Formative evaluation of a community-based maternity services program for the uninsured

Abstract

Blue Cross and Blue Shield of Michigan (BCBSM) funded a 1-year pilot program to expand prenatal services in 7 Michigan cities. These cities were selected because they had high unemployment (20 to 34%) rates and high infant mortality rates. The objective was to provide antenatal care to women ineligible for Medicaid and without private health insurance whose household income fell below 185% of the poverty level. The program was locally operated by community action agencies (CAAs). These are nonprofit antipoverty agencies. Data sources include interviews with project administrators a review of a sample of medical records and surveys of providers and patients. 6 out of the 7 local projects had an overall response rate of 82% (673 of 817) to the participant survey. A response rate of 57% was achieved for physicians (n=41). Locating and enrolling eligible women was likely to be difficult. The CAA administrators thought that outreach efforts needed to be intensive. The CAA put stories in newspapers and had public service announcements on radio and television. Physicians were recruited. Approximately 1/3 of the families were unemployed and had no prior insurance. About 18% of the families reporting prior insurance and unemployment are recently laid off losing insurance along with their jobs. The final group (14%) reflects families who had had jobs that provided insurance but after being laid off accepted lower paying jobs that did not have insurance benefits. About 60% had not received prenatal care before enrolling. They said they probably would not get care if it were not for the program and claimed they had some difficulty in getting care. Money was the main obstacle (71%) to care. A majority of physicians (62.5%) were very satisfied or satisfied with the overall program. The average age of patients in the sample of medical records was 24.8 years. About 12% were adolescents. Approximately 3.4 were White; 20% were Black. 8.2% was the low birth weight rate. The medical record specialists rated care as excellent or more than adequate for 80%. Overall project physicians followed the prescribed care guidelines. The voucher-medical record agreement rate for 6 components of care was more than 90%.