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  1. The effect of health maintenance organization vs commercial insurance status on obstetrical management and outcome.

    Article - En anglais

    Objective 

    To compare obstetrical management and birth outcomes between patients with health maintenance organization (HMO) insurance and those with private commercial insurance.

    Design 

    Retrospective, population-based cohort study.

    Setting 

    King County, Washington.

    Patients 

    Among newborns delivered in 1992 and 1993, a random sample of 4000 birth records listing HMO insurance for prenatal care was compared with a random sample of 4000 birth records listing private commercial insurance as the primary coverage.

    Main Outcome Measures 

    Use of ultrasonography and amniocentesis ; rate of primary cesarean section performed ; adequacy of prenatal care ; incidence of maternal medical complications, low birth weight, and congenital malformations ; and length of hospital stay.

    Results 

    Women covered by HMO compared with commercial insurance were more likely to undergo ultrasonography (relative risk [RR], 1.4 : 95% confidence interval ICI], 1.3-1.4).

    Inadequate prenatal care was less frequent among HMO-insured patients (RR, 0.6 ; 95% Cl, 0.5-0.7), as was the incidence of birth weight below 2500 g (RR, 0.7 ; 95% CI, 0.6-0.9).

    No differences in rates of cesarean section and congenital anomalies were observed.

    Among women without obstetrical risk factors, HMO-insured mothers were at an increased risk of labor and delivery complications (RR, 1.4 ; 95% Cl, 1.3-1.5) ; their infants were at an increased risk of infant distress (RR, 1.8 ; 95% CI, 1.5-2.2). (...)

    Mots-clés Pascal : Obstétrique, Rétrospective, Etude comparative, Surveillance sanitaire, Organisation fonctionnelle, Hôpital général, Assurance maladie, Femelle, Evaluation, Homme, Appareil génital femelle pathologie, Pédiatrie, Politique sanitaire

    Mots-clés Pascal anglais : Obstetrics, Retrospective, Comparative study, Sanitary surveillance, Functional organization, General hospital, Health insurance, Female, Evaluation, Human, Female genital diseases, Pediatrics, Health policy

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 98-0020844

    Code Inist : 002B20G01. Création : 17/04/1998.