| Enrollment in Medicaid managed care increased dramatically during the early 1990's. With the rapid development and implementation of State Medicaid managed care programs, questions have arisen regarding the quality of care provided through these plans. This study examines the relationship between managed care enrollment and processes and outcomes of care for women and newborns in Medicaid.; Data gathered from electronic birth certificates, medical records, Medicaid enrollment files and Medicaid claims are used to examine maternal socioeconomic, demographic and health characteristics, obstetric processes of care and birth outcomes. The processes of interest include the timing of the initial prenatal visit, the number of prenatal visits and the probability of cesarean delivery. The outcomes of interest are birth weight and gestational age.; Bivariate statistics compare those in Medicaid fee-for-service (MFFS) plans to those in Medicaid managed care (MMC) plans. Standard multivariate methods control for confounding factors while estimating the relationship between MMC enrollment and processes and outcomes of care. Simultaneous equations models are used to account for potential biases that may arise due to unobservable differences between MFFS and MMC populations.; The bivariate statistics reveal several significant differences in the characteristics of MFFS and MMC populations. Also, women in MMC seek prenatal care earlier and have more prenatal visits. No differences are observed, however, in the type of delivery, birth weight or gestational age. Standard multivariate analyses suggest women in MMC may be slightly less likely to initiate care in the first trimester, although the remaining standard models indicate that MMC enrollment is not significantly associated with the other processes and outcomes of care. The simultaneous equations models tend to find larger but less precise effects of MMC enrollment and one model provides statistically significant evidence that MMC enrollment may decrease the probability of having a cesarean. All other effects remain statistically insignificant.; This study concludes that enrollment into Medicaid managed care does not significantly affect the quality of care for women and newborns once analytical models control for population differences. In addition, the simultaneous equations models underscore the importance of considering biases that may arise due to unobservable population differences. |
