Skip to main content
NCBI home page
Health Services Research logoLink to Health Services Research
. 2001 Aug;36(4):751–771.

The long-term effects of Medicaid managed care on obstetrics care in three California counties.

M Tai-Seale 1, A T LoSasso 1, D A Freund 1, S E Gerber 1
PMCID: PMC1089255  PMID: 11508638

Abstract

OBJECTIVE: To evaluate the long-term effects of Medicaid managed care (MMC) on obstetric service use and program costs in California. DATA SOURCES/STUDY SETTING: Longitudinal administrative data on Medi-Cal enrollment and claims and encounters related to pregnancy and delivery services were gathered from three counties--two long-standing MMC counties and one traditional fee-for-service Medicaid county--in California between 1987 and 1992. STUDY DESIGN: We studied Aid to Families with Dependent Children (AFDC) beneficiaries with live singleton vaginal deliveries with associated hospital stays of 14 days or less. Effects of managed care were examined with respect to prenatal visits, length of stay for delivery, maternal postpartum readmission rates, and total program expenditures. Multivariate analyses examined how the relative effect of managed care on service use and program expenditures in each MMC county evolves over time in comparison to fee-for-service. We controlled for length of Medi-Cal enrollment prior to delivery, data censoring, and individual characteristics such as race and age. PRINCIPAL FINDINGS: Prenatal care use is consistently lower in the MMC counties, although all three counties' prenatal care provision is well below the national standard. Drastic increases in one-day-stay deliveries were found: up to almost 50 percent of deliveries in MMC counties were one-day stays. Program cost savings associated with MMC enrollment are unambiguous. CONCLUSIONS: MMC cost savings might have come at the expense of reduced provision of prenatal care and shorter delivery length of stay. Future studies should verify any possible causal link and the effects on maternal and infant health outcomes.

Full text

PDF
751

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Braveman P., Egerter S., Pearl M., Marchi K., Miller C. Problems associated with early discharge of newborn infants. Early discharge of newborns and mothers: a critical review of the literature. Pediatrics. 1995 Oct;96(4 Pt 1):716–726. [PubMed] [Google Scholar]
  2. Carey T. S., Weis K., Homer C. Prepaid versus traditional Medicaid plans: lack of effect on pregnancy outcomes and prenatal care. Health Serv Res. 1991 Jun;26(2):165–181. [PMC free article] [PubMed] [Google Scholar]
  3. Fowles J. B., Weiner J. P., Knutson D., Fowler E., Tucker A. M., Ireland M. Taking health status into account when setting capitation rates: a comparison of risk-adjustment methods. JAMA. 1996 Oct 23;276(16):1316–1321. [PubMed] [Google Scholar]
  4. Freund D. A., Hurley R. E., Paul J., Grubb C., Rossiter L. F., Adamache K. W. Interim findings from the Medicaid competition demonstrations. Adv Health Econ Health Serv Res. 1989;10:153–181. [PubMed] [Google Scholar]
  5. Freund D. A., Rossiter L. F., Fox P. D., Meyer J. A., Hurley R. E., Carey T. S., Paul J. E. Evaluation of the Medicaid competition demonstrations. Health Care Financ Rev. 1989 Winter;11(2):81–97. [PMC free article] [PubMed] [Google Scholar]
  6. Gazmararian J. A., Koplan J. P., Cogswell M. E., Bailey C. M., Davis N. A., Cutler C. M. Maternity experiences in a managed care organization. Health Aff (Millwood) 1997 May-Jun;16(3):198–208. doi: 10.1377/hlthaff.16.3.198. [DOI] [PubMed] [Google Scholar]
  7. Goldfarb N. I., Hillman A. L., Eisenberg J. M., Kelley M. A., Cohen A. V., Dellheim M. Impact of a mandatory Medicaid case management program on prenatal care and birth outcomes. A retrospective analysis. Med Care. 1991 Jan;29(1):64–71. doi: 10.1097/00005650-199101000-00006. [DOI] [PubMed] [Google Scholar]
  8. Hillman A. L. Commentary: burden of proof in an era of outcomes research and managed care. Health Serv Res. 1998 Apr;33(1):75–78. [PMC free article] [PubMed] [Google Scholar]
  9. Holahan J., Rangarajan S., Schirmer M. Medicaid managed care payment rates in 1998. Health Aff (Millwood) 1999 May-Jun;18(3):217–227. doi: 10.1377/hlthaff.18.3.217. [DOI] [PubMed] [Google Scholar]
  10. Krieger J. W., Connell F. A., LoGerfo J. P. Medicaid prenatal care: a comparison of use and outcomes in fee-for-service and managed care. Am J Public Health. 1992 Feb;82(2):185–190. doi: 10.2105/ajph.82.2.185. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Levinson A., Ullman F. Medicaid managed care and infant health. J Health Econ. 1998 Jun;17(3):351–368. doi: 10.1016/s0167-6296(97)00031-3. [DOI] [PubMed] [Google Scholar]
  12. Oleske D. M., Branca M. L., Schmidt J. B., Ferguson R., Linn E. S. A comparison of capitated and fee-for-service Medicaid reimbursement methods on pregnancy outcomes. Health Serv Res. 1998 Apr;33(1):55–73. [PMC free article] [PubMed] [Google Scholar]
  13. Weiner J. P., Starfield B. H., Steinwachs D. M., Mumford L. M. Development and application of a population-oriented measure of ambulatory care case-mix. Med Care. 1991 May;29(5):452–472. doi: 10.1097/00005650-199105000-00006. [DOI] [PubMed] [Google Scholar]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust

RESOURCES