The Impact of Managed Care on Drug-Dependent Pregnant and Postpartum Women and Their Children

Abstract

In the shift from fee-for-service (FFS) to managed care (MC), many drug user treatment programs have eliminated all but basic services, lessening short-term costs without considering long-term consequences. This study explored maternal and infant outcomes at an urban drug user treatment center for pregnant drug-dependent women under FFS (1995) vs. MC (2000) service periods. The two groups had similar birth parameters, but the MC group had more fetal and infant deaths, decreased immunization rates, and greater incidences of social services intervention. While these data are correlational and need to be interpreted with caution, they suggest poorer outcomes for drug-exposed children under MC and invite further study of short- and long-term consequences of such change.

Keywords:

• managed care
• substance use treatment
• drug dependence
• pediatrics
• pregnancy
• drug-exposed

Notes

¹The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note.

²Treatment can be briefly and usefully defined as a planned, goal directed change process, which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual help–based (AA, NA, etc.) and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types—that are not also used with non-substance users. Editor's note.