Abstract
Introduction
Little is known about access to and use of prenatal care by veterans using U.S. Department
of Veterans Affairs (VA) maternity benefits. We compared the timeliness and adequacy
of prenatal care by veteran status and payor.
Study Design
We used VA clinical and admistrative data linked with California vital statistics
patient discharge data to identify all births to VA-enrolled veterans and non-veterans
between 2000 and 2012. Births were categorized based on veteran status and payor (non-veterans
with Medicaid, non-veterans with private insurance, VA-enrolled veterans using VA
maternity care benefits, and VA-enrolled veterans with other payor). Outcomes were
timeliness of prenatal care (initiation before the end of the first trimester) and
adequacy of prenatal care as measured by the Kotelchuck Index (inadequate, intermediate,
adequate). Covariates included demographic, health, and pregnancy characteristics.
We used generalized linear models and multinomial logistic regression to analyze the
association of veteran status and payor with timeliness of prenatal care and adequacy
of prenatal care, respectively.
Results
We identified 6,196,432 births among VA-enrolled veterans (n = 17,495) and non-veterans (n = 6,178,937). Non-veterans using Medicaid had the lowest percentage of timely prenatal
care (78.1%; n = 2,240,326), followed by VA-enrolled veterans using VA maternity care benefits (82.8%;
n = 1,248). VA-enrolled veterans using VA maternity care benefits were the most likely
to receive adequate prenatal care (92.0%; n = 1,365). Results remained consistent after adjustment.
Conclusions
This study provides key baseline data regarding access to and use of prenatal care
by veterans using VA maternity benefits. Longitudinal studies including more recent
data are needed to understand the impact of changing VA policy.
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Biography
Jodie G. Katon, PhD, MS, is a Core Investigator, VA Puget Sound Health Services Research and Development Center of Innovation, and Assistant Research Professor, University of Washington, Department of Health Services. Her research focuses on women veterans' reproductive health and health disparities.
Biography
Jonathan G. Shaw, MD, MS, is a practicing family physician, Ravenswood Family Health Center, East Palo Alto, and a health services researcher at Stanford and the VA Palo Alto. His research focuses on psychosocial influences on health and health care across the lifespan.
Biography
Vilija R. Joyce, MS, is Associate Director/Research Associate, VA Health Economics Resource Center. Vilija's work has focused on assessing health-related quality of life as well as the costs of care for veterans living with HIV, hepatitis C, and opioid use disorder.
Biography
Susan K. Schmitt, PhD, a statistical programmer at the Health Economics Resource Center and the Center for Health Care Evaluation, VA Palo Alto HCS, works on a variety of research projects to improve the quality of health care for veterans.
Biography
Ciaran S. Phibbs, PhD, is a Health Economist, Health Economics Resource Center/the Center for Health Care Evaluation, VA Palo Alto HCS; Health Research and Policy Department, and Pediatrics Department, Stanford University. His research includes perinatal care, nurse staffing, and hospital markets.
Article info
Publication history
Published online: January 21, 2022
Accepted:
December 20,
2021
Received in revised form:
December 10,
2021
Received:
January 20,
2021
Identification
Copyright
Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health, George Washington University.