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Effects of Tennessee Medicaid managed care on obstetrical care and birth outcomes.
J Health Polit Policy Law. 2001 Dec; 26(6):1291-324.JH

Abstract

A comparative study was conducted in two neighboring states, Tennessee and North Carolina, to determine whether Medicaid managed care (implemented in Tennessee as TennCare) affected prenatal care, care patterns at labor-delivery, and birth outcomes. A pre- and post-design coupled with a difference-in-difference approach--using North Carolina as a control--was used to assess TennCare's effects for all births and for three categories of high-risk mothers (under age eighteen, unwed, or living in high poverty areas). Data from 328,296 singleton births in birth files and matched birth-death files for 1993 and 1995 in both states were used to analyze a number of variables related to maternal behavior during pregnancy, utilization of care before and after labor-delivery, patterns of obstetrical care at delivery, and birth outcomes. Under TennCare, Tennessee mothers were relatively more likely to obtain no prenatal care or to wait and initiate third trimester care as compared to those in North Carolina. Relative utilization of specific prenatal procedures declined, Apgar scores fell very slightly, and birth abnormalities increased in the poverty subsample. TennCare had no significant effect on infant mortality. Utilization reductions in obstetrical services were achieved with apparent spillovers to non-TennCare births, but without adverse effects overall. TennCare was neither a panacea nor an unmitigated disaster. It is a model worth examining, but not uncritically.

Authors+Show Affiliations

Center for Health Policy, Law and Management, Duke University, Durham, NC 27708, USA. conoverc@hpolicy.duke.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11831581

Citation

Conover, C J., et al. "Effects of Tennessee Medicaid Managed Care On Obstetrical Care and Birth Outcomes." Journal of Health Politics, Policy and Law, vol. 26, no. 6, 2001, pp. 1291-324.
Conover CJ, Rankin PJ, Sloan FA. Effects of Tennessee Medicaid managed care on obstetrical care and birth outcomes. J Health Polit Policy Law. 2001;26(6):1291-324.
Conover, C. J., Rankin, P. J., & Sloan, F. A. (2001). Effects of Tennessee Medicaid managed care on obstetrical care and birth outcomes. Journal of Health Politics, Policy and Law, 26(6), 1291-324.
Conover CJ, Rankin PJ, Sloan FA. Effects of Tennessee Medicaid Managed Care On Obstetrical Care and Birth Outcomes. J Health Polit Policy Law. 2001;26(6):1291-324. PubMed PMID: 11831581.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of Tennessee Medicaid managed care on obstetrical care and birth outcomes. AU - Conover,C J, AU - Rankin,P J, AU - Sloan,F A, PY - 2002/2/8/pubmed PY - 2002/2/12/medline PY - 2002/2/8/entrez SP - 1291 EP - 324 JF - Journal of health politics, policy and law JO - J Health Polit Policy Law VL - 26 IS - 6 N2 - A comparative study was conducted in two neighboring states, Tennessee and North Carolina, to determine whether Medicaid managed care (implemented in Tennessee as TennCare) affected prenatal care, care patterns at labor-delivery, and birth outcomes. A pre- and post-design coupled with a difference-in-difference approach--using North Carolina as a control--was used to assess TennCare's effects for all births and for three categories of high-risk mothers (under age eighteen, unwed, or living in high poverty areas). Data from 328,296 singleton births in birth files and matched birth-death files for 1993 and 1995 in both states were used to analyze a number of variables related to maternal behavior during pregnancy, utilization of care before and after labor-delivery, patterns of obstetrical care at delivery, and birth outcomes. Under TennCare, Tennessee mothers were relatively more likely to obtain no prenatal care or to wait and initiate third trimester care as compared to those in North Carolina. Relative utilization of specific prenatal procedures declined, Apgar scores fell very slightly, and birth abnormalities increased in the poverty subsample. TennCare had no significant effect on infant mortality. Utilization reductions in obstetrical services were achieved with apparent spillovers to non-TennCare births, but without adverse effects overall. TennCare was neither a panacea nor an unmitigated disaster. It is a model worth examining, but not uncritically. SN - 0361-6878 UR - https://www.unboundmedicine.com/medline/citation/11831581/Effects_of_Tennessee_Medicaid_managed_care_on_obstetrical_care_and_birth_outcomes_ L2 - https://read.dukeupress.edu/jhppl/article-lookup/doi/10.1215/03616878-26-6-1291 DB - PRIME DP - Unbound Medicine ER -