PATTERNS OF MATERNITY CARE: EFFECTS ON COST AND QUALITY

穷人的保健系统复杂而分散， 特别是在怀孕和其他生殖健康方面 服务 获得生殖保健和其他初级保健 照顾服务，贫困妇女可能不得不与各种各样的 设施和从业人员。 似乎这种分裂 会阻碍预防保健的利用， 获得的护理，并导致成本增加时，服务是 由于缺乏协调的护理而延迟或重复。 本研究的目的是描述利用 不同类型的医疗保健怀孕的医疗补助受助人， 研究不同的利用模式与 产妇护理的数量、费用和质量。 研究人群 将是连续登记的马里兰州医疗补助接受者的样本 1988年出生的人，数据来源将包括医疗补助计划。 索赔、出生证明和病历摘要。 这项研究将 根据其连续性描述利用率，定义为 与提供者存在长期关系， 情节和问题，以及连续性， 护理是由提供者或从业者在特定的事件中提供的。 病 这项研究有可能增加关于 的质量和成本的影响 产妇保健，并就如何改善保健结构提出建议 照顾穷人。

The health care system for the poor is complex and fragmented, especially with regard to pregnancy and other reproductive health services. To obtain reproductive health care and other primary health care services, poor women may have to interact with a variety of facilities and practitioners. It seems likely that this fragmentation would discourage utilization of preventive care, compromise the quality of care that is obtained, and result in increased costs when services are delayed or repeated because of the lack of coordinated care. The purpose of this study is to describe the utilization of different types of health care by pregnant Medicaid recipients and examine the relationship of different patterns of utilization to the amount, costs and quality of maternity care. The population under study will be a sample of continuously enrolled Maryland Medicaid recipients who gave birth in 1988, and the sources of data will include Medicaid claims, birth certificates, and medical chart abstracts. The study will describe utilization in terms of its longitudinality, defined as the existence of a long-term relationship with a provider spanning illness episodes and problems, and continuity, the degree to which continuous care is given by providers or practitioners within a specific episode of illness. This study has the potential to add to research evidence about the effects of continuity and longitudinality on the quality and costs of maternity care and to suggest ways to improve the structure of health care delivery for the poor.