Outcomes of enhanced prenatal services for Medicaid-eligible women in public and private settings.
OBJECTIVE
With changes in Medicaid, more low-income women are receiving prenatal care in private practice settings. The authors sought to determine whether private settings can provide the enhanced prenatal support services for low-income women that have been offered for decades in public settings.


METHODS
The authors analyzed birth outcomes of Medicaid-eligible women receiving care from public and private providers certified to deliver enhanced prenatal care services, which included assessments of nutritional, psychosocial, and health educational risks and individualized counseling along with clinical care. Birth outcomes were compared by type of provider setting using multivariate logistic regression models to adjust for differences in risks and use of care.


RESULTS
Among settings certified to deliver enhanced perinatal support services, private physicians' offices had the best risk-adjusted birth outcomes and public health department clinics the worst, while public hospital clinics had outcomes no different from private physicians' offices. Adjusted for prenatal care use, outcomes were still better for women seen in private physicians' offices than for women seen in public health department clinics, community clinics, or private hospital clinics.


CONCLUSIONS
The findings suggest that given a certification process, private providers can provide enhanced support services as effectively as providers in public practice settings.
Simpson
L
L
Institute for Health Policy Studies, University of California, School of Medicine, San Francisco 94109, USA.
Korenbrot
C
C
Greene
J
J
D000554:Ambulatory Care Facilities; D003625:Data Collection; D005260:Female; D006801:Humans; D006278:Medicare; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D011787:Quality of Health Care; D014481:United States