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

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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.

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The Puerto Rico Health Services Research Institute (PRHSI) was established in October 2003, to develop and enhance the capacity to conduct health services research in the Department of Health Services Administration (DHSA) and the Puerto Rico School of Public Health (SPH) at the University of Puerto Rico Medical Sciences Campus. The PRHSI is funded by the Agency for Healthcare Research and Quality (AHRQ) as a Minority Research Infrastructure Support Program (M-RISP). The study was supported by AHRQ Grant #1 R24 HS014060-01. Also, this investigation was in part supported by an RCMI clinical research infrastructure initiative (RCRII), award 1P20 RR11126, from the National Center for Research Resources (NCRR), National Institutes of Health.

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Correspondence to Heriberto A. Marín.

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Marín, H.A., Ramírez, R., Wise, P.H. et al. The Effect of Medicaid Managed Care on Prenatal Care: The Case of Puerto Rico. Matern Child Health J 13, 187–197 (2009).

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