Department of Global Health and Population, Takemi program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.
Department of Health Administration, Hanyang Cyber University, Seoul, Republic of Korea.
PLoS One. 2020 May 6;15(5):e0232760. doi: 10.1371/journal.pone.0232760. eCollection 2020.
The Korean government has been providing financial support to open and operate the maternal hospital in Obstetrically Underserved Areas (OUAs) since 2011. Our study aims to assess the effectiveness of the government-support program for OUAs and to suggest future directions for it.
We performed sequential-mixed method approach. Descriptive analyses and multi-level logistic regression were performed based on the 2015 Korean National Health Insurance claim data. Data for the qualitative analysis were obtained from in-depth interviews with health providers and mothers in OUAs.
Descriptive analyses indicated that the share of babies born in the hospitals located in the area among total babies ever born from mothers residing in the area (Delivery concentration Index: DCI) was lower in government-supported OUAs than other areas. Qualitative analyses revealed that physical distance is no longer a barrier in current OUAs. Mothers travel to neighboring big cities to seek elective preferences only available at specialized maternal hospitals rather than true medical need. Increasing one-child families changed the mother's perception of pregnancy and childbirth, making them willing to pay for more expensive services. Concern about an emergency for mothers or infants, especially of high-risk mothers was also an important factor to make mothers avoid local government-supported hospitals. Adjusted multi-level logistic regression indicated that DCIs of government-supported OUAs were higher than the ones of their counterpart areas.
Our results suggest that current OUAs do not reflect reality. Identification of true OUAs where physical distance is a real barrier to the use of obstetric service and focused investment on them is necessary. In addition, more sophisticated performance indicator other than DCI needs to be developed.
自 2011 年以来，韩国政府一直为在产科服务不足地区（OUAs）开设和运营妇产科医院提供财政支持。我们的研究旨在评估政府对 OUA 的支持计划的有效性，并为其提出未来的方向。
我们采用了顺序混合方法。根据 2015 年韩国国家健康保险索赔数据进行描述性分析和多层次逻辑回归分析。定性分析的数据来自 OUAs 中卫生提供者和母亲的深入访谈。
描述性分析表明，与其他地区相比，政府支持的 OUA 中，在该地区出生的婴儿占该地区所有母亲所生孩子的比例（分娩集中指数：DCI）较低。定性分析表明，目前 OUA 中的物理距离已不再是障碍。母亲们前往邻近的大城市，只为寻求在专门的妇产科医院才能提供的选择性偏好，而不是真正的医疗需求。独生子家庭的增加改变了母亲对怀孕和分娩的看法，使她们愿意为更昂贵的服务付费。对母亲或婴儿的紧急情况的担忧，尤其是高危母亲的担忧，也是使母亲避免当地政府支持的医院的一个重要因素。调整后的多层次逻辑回归表明，政府支持的 OUA 的 DCI 高于其对照地区。
我们的结果表明，当前的 OUA 并不反映现实。有必要确定真正的 OUA，在这些地区，物理距离是使用产科服务的真正障碍，并对其进行集中投资。此外，还需要开发比 DCI 更复杂的绩效指标。
