MANAGED CARE DOES NOT LOWER COSTS BUT MAY RESULT IN POORER OUTCOMES FOR PATIENTS WITH GESTATIONAL DIABETES

OBJECTIVE: Our purpose was to compare the costs of prenatal care and s ubsequent maternal and neonatal outcomes in patients with gestational diabetes cared for in an inner-city university hospital house staff cl inic versus an inner-city managed care organization. STUDY DESIGN: A r etrospective cohort study was conducted. The groups consisted of 115 p atients with gestational diabetes who were cared for in a house staff clinic ard a demographically similar group of 85 patients cared for in a neighborhood managed care organization. The groups were examined re garding baseline demographics, intensity of prenatal care, maternal an d neonatal outcomes, and total cost of the provision of care. RESULTS: There was no difference between groups in the total cost of maternal- infant care. A larger percentage of patients in the house staff group saw the physician frequently. In contrast, patients cared for in the m anaged care organization underwent more tests of fetal well-being. The re was a greater rate of neonatal macrosomia in the managed care organ ization group compared with the house staff group. CONCLUSIONS: Manage d care does not decrease the cost of caring for patients with gestatio nal diabetes but does lead to a greater rate of neonatal macrosomia, w hich may reflect poorer glucose control.