Advertisement

Maternal and Child Health Journal

, Volume 23, Issue 2, pp 173–182 | Cite as

Oregon’s Expansion of Prenatal Care Improved Utilization Among Immigrant Women

  • Jonas J. SwartzEmail author
  • Jens Hainmueller
  • Duncan Lawrence
  • Maria I. Rodriguez
Article

Abstract

Objectives To determine whether expanding Emergency Medicaid to cover prenatal care in Oregon affected maternal health outcomes for unauthorized immigrants. Methods This study takes place in Oregon from 2003 to 2015 and includes all Emergency Medicaid and Medicaid claims for women aged 12–51 with a pregnancy related claim. To isolate the effect of expanding access to prenatal care, we utilized a difference-in-differences approach that exploits the staggered rollout of the prenatal care program. The primary outcome was a composite measure of severe maternal morbidity and mortality. Additional outcomes include adequacy of prenatal care, detection of pregnancy complications and birth outcomes. Results A total of 213,746 pregnancies were included, with 35,182 covered by Emergency Medicaid, 12,510 covered by Emergency Medicaid Plus (with prenatal care), and 166,054 covered by standard Medicaid. Emergency Medicaid Plus coverage did not affect severe maternal morbidity (all pregnancies 0.05%, CI − 0.29; 0.39; high-risk pregnancies 2.20%, CI − 0.47; 4.88). The program did reduce inadequate care among all pregnancies (− 31.75%, 95% CI − 34.47; − 29.02) and among high risk pregnancies (− 38.60%, CI − 44.17; − 33.02) and increased diagnosis of gestational diabetes (6.24%, CI 4.36; 8.13; high risk pregnancies 10.48%, CI 5.87; 15.08), and poor fetal growth (7.37%, CI 5.69; 9.05; high risk pregnancies 5.34%, CI 1.00; 9.68). The program also increased diagnosis of pre-existing diabetes mellitus (all pregnancies 2.93%, CI 2.16; 3.69), hypertensive diseases of pregnancy (all pregnancies 1.28%, CI 0.52; 2.04) and a history of preterm birth (all pregnancies 0.87%, CI 0.27; 1.47). Conclusions for Practice Oregon’s prenatal care expansion program produced positive effects for unauthorized immigrant women and their children.

Keywords

Unauthorized immigrants Emergency Medicaid CHIP Prenatal care Oregon 

Notes

Funding

This study was funded by a Grant from the Robert Wood Johnson Foundation for Drs. Hainmueller and Rodriguez, Grant 73792. The funder approved the project including design but then had no direct role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Dr. Rodriguez is a Women’s Reproductive Health Research fellow; Grant 1K12HD085809.

Supplementary material

10995_2018_2611_MOESM1_ESM.docx (169 kb)
Supplementary material 1 (DOCX 170 KB)

References

  1. AAA. (2012). Guidelines for perinatal care. American Academy of Pediatrics. American College of Obstetricians and Gynecologists (7th ed.). Washington, DC: Elk Grove Village (IL).Google Scholar
  2. ACOG Committee on Practice Bulletins. (2005). ACOG practice bulletin. Clinical Management guidelines for obstetrician-gynecologists. Number 60, March 2005. Pregestational diabetes mellitus. Obstetrics and Gynecology, 105(3), 675–685.CrossRefGoogle Scholar
  3. Angier, H., Gold, R., Crawford, C., O’Malley, J. P., Tillotson, C. J., Marino, M., & DeVoe, J. E. (2014). Linkage methods for connecting children with parents in electronic health record and state public health insurance data. Maternal and Child Health Journal, 18(9), 2025–2033.  https://doi.org/10.1007/s10995-014-1453-8.CrossRefGoogle Scholar
  4. Bauer, J., Angus, L., Fischler, N., Rosenberg, K. D., Gipson, T. F., & Devoe, J. (2011). The impact of citizenship documentation requirements on access to medicaid for pregnant women in Oregon. Maternal and Child Health Journal, 15(6), 753–758.  https://doi.org/10.1007/s10995-010-0632-5.CrossRefGoogle Scholar
  5. California Health Care Foundation. (2013). Medi-Cal facts and figures: A program transforms. Oakland: California Health Care Foundation. Retrieved from http://www.chcf.org/publications/2013/05/medical-facts-figures.
  6. Carroli, G., Rooney, C., & Villar, J. (2001). How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence. Paediatric and Perinatal Epidemiology, 15(s1), 1–42.CrossRefGoogle Scholar
  7. Committee on Practice Bulletins–Obstetrics. (2013). Practice bulletin no. 137: Gestational diabetes mellitus. Obstetrics and Gynecology, 122(2 Pt 1), 406–416.  https://doi.org/10.1097/01.AOG.0000433006.09219.f1.Google Scholar
  8. Dahlen, H. M., McCullough, J. M., Fertig, A. R., Dowd, B. E., & Riley, W. J. (2017). Texas medicaid payment reform: Fewer early elective deliveries and increased gestational age and birthweight. Health Affairs (Project Hope), 36(3), 460–467.  https://doi.org/10.1377/hlthaff.2016.0910.CrossRefGoogle Scholar
  9. Derose, K. P., Escarce, J. J., & Lurie, N. (2007). Immigrants and health care: Sources of vulnerability. Health Affairs, 26(5), 1258–1268.  https://doi.org/10.1377/hlthaff.26.5.1258.CrossRefGoogle Scholar
  10. Design Registrations | Egap. (n.d.). Retrieved May 9, 2017, from http://egap.org/design-registrations.
  11. Dimick, J. B., & Ryan, A. M. (2014). Methods for evaluating changes in health care policy: The difference-in-differences approach. JAMA, 312(22), 2401–2402.  https://doi.org/10.1001/jama.2014.16153.CrossRefGoogle Scholar
  12. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. (2017). Severe Maternal Morbidity in the United States | Pregnancy | Reproductive Health |CDC. Retrieved March 2, 2018, from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html.
  13. Drewry, J., Sen, B., Wingate, M., Bronstein, J., Foster, E. M., & Kotelchuck, M. (2015). The impact of the state children’s health insurance program’s unborn child ruling expansions on foreign-born Latina prenatal care and birth outcomes, 2000–2007. Maternal and Child Health Journal, 19(7), 1464–1471.  https://doi.org/10.1007/s10995-014-1650-5.CrossRefGoogle Scholar
  14. DuBard, C. A., & Massing, M. W. (2007). Trends in emergency medicaid expenditures for recent and undocumented immigrants. JAMA: The Journal of the American Medical Association, 297(10), 1085–1092.CrossRefGoogle Scholar
  15. Fuentes-Afflick, E., & Lurie, P. (1997). Low birth weight and Latino ethnicity. Examining the epidemiologic paradox. Archives of Pediatrics & Adolescent Medicine, 151(7), 665–674.CrossRefGoogle Scholar
  16. Iams, J. D., Applegate, M. S., Marcotte, M. P., Rome, M., Krew, M. A., Bailit, J. L., … Lannon, C. (2017). A statewide progestogen promotion program in Ohio. Obstetrics and Gynecology, 129(2), 337–346.  https://doi.org/10.1097/AOG.0000000000001841.CrossRefGoogle Scholar
  17. Johnson, K., Applegate, M., & Gee, R. E. (2015). Improving medicaid: Three decades of change to better serve women of childbearing age. Clinical Obstetrics and Gynecology, 58(2), 336–354.  https://doi.org/10.1097/GRF.0000000000000115.CrossRefGoogle Scholar
  18. Kotelchuck, M. (1994a). An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. American Journal of Public Health, 84(9), 1414–1420.CrossRefGoogle Scholar
  19. Kotelchuck, M. (1994b). The adequacy of prenatal care utilization index: Its US distribution and association with low birthweight. American Journal of Public Health, 84(9), 1486–1489.CrossRefGoogle Scholar
  20. Lain, S. J., Hadfield, R. M., Raynes-Greenow, C. H., Ford, J. B., Mealing, N. M., Algert, C. S., & Roberts, C. L. (2012). Quality of data in perinatal population health databases: A systematic review. Medical Care, 50(4), e7–e20.  https://doi.org/10.1097/MLR.0b013e31821d2b1d.CrossRefGoogle Scholar
  21. Lu, M. C., Lin, Y. G., Prietto, N. M., & Garite, T. J. (2000). Elimination of public funding of prenatal care for undocumented immigrants in California: A cost/benefit analysis. American Journal of Obstetrics and Gynecology, 182(1 Pt 1), 233–239.CrossRefGoogle Scholar
  22. Lydon-Rochelle, M. T., Holt, V. L., Nelson, J. C., Cárdenas, V., Gardella, C., Easterling, T. R., & Callaghan, W. M. (2005). Accuracy of reporting maternal in-hospital diagnoses and intrapartum procedures in Washington State linked birth records. Paediatric and Perinatal Epidemiology, 19(6), 460–471.  https://doi.org/10.1111/j.1365-3016.2005.00682.x.CrossRefGoogle Scholar
  23. ​Maternal Morbidity Working Group, Firoz, T., Chou, D., von Dadelszen, P., Agrawal, P., Vanderkruik, R., … Say, L. (2013). Measuring maternal health: Focus on maternal morbidity. Bulletin of the World Health Organization, 91(10), 794–796.CrossRefGoogle Scholar
  24. Markus, A. R., Andres, E., West, K. D., Garro, N., & Pellegrini, C. (2013). Medicaid covered births, 2008 through 2010, in the context of the implementation of health reform. Women’s Health Issues, 23(5), e273–e280.CrossRefGoogle Scholar
  25. Mbuagbaw, L., Medley, N., Darzi, A. J., Richardson, M., Habiba Garga, K., & Ongolo-Zogo, P. (2015). Health system and community level interventions for improving antenatal care coverage and health outcomes. The Cochrane Database of Systematic Reviews, 12, CD010994.  https://doi.org/10.1002/14651858.CD010994.pub2.Google Scholar
  26. Moyer, V. A. (2014). Screening for gestational diabetes mellitus: U.S. preventive services task force recommendation statement. Annals of Internal Medicine, 160(6), 414–420.  https://doi.org/10.7326/M13-2905.CrossRefGoogle Scholar
  27. Office of Budget (OB), A. S. for F. R. (ASFR). (2018). FY 2019 budget & performance [Text]. Retrieved March 2, 2018, from https://www.hhs.gov/about/budget/index.html.
  28. Rodriguez, M. I., Angus, L., Elman, E., Darney, P. D., & Caughey, A. B. (2011). Financial effect of instituting Deficit Reduction Act documentation requirements in family planning clinics in Oregon. Contraception, 83(6), 537–541.CrossRefGoogle Scholar
  29. Swartz, J. J., Darney, B. G., Caughey, A. B., & Rodriguez, M. I. (2015). Obstetrics drives emergency medicaid spending: Trends in Oregon’s Emergency Medicaid Program over 35 months.Google Scholar
  30. Swartz, J. J., Hainmueller, J., Lawrence, D., & Rodriguez, M. I. (2017). Expanding prenatal care to unauthorized immigrant women and the effects on infant health. Obstetrics and Gynecology.  https://doi.org/10.1097/AOG.0000000000002275.Google Scholar
  31. Vintzileos, A. M., Ananth, C. V., Smulian, J. C., Scorza, W. E., & Knuppel, R. A. (2002). The impact of prenatal care in the United States on preterm births in the presence and absence of antenatal high-risk conditions. American Journal of Obstetrics and Gynecology, 187(5), 1254–1257.CrossRefGoogle Scholar
  32. Wherry, L. R., Fabi, R., Schickedanz, A., & Saloner, B. (2017). State and federal coverage for pregnant immigrants: Prenatal care increased, no change detected for infant health. Health Affairs, 36(4), 607–615.  https://doi.org/10.1377/hlthaff.2016.1198.CrossRefGoogle Scholar
  33. WHO Recommendations on Health Promotion Interventions for Maternal and Newborn Health. (2015). Geneva: World Health Organization. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK304983/.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Jonas J. Swartz
    • 1
    • 2
    Email author
  • Jens Hainmueller
    • 3
    • 4
    • 5
  • Duncan Lawrence
    • 4
  • Maria I. Rodriguez
    • 2
  1. 1.Department of Obstetrics and GynecologyUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Department of Obstetrics and GynecologyOregon Health & Science UniversityPortlandUSA
  3. 3.Department of Political ScienceStanford UniversityStanfordUSA
  4. 4.Immigration Policy LabStanford UniversityStanfordUSA
  5. 5.Graduate School of BusinessStanford UniversityStanfordUSA

Personalised recommendations