title: Managed care does not lower costs but may result in poorer outcomes for patients with gestational diabetes.
abstract: OBJECTIVE
  Our purpose was to compare the costs of prenatal care and subsequent maternal and neonatal outcomes in patients with gestational diabetes cared for in an inner-city university hospital house staff clinic versus an inner-city managed care organization.
  
  
  METHODS
  A retrospective cohort study was conducted. The groups consisted of 115 patients with gestational diabetes who were cared for in a house staff clinic and a demographically similar group of 85 patients cared for in a neighborhood managed care organization. The groups were examined regarding baseline demographics, intensity of prenatal care, maternal and neonatal outcomes, and total cost of the provision of care.
  
  
  RESULTS
  There was no difference between groups in the total cost of maternal-infant care. A larger percentage of patients in the house staff group saw the physician frequently. In contrast, patients cared for in the managed care organization underwent more tests of fetal well-being. There was a greater rate of neonatal macrosomia in the managed care organization group compared with the house staff group.
  
  
  CONCLUSIONS
  Managed care does not decrease the cost of caring for patients with gestational diabetes but does lead to a greater rate of neonatal macrosomia, which may reflect poorer glucose control.
authors.affiliation: Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Bienstock
authors.forename: K J
authors.initials: KJ
authors.lastname: Blakemore
authors.forename: E
authors.initials: E
authors.lastname: Wang
authors.forename: D
authors.initials: D
authors.lastname: Presser
authors.forename: D
authors.initials: D
authors.lastname: Misra
authors.forename: E K
authors.initials: EK
authors.lastname: Pressman
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008329:Managed Care Programs; D011247:Pregnancy; D011295:Prenatal Care; D012189:Retrospective Studies