Assessing Gaps in the Maternal and Child Health Safety Net

Abstract

The Patient Protection and Affordable Care Act of 2010 proposed sweeping changes to health insurance and health care delivery systems. As a result, local health departments, community health centers, and other safety net providers are expected to play a role in providing access to care for millions of individuals. This study examines the availability of population-based services by local health departments and community health centers in the Midwest/Great Lakes region. For this study, the authors used secondary data on location of community health centers collected by the Health Resources and Services Administration and local health department services delivery from the 2008 National Profile of Local Health Departments. To simultaneously examine the geospatial patterns of service delivery and location of community health centers, the geographic information system shape files of local health department jurisdictions were used to examine prenatal care services. Additionally, the effect of service availability was examined by analyzing the rate of low birth weight births within the service areas of these facilities. Results show large variation in the distribution of community health centers. Additionally, the analysis of local health department services shows that prenatal care services are not available in every jurisdiction. Furthermore, the rates of low birth weight births in these areas are significantly higher than in areas where prenatal care is available. Future studies are needed to examine the relationship between safety net providers as well as their role in improving population health.

Mapping the Location of Health Centers in Relation to “Maternity Care Deserts”

“…To our knowledge, this study is the first nationwide study to examine the availability of population-based services, more specifically maternal health services, offered by CHCs measured as visits to maternity care providers in relation to CHCs’ geographic distance to a “desert.” 30 Our results support our hypothesis according to which CHCs located closer to MCDs would have more visits for NPs and FPs, who are general practitioners, than for specialists, such OB/GYNs and nurse midwifes. This finding is consistent with the existing literature, which shows that specialist supply across the board tends to be lower in rural and MUAs and therefore NPs and FPs fill in the gap.…”