Distribution and impact of primary healthcare funding in inadequate prenatal care usage: a retrospective population-based cohort study

Abstract

Timely access to prenatal care is necessary to improve perinatal outcomes. The scope of this study was to assess how funding is distributed among sociodemographic groups and if funding impacted the adequacy of antenatal care usage. A retrospective cohort study was conducted. The Kotelchuck Index was used to classify prenatal care usage. Public primary care funding was classified as fixed or variable spending. Municipalities were classified as low, medium-low, medium-high, and high funding, ranking separately per funding type. Poisson regressions were used to calculate the relative risk of inadequate prenatal care usage. Inadequate antenatal care usage was present in 20.2% of the cohort. Higher funding was associated with a lower risk of inadequate prenatal care utilization. A high variable funding level had the highest effect, with an RR of 0.88. Patients who were black, mixed race, or didn’t have a partner were underrepresented in higher funding levels. The variable model had higher monetary volume and was more impactful. Broad social vulnerability indicators are inadequate to direct funding among the specific population of pregnant patients, which could benefit from a particular funding model and criteria.