The effect of a Medicaid managed care program on the adequacy of prenatal care utilization in Rhode Island.
OBJECTIVE
The purpose of this study was to determine whether adequacy of prenatal care utilization improved after the implementation of a Medicaid managed care program in Rhode Island.


METHODS
Rhode Island birth certificate data (1993-1995; n = 37021) were used to analyze pre- and post-program implementation changes in adequacy of prenatal care utilization. Logistic regression models were used to characterize the variation in prenatal care adequacy as a function of both time and the various covariates.


RESULTS
Adequacy of prenatal care utilization for Medicaid patients improved significantly after implementation of the program, from 57.1% to 62.1% (odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.1, 1.3). After the program was implemented, Medicaid patients who went to private physicians' offices for prenatal care were 1.4 times as likely as before to receive adequate prenatal care (OR = 1.4, 95% CI = 1.2, 1.7).


CONCLUSIONS
Unlike many other Medicaid expansions for pregnant women, the RIte Care program in Rhode Island has resulted in significant improvement in adequacy of prenatal care utilization for its enrollees. This improvement was due to specific program interventions that addressed and changed organizational and delivery system barriers to care.
Griffin
J F
JF
MCH Evaluation, Inc, Barrington, RI 02806, USA. jane_griffin@brown.edu
Hogan
J W
JW
Buechner
J S
JS
Leddy
T M
TM
D000293:Adolescent; D000328:Adult; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data* / Q000639:trends; D006302:Health Services Research; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration* / Q000592:standards; D008484:Medicaid / Q000458:organization & administration*; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D015397:Program Evaluation; D012237:Rhode Island; D013221:State Health Plans / Q000592:standards; D014481:United States