income areas. Their findings revealed that Medicaid and non-Medicaid mothers residing in low-income areas had increased likelihood of receiving late prenatal care compared with mothers living in high-income areas.…”

Section: Resultsmentioning

confidence: 99%

Medicaid and Preterm Birth and Low Birth Weight: The Last Two Decades

Anum

Retchin

Strauss

2010

Journal of Women's Health

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Objectives: To determine if (1) birth outcomes among women on Medicaid differ significantly from outcomes of those with private insurance, after controlling for known risk factors, and (2) enhanced prenatal care influences care use and birth outcomes. Methods: This is a review of studies published between 1989 and 2009 that examined birth outcomes (1) between women on Medicaid and those with private insurance and (2) among Medicaid enrollees who received comprehensive prenatal care. Results: When corrected for risk variables, birth outcomes are not different between private insurance and Medicaid patients. The impact of comprehensive prenatal care programs on birth outcomes varies across states and regions. Conclusions: There is a need for critical evaluation of comprehensive programs in a regional and state context to determine opportunities for improvement.

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“…[12][13][14] In addition, studies have shown that social status impacts on prenatal behavior and birth outcomes. [15][16][17][18] We speculated that the adverse outcomes of NEC and sepsis are secondary to multiple factors and not just the fact that they have MMC. NEC and BS data suggest that there may be some alteration in neonatal immune status in the MMC population.…”

Section: Discussionmentioning

confidence: 99%