Effects of Medicaid eligibility expansion on prenatal care and pregnancy outcome in Tennessee

Article Abstract:

The federal government has tried to lower the nation's high infant mortality rate by increasing programs for prenatal care. In spite of spending $654 million per year, no one knows whether these programs are effective. As of April 1, 1990, new Medicaid eligibility criteria required the states to include pregnant women and infants with family incomes up to 133 percent of the poverty line, for which the states are reimbursed by the federal government from 50 to 80 percent of Medicaid expenditures. However, some states may fund these required expansions by reducing other health programs, such as prenatal care clinics, thereby canceling the intended increase in prenatal care. The authors studied all live births in Tennessee over three years, finding 62,946 births that met their criteria. Twenty-two percent of the mothers were enrolled in Medicaid before the expansion on July 1, 1985, and 29 percent were enrolled after. Although rates of enrollment increased, there were no corresponding improvements in access to prenatal care, birth weight, or neonatal mortality. Maternal groups with the most problems also had the highest rates of Medicaid enrollment, suggesting that expansion of Medicaid alone does not ensure better outcomes. Both before and after the change in eligibility requirements, two thirds of the mothers enrolled after the first three months of pregnancy, perhaps because Medicaid rules required a woman to be pregnant before applying, and the enrollment process is long, making early prenatal care impossible. In addition, eligibility is based on family income after medical expenses, so that women with no previous illness become eligible only after incurring pregnancy-related medical expenses, probably late in pregnancy. Recently Tennessee began issuing temporary cards, thus shortening the process. Nonfinancial barriers include lack of obstetricians who accept Medicaid, lack of awareness of eligibility, and lack of transportation. Progress in reducing infant mortality may require changes in both financial and nonfinancial barriers to prenatal care in order to be effective. (Consumer Summary produced by Reliance Medical Information, Inc.)

Laws, regulations and rules, Finance, Patient outcomes, Mortality, Infants (Newborn), Newborn infants, Infant mortality, Medicaid, Tennessee, Maternal health services, United States. Centers for Medicare and Medicaid Services. Early and Periodic Screening, Diagnosis and Treatment Program

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Benzodiazepines of long and short elimination half-life and the risk of hip fracture

Article Abstract:

Benzodiazepines are commonly used to treat anxiety and insomnia, or the inability to sleep. Their side effects of drowsiness, confusion, dizziness, and loss of coordination may increase in severity and frequency in older patients taking benzodiazepines with long elimination half-lives. The elimination half-life is the length of time for half the amount of the drug to be removed from the body. Among the elderly, a loss of coordination and other side effects of benzodiazepines may result in an increased risk of falling and fall-related fractures. The risk of hip fracture was compared in patients taking benzodiazepines with short (less than 24 hours) or long (24 hours or more) elimination half-lives. The subjects were 65 years or older and residents of the Canadian province of Saskatchewan. The findings show that the risk of hip fracture was greater in users of long half-life benzodiazepines than in users of short half-life benzodiazepines. This finding was not related to age, sex, calendar year, nursing home residence, or history of hospitalization. Further examination of medical records showed that the findings were also unrelated to impaired intellect or dementia, ability to walk or function, and body weight.

Injuries, Physiological aspects, Fractures (Injuries), Fractures, Benzodiazepines

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Antihypertensives and the risk of serious hypoglycemia in older persons using insulin or sulfonylureas

Article Abstract:

There appears to be very little risk that antihypertensive drugs will cause hypoglycemia when taken by diabetics using insulin or sulfonylurea drugs. This was the conclusion of a study that followed 13,559 elderly diabetics who were taking these drugs for their diabetes as well as beta blockers, ACE inhibitors and other drugs for hypertension. Patients taking ACE inhibitors had a slightly higher risk of a serious episode of hypoglycemia, but this risk disappeared when the data were adjusted for other factors.

Drug therapy, Diabetes, Diabetes mellitus, Antihypertensive drugs, Antihypertensive agents, Hypoglycemia

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