Primary care case management and birth outcomes in the Iowa Medicaid program.
OBJECTIVE
This study compares prenatal care utilization and birth outcomes between Iowa Medicaid recipients receiving care in a primary care case management (PCCM) system and those receiving care in a fee-for-service (FFS) system.


METHODS
Birth certificates linked with Medicaid hospitalization claims were analyzed for seven PCCM and seven FFS counties.


RESULTS
From 1989 through 1992, there was (1) a 20% increase in the number of women who received adequate prenatal care in the FFS counties, vs a 5% increase in the PCCM counties; (2) a 17% increase in the number of women who initiated care within the first trimester in the FFS counties, vs a 6% increase in the PCCM counties; and (3) a 442% increase in the number of women who received enhanced prenatal services in the FFS counties, vs a 278% increase in the PCCM counties. There were no significant differences between groups in mean gestational age or birthweight; however, there was an increase of very-low-birthweight babies in both groups.


CONCLUSIONS
PCCM, as implemented by the Iowa Medicaid program, has not appreciably improved prenatal care utilization or birth outcomes.
Schulman
E D
ED
University of Kentucky, Lexington 40536-0003, USA.
Sheriff
D J
DJ
Momany
E T
ET
D019090:Case Management / Q000458:organization & administration*; D018588:Fee-for-Service Plans / Q000458:organization & administration*; D005260:Female; D006302:Health Services Research; D006801:Humans; D007484:Iowa; D008137:Longitudinal Studies; D008484:Medicaid; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D014481:United States