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Public Health Rep. 1995 May-Jun; 110(3): 319–326.
PMCID: PMC1382127

Do increases in payments for obstetrical deliveries affect prenatal care?

Abstract

Raising fees is one of the primary means that State Medicaid Programs employ to maintain provider participation. While a number of studies have sought to quantify the extent to which this policy retains or attracts providers, few have looked at the impact of these incentives on patients. In this study, the authors used Medicaid claims data to examine changes in volume and site of prenatal care among women who delivered babies after the Maryland Medicaid Program raised physicians fees for deliveries 200 percent at the end of its 1986 fiscal year. Although the State's intent was to stabilize the pool of nonhospital providers who were willing to deliver Medicaid babies, it was also hoped that women would benefit through greater access to prenatal care, especially care rendered in a nonhospital setting. The authors' hypotheses were that (a) the fee increase for obstetrical deliveries would result in an increase in prenatal visits by women on Medicaid, and (b) the fee increase would lead to a shift in prenatal visits from hospital to community based providers. The data for Maryland's Medicaid claims for the fiscal years 1985 through 1987 were used. Comparisons were made in the average number of prenatal visits and the ratio of hospital to nonhospital prenatal visits before and after the fee increase. Data for continuously enrolled women who delivered in the last 4 months of each fiscal year were analyzed for between and within year differences using Student's t-test and ANOVA techniques.(ABSTRACT TRUNCATED AT 250 WORDS)

Full text

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Fox MH, Phua KL. Pediatricians participating in Medicaid. JAMA. 1992 Dec 16;268(23):3314–3315. [PubMed]
  • Fox MH, Weiner JP, Phua K. Effect of Medicaid payment levels on access to obstetrical care. Health Aff (Millwood) 1992 Winter;11(4):150–161. [PubMed]
  • Hadley J. Physician participation in Medicaid: evidence from California. Health Serv Res. 1979 Winter;14(4):266–280. [PMC free article] [PubMed]
  • Gabel JR, Rice TH. Reducing public expenditures for physician services: the price of paying less. J Health Polit Policy Law. 1985 Winter;9(4):595–609. [PubMed]
  • Fossett JW, Peterson JA. Physician supply and Medicaid participation. The causes of market failure. Med Care. 1989 Apr;27(4):386–396. [PubMed]
  • Strobino DM, Chase GA, Kim YJ, Crawley BE, Salim JH, Baruffi G. The impact of the Mississippi Improved Child Health Project on prenatal care and low birthweight. Am J Public Health. 1986 Mar;76(3):274–278. [PubMed]
  • Buescher PA, Roth MS, Williams D, Goforth CM. An evaluation of the impact of maternity care coordination on Medicaid birth outcomes in North Carolina. Am J Public Health. 1991 Dec;81(12):1625–1629. [PubMed]
  • Cohen JW. Medicaid policy and the substitution of hospital outpatient care for physician care. Health Serv Res. 1989 Apr;24(1):33–66. [PMC free article] [PubMed]
  • Rosenbach ML. The impact of Medicaid on physician use by low-income children. Am J Public Health. 1989 Sep;79(9):1220–1226. [PubMed]
  • Fossett JW, Perloff JD, Kletke PR, Peterson JA. Medicaid patients' access to office-based obstetricians. J Health Care Poor Underserved. 1991 Spring;1(4):405–421. [PubMed]
  • Long SH, Settle RF, Stuart BC. Reimbursement and access to physicians' services under Medicaid. J Health Econ. 1986 Sep;5(3):236–251. [PubMed]
  • Krieger JW, Connell FA, LoGerfo JP. Medicaid prenatal care: a comparison of use and outcomes in fee-for-service and managed care. Am J Public Health. 1992 Feb;82(2):185–190. [PubMed]
  • Carey TS, Weis K, Homer C. Prepaid versus traditional Medicaid plans: lack of effect on pregnancy outcomes and prenatal care. Health Serv Res. 1991 Jun;26(2):165–181. [PMC free article] [PubMed]
  • Piper JM, Ray WA, Griffin MR. Effects of Medicaid eligibility expansion on prenatal care and pregnancy outcome in Tennessee. JAMA. 1990 Nov 7;264(17):2219–2223. [PubMed]
  • Buescher PA, Ward NI. A comparison of low birth weight among Medicaid patients of public health departments and other providers of prenatal care in North Carolina and Kentucky. Public Health Rep. 1992 Jan-Feb;107(1):54–59. [PMC free article] [PubMed]

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