PATTERNS OF MATERNITY CARE: EFFECTS ON COST AND QUALITY

针对穷人的医疗保健系统既复杂又支离破碎， 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 护理服务，贫穷的妇女可能不得不与各种 设施和从业人员。这种碎片化似乎很可能是 会阻碍预防性护理的使用，影响质量 获得的护理，并导致成本增加时，服务 由于缺乏协调一致的护理而延迟或重复。 这项研究的目的是描述利用 怀孕的医疗补助接受者和 检查不同使用模式与 产妇保健的数额、费用和质量。研究中的人口 将是连续登记的马里兰州医疗补助接受者的样本 世卫组织于1988年生育，数据来源将包括医疗补助 申报单、出生证明和病历摘要。这项研究将 根据其经度描述利用率，定义为 与疾病提供者存在长期关系 插曲和问题，以及连续性，连续性的程度 护理由提供者或从业者在特定的一集内提供 生病了。 这项研究有可能增加关于 连续度和纵向对产品质量和成本的影响 产妇保健和提出改善卫生结构的方法 为穷人提供关怀服务。

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.