匈牙利生育的非正式现金支付：女性是为了确保已知的提供者、尊重还是护理质量而支付吗？

Informal cash payments for birth in Hungary: Are women paying to secure a known provider, respect, or quality of care?

机构信息

Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary; CERGE-EI Fellow, Prague, Czech Republic.

Department of Obstetrics and Gynecology, University of California at San Francisco, San Francisco, CA, USA; Department Global Health Sciences, University of California at San Francisco, San Francisco, CA, USA; Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary.

出版信息

Soc Sci Med. 2017 Sep;189:86-95. doi: 10.1016/j.socscimed.2017.07.015. Epub 2017 Jul 21.

DOI:10.1016/j.socscimed.2017.07.015

PMID:28787630

Abstract

BACKGROUND

In Central and Eastern Europe, many women make informal cash payments to ensure continuity of provider, i.e., to have a "chosen" doctor who provided their prenatal care, be present for birth. High rates of obstetric interventions and disrespectful maternity care are also common to the region. No previous study has examined the associations among informal payments, intervention rates, and quality of maternity care.

METHODS

We distributed an online cross-sectional survey in 2014 to a nationally representative sample of Hungarian internet-using women (N = 600) who had given birth in the last 5 years. The survey included items related to socio-demographics, type of provider, obstetric interventions, and experiences of care. Women reported if they paid informally, and how much. We built a two-part model, where a bivariate probit model was used to estimate conditional probabilities of women paying informally, and a GLM model to explore the amount of payments. We calculated marginal effects of the covariates (provider choice, interventions, respectful care).

RESULTS

Many more women (79%) with a chosen doctor paid informally (191 euros on average) compared to 17% of women without a chosen doctor (86 euros). Based on regression analysis, the chosen doctor's presence at birth was the principal determinant of payment. Intervention and procedure rates were significantly higher for women with a chosen doctor versus without (cesareans 45% vs. 33%; inductions 32% vs. 19%; episiotomy 75% vs. 62%; epidural 13% vs. 5%), but had no direct effect on payments. Half of the sample (42% with a chosen doctor, 62% without) reported some form of disrespectful care, but this did not reduce payments.

CONCLUSION

Despite reporting disrespect and higher rates of interventions, women rewarded the presence of a chosen doctor with informal payments. They may be unaware of evidence-based standards, and trust that their chosen doctor provided high quality maternity care.

摘要

背景

在中东欧，许多妇女会进行非正式的现金支付，以确保有一个提供产前护理的“指定”医生，即“选择”医生，以便在分娩时在场。该地区还普遍存在高比例的产科干预措施和不尊重产妇护理的情况。以前没有研究检查过非正式支付、干预率和产妇护理质量之间的关联。

方法

我们于 2014 年向匈牙利互联网使用的、在过去 5 年内分娩的具有代表性的女性（N=600）进行了在线横断面调查。该调查包括与社会人口统计学、提供者类型、产科干预措施和护理体验相关的项目。妇女报告是否进行了非正式支付，以及支付了多少。我们构建了一个两部分模型，其中使用二元 Probit 模型估计妇女进行非正式支付的条件概率，使用广义线性模型（GLM）模型探索支付金额。我们计算了协变量（提供者选择、干预、尊重护理）的边际效应。

结果

与没有选择医生的妇女（17%，86 欧元）相比，更多的有选择医生的妇女（79%）进行了非正式支付（平均 191 欧元）。基于回归分析，医生在场分娩是支付的主要决定因素。有选择医生的妇女的剖宫产率（45%对 33%）、引产率（32%对 19%）、会阴切开率（75%对 62%）和硬膜外麻醉率（13%对 5%）显著更高，但对支付没有直接影响。样本的一半（有选择医生的妇女为 42%，没有选择医生的妇女为 62%）报告了某种形式的不尊重护理，但这并没有减少支付。