Perinatal outcomes following implementation of TennCare

JAMA. 1998 Jan 28;279(4):314-6. doi: 10.1001/jama.279.4.314.

Abstract

Context: The abrupt initiation of capitated Medicaid care in Tennessee (TennCare) in 1994 prompted many questions about changes in quality of care.

Objective: To evaluate the effect on perinatal outcomes of the transition to TennCare in 1994.

Design: Before and after retrospective cohort analysis.

Setting and population: Births to women residing in Tennessee between 1990 and 1995 with complete demographic information on birth certificates, with a focus on women enrolled in Medicaid giving birth in 1993 (before TennCare) and 1995 (after TennCare).

Outcome measures: Late prenatal care (after the fourth month of pregnancy) or inadequate prenatal visits, low and very low birth weight, and death in the first 60 days of life.

Results: Tennessee residents had 72014 study births in 1993 and 72278 in 1995, of which 37543 (52.1%) and 35707 (49.4%) were to women enrolled in Medicaid at delivery. For these Medicaid births, there were no changes after TennCare in the proportions with late prenatal care (16.2% in 1993 vs 15.8% in 1995), inadequate prenatal visits (5.9% vs 5.6%), low birth weight (9.4% vs 9.0%), very low birth weight (1.6% vs 1.5%), and death in the first 60 days (0.6% both years). These findings were unchanged in multivariate analysis, in analysis of high-risk subgroups, and in analysis of women with demographics characteristic of Medicaid women.

Conclusion: Study perinatal outcomes did not change among Medicaid births following the transition to TennCare.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Birth Weight
  • Female
  • Gestational Age
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Infant Mortality
  • Infant, Newborn
  • Logistic Models
  • Managed Care Programs / statistics & numerical data*
  • Medicaid / statistics & numerical data*
  • Medically Uninsured
  • Multivariate Analysis
  • Outcome Assessment, Health Care
  • Pregnancy
  • Pregnancy Outcome / epidemiology*
  • Pregnancy, High-Risk
  • Prenatal Care / statistics & numerical data*
  • Retrospective Studies
  • State Health Plans / statistics & numerical data*
  • Tennessee / epidemiology
  • United States