A study led by a UNC Gillings School of Global Public Health researcher has examined the impact of North Carolina state budget cuts upon maternal health service use and outcomes among Medicaid-enrolled pregnant women in the state.
Dr. Dorothy Cilenti, clinical assistant professor of maternal and child health and adjunct professor of health policy and management at the Gillings School, is lead author of the study, published in the February issue of the Journal of Public Health Management and Practice.
Acknowledging that downturns in the economy tend to affect most profoundly those people at the bottom of the economic scale, Dr. Cilenti and colleagues determined to analyze how the Great Recession that began in 2008 affected the poorest mothers and their children during 2009 and 2010.
Maternal and child health services historically have been at the center of the health services safety net in the U.S., with infant mortality and morbidity rates reflecting the health of local communities. Pregnancy services originally were mandated by all states’ Medicaid programs, but fiscal pressures related to decreased funding and increased enrollment in the program have caused some to reassess what services can be made available.
In 2009, Medicaid covered more than half of North Carolina’s 126,785 live births. That year, North Carolina reduced reimbursement rates for case management services for pregnant women by 19 percent, despite the recession’s disproportionate impact upon the state and its workers.
Many of the health outcomes for women and children remained stable over the course of 2010, but among outcome variables was a decrease in the number of obstetric visits.
The authors suggest that the stable health outcomes may be due to more women enrolling in Medicaid during the recession who only recently had suffered financial setbacks, i.e., job loss, that pushed them into poverty. The stability reflected in the study, they say, also has to do with the short-term nature of the analysis, in that the study did not review longer-term outcomes such as neonatal and infant mortality.
The report on the briefing is available online.