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Managed care and perinatal regionalization in Washington State.
S E Gerber1, D G Dobrez, P P Budetti
1Section of Maternal-Fetal Medicine and Department of Obstetrics and Gynecology, Northwestern Memorial Hospital, Northwestern University Medical School, Chicago, USA. s-gerber@northwestern.edu
Obstetrics and Gynecology
|June 30, 2001
Summary
Managed care growth did not significantly associate with perinatal deregionalization in Washington State. Health Maintenance Organization (HMO) penetration did not correlate with changes in low birth weight (LBW) or very low birth weight (VLBW) deliveries at hospitals.
Area of Science:
- Perinatal care research
- Health services research
- Public health policy
Background:
- Managed care, including Health Maintenance Organizations (HMOs), has grown significantly.
- Perinatal deregionalization refers to the redistribution of high-risk births away from specialized centers.
- Understanding the relationship between managed care and perinatal care delivery is crucial for public health.
Purpose of the Study:
- To investigate the association between managed care penetration and perinatal deregionalization in Washington State.
- To determine if increased Health Maintenance Organization (HMO) presence correlates with changes in the distribution of low birth weight (LBW) and very low birth weight (VLBW) deliveries.
Main Methods:
- Analysis of low birth weight (LBW) and very low birth weight (VLBW) delivery proportions by hospital level (I, II, III) in Washington State for 1989, 1993, and 1996.
- Data on perinatal care levels, Health Maintenance Organization (HMO) penetration, and maternal characteristics were collected.
- Multiple linear regression was used to assess the association between changes in HMO penetration and changes in LBW/VLBW delivery proportions.
Main Results:
- Trends in LBW deliveries showed initial declines at level III hospitals and increases at levels I and II, reversing between 1993 and 1996.
- Very low birth weight (VLBW) delivery trends were less consistent, with some increases observed at level I and III hospitals.
- After controlling for maternal characteristics, increased Health Maintenance Organization (HMO) penetration was not significantly associated with increased LBW or VLBW deliveries at non-level III hospitals; in some cases, it was associated with a decrease.
Conclusions:
- The trend toward perinatal deregionalization observed in the early 1990s in Washington State did not persist despite continued Health Maintenance Organization (HMO) growth.
- At the hospital level, the increasing presence of HMOs does not demonstrate a significant association with perinatal deregionalization.