Access to physicians, obstetric care use, and adequacy of prenatal care for Medicaid patients in Maine: 1985–1989

Abstract

To document trends in prenatal care utilization and provider participation in the Maine Medicaid program for the period 1985-1989, and to examine the effect of physician availability on adequacy of care. Five years of Medicaid claims data and 3 years of claims data linked to birth certificates were analyzed. Large decreases in overall physician participation in the Medicaid program were due to reductions in the number of family physicians and general practitioners, whereas the number of obstetricians increased during this time. Large increases in provider caseloads resulted from an increase in recipient enrollment. The number of prenatal visits per patient, a measure of access, increased during this time. Adequacy of care was not associated with physician availability after controlling for maternal age, maternal education, out-migration for care, and type of location (rural versus urban). Important differences by type of location that emerged included less physician availability in rural areas but a higher likelihood of receiving adequate care. Women from low-availability areas were more likely to seek care outside of their primary care area of residence. Women living in rural areas who out-migrated for care were not more likely to receive inadequate prenatal care. Access to prenatal care for Medicaid recipients may have increased from 1985 to 1989 despite decreased overall physician participation in the program, perhaps because of more participating obstetricians. In addition, adequacy of care was not associated with physician availability in this population. Women residing in rural areas experienced lower physician availability and greater out-migration for care with no adverse effect on adequacy of prenatal care.