Impact of Managed Care on Drug-Dependent Pregnant and Postpartum Women and Their Children

• NCJ Number: 219356
• Journal: Substance Use & Misuse Volume: 42 Issue: 6 Dated: 2007 Pages: 961-974
• Author(s): Lauren M. Jansson; Dace S. Svikis; Martha Velez; Erik Fitzgerald; Hendree E. Jones
• Date Published: 2007
• Length: 14 pages
• Grant Number(s): K08 DA00495; R01 DA12403
• Sponsoring Agency: National Institute on Drug Abuse
• Publication Format: Article
• Publication Type: Program/Project Evaluation
• Language: English
• Country: United Kingdom

Annotation

This study examined maternal and infant outcomes at an urban drug treatment center for pregnant drug-dependent women under fee-for-service (FFS) compared with managed-care (MC) service periods.

Abstract

The study found adverse consequences for the drug-dependent women being treated under MC, with their fetuses and infants being the most adversely affected. Compared with FFS, MC showed significant increases in fetal and infant death rates, rates of nonimmunized children, and rates of interventions by Children's Protective Services. In 1998, Maryland adopted a universal managed-care policy for health care. Although many substance user treatment facilities around the State began to close, others struggled to restructure and remain open. One such program was the Center for Addiction and Pregnancy (CAP), a treatment facility for pregnant and postpartum drug-dependent women and their children. Under MC, CAP operated under management by third-party organizations or a few MC organizations that authorized treatment under criteria unique to the company. CAP medical practitioners based treatment decisions on cost rather than diagnostic data. Staff numbers were reduced, and job descriptions were revised to allow the hiring of less costly staff. The majority of treatment services were shifted to mid-level providers with increasing caseloads and less education and training. In addition, many treatment decisions were made by MC organizational staff rather than treatment staff. The length of stay for women under treatment was decreased from approximately 1-2 years postpartum to a maximum of 6-8 weeks postpartum. The FFS group, which was treated by the CAP prior to the institution of MC, consisted of 132 women; and the MC group treated by CAP consisted of 108 women. Demographic data for the two groups were similar, as was legal involvement. Recent substance use was also similar for both groups. 4 tables and 26 references