The Impact of Informed Variation for Pregnant Women on the Utilization of Prenatal care、mode of delivery and Neonatal Health status

• Main Authors: Chou, Shiou-Shin, 周曉馨
• Other Authors: Yang, Chiang-Hsing Ph. D
• Format: Others
• Language: zh-TW
• Published: 2007
• Online Access: http://ndltd.ncl.edu.tw/handle/64524071490728761756

碩士 === 國立台北護理學院 === 醫護管理研究所 === 95 === Background: The information asymmetry may result in the difference in choosing medical services. Physician’s expertise influences their own as well as their spouses’ choices of medical care. Although some studies had explored this issue, their findings varied from one paper to another. On the other hand, because of language barriers and cultural differences, lay consumers and immigrant women have relatively less medical information. Whether they could have different medical choices or not is worth to study. Most of the previous studies focused on one single-issue, integrated perspectives and empirical evidence addressed on these two issues is lack. Objectives: To bridge the existing gap, this study examined the differences concerning the adequacy of prenatal care, the mode of delivery, and neonatal health status of their infants between medically informed consumers (female physicians and male physicians’ spouses) and lay consumers (domestic and immigrant women). Materials & Methods: A cross-sectional correctional study design was employed. Data were obtained from the Bureau of National Health Insurance Inpatient Case File, and the observation period is from July 1, 2005 to June 30, 2006. Hierarchical logistic regression analysis was applied. Results: 1. The adequacy of prenatal care was not found to be insignificantly different between informed consumer and lay consumer groups. But compared to domestic pregnant women, immigrants pregnant women tendered to under utilize prenatal care (OR=1.142, 95% CI：1.073-1.215). 2. There was no significant difference in the mode of delivery between informed consumers and lay consumers. But compared to domestic pregnant women, immigrants pregnant women was less likely to undergo cesarean section (OR=0.778, 95% CI：0.712-0.850). While, female physicians themselves were in higher likelihood to use cesarean section as the mode of delivery (OR=1.700, 95% CI：0.871-3.316). 3. The health status for the neonates born by informed or lay mothers was not found to be statistically significant. Nevertheless, neonates born by immigrant mothers tended to be healthier and less likely being admitted to hospital (OR=0.306, CI：0.247-0.379)than those neonates born by domestic mothers. In addition, those neonates born by domestic lay mothers tended to be less healthy and in a higher likelihood of being admitted to hospital, compared to those bore by the medically informed mothers (OR=0.225, 95% CI：0.031-1.6420). Conclusions: Compare to lay domestic women, medically informed consumer group tended to use less prenatal care, it could because they seek informal consultations for substitute. A higher cesarean section rate of female physicians could due to their higher working opportunity costs, higher ages, afraid of pain, and better perception concerning the risk of cesarean operation. Additionally, because of their professional advantages, informed consumers’ usually have better neonatal care, consequently they are more likely to have healthier neonates. In contrast, the inadequacy of prenatal care for immigrant women might result from the under coverage of insurance. A significantly lower cesarean section rate might reflect the social-economical and cultural differences for immigrant women. Neonates born by immigrant mothers tended to be healthier and have a lower risk of inpatient care could because mothers were younger and in better health status. Limitations: Because the inherent constraints with secondary data, when female immigrants change their nationalities, and become residents/citizens of Taiwan, their original identification changed. This identification change could make them categorized as domestic lay women. Another limitation was that the classification of a subject‘s social economic status was based on the insured’ premium, which would lead to less precise measure of this variable. Key words: information asymmetry, informed consumers, immigrant women, cesarean section, normal spontaneous delivery, utilization of prenatal care, neonatal health status, perinatal period disease.