Effect of medicaid managed care on pregnancy complications

Objective: This study examined the impact of managed care on hospital obste tric outcomes in Medicaid-sponsored women. Methods: The study sample consisted of a total of 525,517 maternal deliveri es for singleton births from three payer groups, Medicaid managed care, Med icaid fee-for-service, and private managed care in 439 short-term-stay nonf ederal hospitals in California and Florida. Quality of care comparisons wer e made using six indicators. Data were derived from linked computer files o f birth certificates, hospital discharge abstracts, Medicaid eligibility re cords, Medicaid health care claims, and surveys of hospital characteristics . Results: The overall multivariate likelihood of an adverse maternal outcome during hospitalization for a delivery was not significantly different betw een Medicaid managed care and Medicaid fee-for-service groups in California and Florida. However, mothers in the Medicaid managed care group compared with mothers in the private managed care group experienced a higher likelih ood of eclampsia (California) (adjusted odds ratio = 1.26; 95% confidence i nterval 1.05, 1.57; P=.04). Conclusion: Overall, managed care has not adversely affected pregnancy outc omes in Medicaid-sponsored women. Yet, payer system changes may be insuffic ient to achieve complete parity of outcomes relative to private managed car e patients. (Obstet Gynecol 2000;95:6-13. (C) 2000 by The American College of Obstetricians and Gynecologists.).