Effect of Medicaid managed care on pregnancy complications

Objective: This study examined the impact of managed care on hospital obstetric outcomes in Medicaid-sponsored women. Methods: The study sample consisted of a total of 525,517 maternal deliveries for singleton births from three payer groups, Medicaid managed care, Medicaid fee-for-service, and private managed care in 439 short-term-stay nonfederal hospitals in California and Florida. Quality of care comparisons were made using six indicators. Data were derived from linked computer files of birth certificates, hospital discharge abstracts, Medicaid eligibility records, 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 between 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 likelihood of eclampsia (California) (adjusted odds ratio = 1.26; 95% confidence interval 1.05, 1.57; P = .04). Conclusion: Overall, managed care has not adversely affected pregnancy outcomes in Medicaid-sponsored women. Yet, payer system changes may be insufficient to achieve complete parity of outcomes relative to private managed care patients.