research report and note cards

1. “Since Medicaid pays for only about two-thirds of the usual fees that health providers expect, it is likely that services are not as readily available to Medicaid recipients as they might be” (Kenny 109).

2. “These gaps are likely to continue into the future, given the trade-offs that many states have had to make to exchange state dollars for maternity services with state dollars for Medicaid expansions” (Strobino 288).

3. “The demand for prenatal care at their clinics, the administrators say, stems in part from the growing tendency of physicians to close their obstetrics practices because of high malpractice insurance rates and to refuse to accept Medicaid patients because of low reimbursement rates” (Donovan, 128).

4. “Several administrators note that a pre- natal program can enhance the public image of a clinic and, if the clinic also offers abortion services, help deflate charges leveled by right-to-life groups that the clinic encourages pregnant women to have abortions” (Donovan, 127).

5. “All clinics have made arrangements with a private obstetrician or with staff physicians at a local hospital for them to see each prenatal care patient at least once-and usually twice-during her pregnancy” (Donovan, 128).

6. “Poor rates of participation in prenatal care reveal that the American maternity care system is fundamentally flawed, fragmented and overly complex, particularly for low-income women, women who are uninsured or underinsured, teenagers, inner-city and rural residents and newly arrived immigrants” (Brown, 79).

7. “First, there are not always enough health department clinics, community health centers or similar facilities in every community to provide prenatal care to those unable or unwilling to use the private health care system, and the waiting time for appointments in facilities that do exist is often long” (Brown, 75).

8. “It could be argued that the stresses and constraints of living in poverty and the inner city not only affect some fetuses adversely (via variables not available for analysis, such as consumption of an inadequate diet, smoking, drinking, drug abuse, and other mechanisms as yet unexplored), but also affect maternal motivation to seek prenatal care” (Gortmaker 656).

9. “There appears to be a U-shaped association between recommended visits received and low-birthweight rates; both women with Inadequate ratings and those with Adequate Plus ratings had increased low-birthweight rates” (Kotelchuck, 1487).

10. “Their high proportion of low-birthweight births should make us somewhat sanguine about proposals to improve US infant mortality rates that simply recommend more prenatal care visits generally or for high-risk women only” (Kotelchuck, 1488).

11. “Prenatal care is one of the most widely used preventive health care services in the United States” (Alexander, 307).

12. “The most recent study of trends in health insurance among American women showed an increasing rate of uninsurance, growing from 11.7% in 1980 to 18.2% in 2005 among women ages 25 to 64” (Kozhimannil, 136).

13. “Income eligibility levels for pregnant women are determined by states and have generally remained steady or increased slightly over the past decade. Eligible women are required to enroll in Medicaid to receive benefits, and some states have recently created policies to simplify enrollment procedures for pregnant women” (Kozhimannil, 139).

14. “However, the number of states that have increased outreach efforts and/or offered enhanced maternal benefits packages has declined slightly since the 1990s” (Kozhimannil, 139).

15. “Only 56 percent of the respondents said they received all of the recommended procedures in the first two visits, and only 32 percent of the respondents said they received advice in all of the areas” (Kogan, 637).

16. “There is scant literature on the relation between ethnicity of the practitioner and patient satisfaction, although it is sometimes suggested that obtaining care from practitioners of one's own ethnic back- ground may be desirable because these caregivers may be better able to deliver culturally competent care” (Handler, 692).

17. “Another way to improve prenatal care is to identify practices, the benefits of which seem suspect or uncertain, and to try to answer these questions by doing research” (Hemminki, 209).

18. “The costs of the care may be an important factor in determining which source of care is sought, and perhaps when and how often visits are made. Thus, maternity benefits beyond basic health insurance may be necessary” (Hemminki, 344).

19. “The report also notes that Medicaid eligibility expansion does not guarantee that providers are available, able and willing to offer the medical and psychosocial services that pregnant women need, in ways that are convenient and acceptable to them” (Witwer, 35).

20. “The Maternity and Infant Care Projects, initiated by the federal government in 1963, often involved opening clinics where none existed or expanding existing facilities, so they could accept more indigent patients” (Brown,179).