Impact of medicaid managed care on utilization of obstetric care: evidence from TennCare's early years.
BACKGROUND
TennCare expanded Medicaid coverage, substituting managed care for fee-for-service reimbursement in Tennessee.


METHODS
To study effects of TennCare on utilization of obstetric care (office visits, prenatal tests, care at labor/delivery), we used a before (1993) and after (1995) design with North Carolina as a control state. Data came from interviews with women with various forms of insurance, delivering in 1993 or 1995 in both states. Multivariate logistic analysis was used to control for other utilization determinants (eg, demographic factors).


RESULTS
TennCare women were only 38% as likely to have initiated prenatal care during the first trimester as those with traditional Medicaid. Ultrasonography and alpha-fetoprotein testing rates were higher for TennCare women, and the cesarean section rate was equivalent. However, access to care remained lower for TennCare than for the privately insured women.


CONCLUSIONS
Overall, relative to traditional Medicaid, TennCare did not adversely affect access to obstetric care during the program's early years.
Center for Health Policy, Law and Management, Duke University, Durham, NC 27708, USA.
Frank A
FA
Sloan
Christopher J
CJ
Conover
May Ling
ML
Mah
Peter J
PJ
Rankin
D000328:Adult; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008484:Medicaid / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D009774:Obstetrics / Q000706:statistics & numerical data*; D009819:Office Visits / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012959:Socioeconomic Factors; D013714:Tennessee