Do increases in payments for obstetrical deliveries affect prenatal care?

Area of Science:

• Health Services Research
• Public Health Policy
• Maternal Health

Background:

• State Medicaid Programs often raise provider fees to ensure participation.
• Previous research focused on provider retention, not patient impact.
• Few studies examined the effect of Medicaid fee increases on patient access to prenatal care.

Purpose of the Study:

• To evaluate the impact of a 200% Maryland Medicaid physician fee increase for obstetrical deliveries on prenatal care utilization.
• To test hypotheses that fee increases would boost prenatal visits and shift care to nonhospital settings.
• To assess changes in the volume and site of prenatal care for Medicaid beneficiaries.

Main Methods:

• Analysis of Maryland Medicaid claims data from fiscal years 1985-1987.
• Comparison of prenatal visit volume and hospital vs. nonhospital care ratios before and after the fee increase.
• Statistical analysis (Student's t-test, ANOVA) of continuously enrolled women delivering in the last four months of each fiscal year.

Main Results:

• Minimal overall change in the amount or location of prenatal care observed post-fee increase.
• Slight increases in prenatal visits noted for women outside Baltimore City, particularly in non-urban areas.
• No uniform shift towards community-based prenatal care was detected.

Conclusions:

• Raising obstetrical delivery fees alone did not significantly enhance prenatal care access or shift care to community providers.
• Fee increases may have a localized impact, potentially stronger in areas with fewer providers.
• Linking fee increases to the amount of prenatal care provided may incentivize comprehensive perinatal services.