Arsenijevic Jelena, Pavlova Milena, Groot Wim
Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands.
Birth. 2014 Mar;41(1):14-25. doi: 10.1111/birt.12096.
Maternity care in Serbia is an integrated part of the centralized health care system inherited from the former Yugoslavia. Childbirth is often perceived as a medical event instead of a physiological process. This paper examines quality and access indicators, and patient payments for maternity care in Serbia.
We apply a method of triangulation using data collected through three sources: online questionnaires filled in by mothers who delivered in one of the maternity wards in Serbia in the period 2000-2008, research publications, and official guidelines. To compare the qualitative data from all three sources, we apply framework analysis.
The results show a good network of maternity wards in Serbia. On the other hand, many women who gave birth in maternity wards in Serbia indicate problems with the treatment they received. The existence of informal patient payments and so-called "special connections" make the position of Serbian women in maternity wards vulnerable, especially when they have neither connections nor the ability to pay. Poor communication and bedside manner of medical staff (obstetricians, other physicians, midwives, and nurses) during the birth process are also frequently reported.
Actions should be taken to improve bedside manners of medical staff. In addition, the government should consider the involvement of private practitioners paid by the national insurance fund to create competition and decrease the need for informal payments and "connections."
塞尔维亚的孕产妇保健是从前南斯拉夫继承而来的集中式医疗保健系统的一个组成部分。分娩常常被视为一个医疗事件而非生理过程。本文考察了塞尔维亚孕产妇保健的质量和可及性指标以及患者支付情况。
我们运用三角测量法，使用通过三种来源收集的数据：2000年至2008年期间在塞尔维亚某一产科病房分娩的母亲填写的在线问卷、研究出版物以及官方指南。为比较来自所有三种来源的定性数据，我们运用框架分析法。
结果显示塞尔维亚有良好的产科病房网络。另一方面，许多在塞尔维亚产科病房分娩的妇女表示她们所接受的治疗存在问题。非正式患者支付以及所谓“特殊关系”的存在使塞尔维亚妇女在产科病房的处境脆弱，尤其是当她们既没有关系又没有支付能力时。分娩过程中医护人员（产科医生、其他医生、助产士和护士）沟通不良和态度不好的情况也经常被报道。
应采取行动改善医护人员的态度。此外，政府应考虑让由国家保险基金支付薪酬的私人执业者参与进来，以形成竞争并减少对非正式支付和“关系”的需求。
