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Primary care case management and birth outcomes in the Iowa Medicaid program
E D Schulman1, D J Sheriff, E T Momany
1University of Kentucky, Lexington 40536-0003, USA.
Objectives:
This study compares prenatal care utilization and birth outcomes between Iowa Medicaid recipients receiving care in a primary care case management (PCCM) system and those receiving care in a fee-for-service (FFS) system.
Methods:
Birth certificates linked with Medicaid hospitalization claims were analyzed for seven PCCM and seven FFS counties.
Results:
From 1989 through 1992, there was (1) a 20% increase in the number of women who received adequate prenatal care in the FFS counties, vs a 5% increase in the PCCM counties; (2) a 17% increase in the number of women who initiated care within the first trimester in the FFS counties, vs a 6% increase in the PCCM counties; and (3) a 442% increase in the number of women who received enhanced prenatal services in the FFS counties, vs a 278% increase in the PCCM counties. There were no significant differences between groups in mean gestational age or birthweight; however, there was an increase of very-low-birthweight babies in both groups.
Conclusions:
PCCM, as implemented by the Iowa Medicaid program, has not appreciably improved prenatal care utilization or birth outcomes.