Effect of managed care on perinatal transports for the publicly funded in upstate New York

Abstract

Objective: To determine if Medicaid Managed Care (MMC) status influences perinatal transfer rates among publicly funded individuals in a well-regionalized area.

Study design: Perinatal transport rates were determined from deidentified data from the NYS Perinatal Data System (PDS). The predictor of interest was managed care status. Covariates included maternal, newborn, and regional variables.

Results: The unadjusted probability of maternal transfer was 28% lower among women enrolled in MMC vs those with Medicaid Fee-for-Service (MFFS) (odds ratio (OR)=0.72; 95% confidence interval (CI): 0.63 to 0.82). When adjusted for clinical variables influencing maternal transfer and hospital level, women in managed care were 44% less likely to be transferred (OR=0.56; 95% CI: 0.36 to 0.86). Newborns were transferred at similar rates regardless of managed care status.

Conclusions: MMC status remains a significant independent predictor for maternal transfer in upstate New York (NY). Despite a well-regionalized organization for perinatal care where pre-existing written protocols for transfer between institutions are established independent of insurance status, managed care may influence decisions on nature and location of care delivery.