The Effect of Medicaid Managed Care on Prenatal Care: The Case of Puerto Rico

  • Heriberto A. Marín
  • Roberto Ramírez
  • Paul H. Wise
  • Marisol Peña
  • Yelitza Sánchez
  • Roberto Torres
Article

DOI: 10.1007/s10995-008-0345-1

Cite this article as:
Marín, H.A., Ramírez, R., Wise, P.H. et al. Matern Child Health J (2009) 13: 187. doi:10.1007/s10995-008-0345-1

Abstract

Objectives From 1994 to the year 2000 the government of Puerto Rico implemented a health care reform which included the mandatory enrollment of the entire Medicaid eligible population under Medicaid managed care (MMC) plans. This study assessed the effect of MMC on the use, initiation, utilization, and adequacy of prenatal care services over the reform period. Methods Using the vital records of all infants born alive in Puerto Rico from the year 1995–2000, a series of bivariate and multivariate analyses were conducted to assess the effect of insurance status (traditional Medicaid, MMC, private insurance and uninsured) on prenatal care utilization patterns. In order to assess the potential influence of selection bias in generating the health insurance assignments, propensity scores (PS) were estimated and entered into the multivariate regressions. Results MMC had a generally positive effect on the frequency and adequacy of prenatal care when compared with the experience of women covered by traditional Medicaid. However, the PS analyses suggested that self-selection may have generated part of the observed beneficial effects. Also, MMC reduced but did not eliminate the gap in the amount and adequacy of prenatal care received by pregnant women covered by Medicaid when compared to their counterparts covered by private insurance. Conclusions The Puerto Rico Health Reform to implement MMC for pregnant women was associated with a general improvement in prenatal care utilization. However, continued progress will be necessary for women covered by Medicaid to reach prenatal care utilization levels experienced by privately insured women.

Keywords

Medicaid managed careHealth reformPregnant womenPrenatal careHealth insurance statusAdequacy of prenatal care

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Heriberto A. Marín
    • 1
    • 4
  • Roberto Ramírez
    • 1
  • Paul H. Wise
    • 2
  • Marisol Peña
    • 3
  • Yelitza Sánchez
    • 1
  • Roberto Torres
    • 1
  1. 1.Puerto Rico Health Services Research Institute (PRHSI), Graduate School of Public Health, Medical Sciences CampusUniversity of Puerto RicoSan JuanPuerto Rico
  2. 2.Center for Health Policy and Center for Primary Care and Outcome Research, Stanford School of MedicineStanford UniversityStanfordUSA
  3. 3.Graduate School of Public Health, Medical Sciences CampusUniversity of Puerto RicoSan JuanPuerto Rico
  4. 4.Escuela Graduada de Salud Publica, Recinto de Ciencias MédicasSan JuanPuerto Rico