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Medicaid Managed Care and Infant Health: A National Evaluation

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  • Robert Kaestner
  • Lisa Dubay
  • Genevieve Kenney

Abstract

In this study, we examine the effects of Medicaid managed care (MMC) on prenatal care utilization and infant health. We obtain separate estimates of the effect of primary care case management (PCCM) managed care programs and HMO managed care plans on prenatal care utilization, birth weight, and cesarean section. The results suggest the following: MMC was associated with a small, clinically unimportant decrease in the number of prenatal care visits; MMC had no statistically significant relationship to the APNCU index of the adequacy of prenatal care; MMC was associated with a significant increase in the incidence of low-birth weight and pre-term birth; and MMC had no association with the incidence of cesarean section. We argue that a causal interpretation of the first and third findings is unsupported by a careful reading of the evidence, and we conclude that Medicaid managed care had virtually no causal effect on, prenatal care use, birth outcomes, and cesarean section.

Suggested Citation

  • Robert Kaestner & Lisa Dubay & Genevieve Kenney, 2002. "Medicaid Managed Care and Infant Health: A National Evaluation," NBER Working Papers 8936, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:8936
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    References listed on IDEAS

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    1. Dubay, Lisa & Kaestner, Robert & Waidmann, Timothy, 2001. "Medical malpractice liability and its effect on prenatal care utilization and infant health," Journal of Health Economics, Elsevier, vol. 20(4), pages 591-611, July.
    2. Sherry Glied & Jane Sisk & Sheila Gorman & Michael Ganz, 1997. "Selection, Marketing, and Medicaid Managed Care," NBER Working Papers 6164, National Bureau of Economic Research, Inc.
    3. Freund, D.A. & Kniesner, T.J. & LoSasso, A.T., 1996. "How Managed Care Affects Medicaid Utilization : A Synthetic Difference-in-Difference Zero-Inflated Count Model," Other publications TiSEM 2ce3c221-d3bc-4f89-9174-c, Tilburg University, School of Economics and Management.
    4. Kotelchuck, M., 1994. "An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index," American Journal of Public Health, American Public Health Association, vol. 84(9), pages 1414-1420.
    5. Mauldon, J. & Leibowitz, A. & Buchanan, J.L. & Damberg, C. & McGuigan, K.A., 1994. "Rationing or rationalizing children's medical care: Comparison of a Medicaid HMO with fee-for-service care," American Journal of Public Health, American Public Health Association, vol. 84(6), pages 899-904.
    6. Glied, Sherry, 2000. "Managed care," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 13, pages 707-753, Elsevier.
    7. Hurley, R.E. & Freund, D.A. & Taylor, D.E., 1989. "Emergency room use and primary care case management: Evidence from four medicaid demonstration programs," American Journal of Public Health, American Public Health Association, vol. 79(7), pages 843-846.
    8. Culyer, A. J. & Wagstaff, Adam, 1993. "Equity and equality in health and health care," Journal of Health Economics, Elsevier, vol. 12(4), pages 431-457, December.
    9. Dubay, Lisa & Kaestner, Robert & Waidmann, Timothy, 1999. "The impact of malpractice fears on cesarean section rates," Journal of Health Economics, Elsevier, vol. 18(4), pages 491-522, August.
    10. Griffin, J.F. & Hogan, J.W. & Buechner, J.S. & Leddy, T.M., 1999. "The effect of a Medicaid managed care program on the adequacy of prenatal care utilization in Rhode Island," American Journal of Public Health, American Public Health Association, vol. 89(4), pages 497-501.
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    Cited by:

    1. Duggan, Mark, 2004. "Does contracting out increase the efficiency of government programs? Evidence from Medicaid HMOs," Journal of Public Economics, Elsevier, vol. 88(12), pages 2549-2572, December.
    2. Kaestner, Robert & Dubay, Lisa & Kenney, Genevieve, 2005. "Managed care and infant health: an evaluation of Medicaid in the US," Social Science & Medicine, Elsevier, vol. 60(8), pages 1815-1833, April.
    3. Ilyana Kuziemko & Katherine Meckel & Maya Rossin-Slater, 2013. "Do Insurers Risk-Select Against Each Other? Evidence from Medicaid and Implications for Health Reform," NBER Working Papers 19198, National Bureau of Economic Research, Inc.
    4. Mark J. Holmes, 2005. "Is Long-Run Output Convergence Associated With International Cooperation? Some New Evidence For Selected African Countries," Journal of Economic Development, Chung-Ang Unviersity, Department of Economics, vol. 30(2), pages 67-85, December.
    5. Anna Aizer & Janet Currie & Enrico Moretti, 2004. "Competition in Imperfect Markets: Does it Help California's Medicaid Mothers?," NBER Working Papers 10429, National Bureau of Economic Research, Inc.

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    • I1 - Health, Education, and Welfare - - Health

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