Specialty bias in obstetric care for high-risk socioeconomic groups in Maine.

From 1982 to 1984, 46,501 infants were born in Maine hospitals in 46,286 deliveries, of which 6,343 were born to women on state Medicaid (Title 19), and 6,307 were born to women with no health insurance. In comparison with others born in Maine during those years, more infants in these presumed low socioeconomic groups died, were transferred immediately to other hospitals, had low birthweights, or were readmitted to a hospital within 30 days of birth. Of all deliveries, 105 family physicians or general practitioners performed 22 percent, 82 obstetricians performed 69 percent, and 16 osteopathic physicians performed 5 percent; but of Medicaid deliveries, obstetricians delivered only 59 percent, while family physicians-general practitioners and osteopaths did commensurately more. The decreased proportion of Medicaid patients cared for by obstetricians was especially prominent in Maine's urban hospital service areas. Pediatricians, on the other hand, cared for the same proportion of Medicaid children as they did all children in all hospital service areas in the state. The distribution of low socioeconomic, higher obstetric risk patient groups among various medical specialties as demonstrated in these data should be considered by health planners, malpractice insurers, and health insurers including state Medicaid programs.