Pattern of Obstetric Clinic Attendance, Deliveries and Neonatal Outcome at a Tertiary Hospital during and after a Free Medical Care Programme

Background: Policies and programs aimed at giving access to healthcare free of charge for some segments of the population are increasingly being put in place by low and middle-income countries. The impact of such policies has so far been rather mixed.Objective:This study sought to determine the pattern of obstetrics clinic attendance, deliveries and neonatal outcome during and after a Free Medical Care (FMC) Programme. Was there any significant difference during and after the FMC programme? Methodology:This was a retrospective population-based study involving the three years of a free medical care programme (2012-2014) and the three years after the programme (2015-2017). Data on antenatal/postnatal clinic attendance, method of deliveries and neonatal outcome were retrieved from the hospital records. The Epi-Info 7 statistical software was used for analysis and statistical significance was set at p<0.05.Results:Mean antenatal attendance was 20763.67±6085.71 and 14269.00±1932.71 during and after the programme respectively, but this difference was not significant (P = 0.143). The mean postnatal attendance of 1457.7±447.69 during and 1025.7±193.52 after was not significant (P=0.200). There was more total number of deliveries during (8596) than after (5989) but this was not significant (P=0.171). There were more operative deliveries during (51.9%) than after (39.3%) and this was significant (P=0.0001). The CS rate was 43.1% with previous CS and CPD both responsible for over 40%. Livebirths were 8,272 (58.8%) duringand 5,796 (41.2%) after, which was significant (P=0.0001). There was significant difference (P=0.006) in the macerated stillborn (MSB) rate during (44.2%) and after (55.8%). The stillborn rate was 66.9 during and 98.2 after the programme.Conclusion: There were more clinic attendance and deliveries during the programme, but it was not statistically significant. There was however statistically significant increase in operative delivery, total births and livebirths, and reduced MSB rate during the programme

Is free medical care possible?

Free medical care is currently a highly debated issue in Korea. However, from a practical point of view, 'completely free' medical care is impossible. Last year the National Health Insurance Corporation (NHIC) reported a huge deficit of up to 1.3 trillion in Korean won, which is the largest deficit in the past 10 years. NHIC expenditures are skyrocketing for many reasons: drug overuse, very expensive new drugs or devices increasing geriatric population and survivors of cancer or chronic illnesses, expanding insurance coverage for new diagnostic tests, drugs, neonates, rare diseases, disabilities, and cancer, occurrence of new diseases, increasing number of doctors, moral hazard, and wasting of resources due to the duplication and counteraction between modern medicine and Oriental medicine. What, then, should we do to provide partially free medical care? We need to reduce expenditures for drugs and increase health insurance premiums. Korean health insurance premium currently low compared to that of other countries in Organization for Economic Co-operation and Development. It is also necessary to introduce the concept of a health tax, in which healthy individuals with a high income pay higher premiums while sick or low-income individuals pay lower premiums. Expanding public health coverage such as vaccinations, regular health surveillance programs, and education on health promotion should be implemented. Private health care insurance can be introduced carefully with close monitoring. The last and most important recommendation is that society must become more ethical and transparent. Korea is entering a new era as a developed country and as a result a welfare system, including medical care is notoptional but is mandatory in some part. However, even a partially free medical care is going to be possible only if the entire health care system is operated in an ethical and efficient way for maximal utilization of limited resources while avoiding moral hazard and waste.

Research on Doctor-Patient Relationgship in the Free Medical Care System of Undergraduate——Taking the Universities in Beijing as an Example / 中华医学教育探索杂志

At present,the satisfaction of free medical care of undergraduate is declining,and the doctor-patient relationship is becoming tense.By investigating and interviewing the three representative universities in Beijing,we conclude three reasons including the supplier of medical service,the receiver and doctor-patient communication.By adhering to the medical treatment concept of"Patient-Oriented",the paper puts forword serveral measures including incresing input and improving system and so on to achieve the harmonious development of doctor-patient relationship of undergraduate.

A study on social help for the medical care of senior citizens with great financial difficulties(SCGFD) in Luwan District of Shanghai / 中华医院管理杂志

Supported by various departments concerned of the district government, medical workers in Luwan District of Shanghai started in 1994 to set up in the whole district community based social help network for the medical care of SCGFD. In the last 4 years, the annual outpatient volume of SCGFD averaged 3.9 times and the annual visits received by SCGFD averaged 2.2 times. The conditions of 78.1% of SCGFD suffering from an illness turned for the better or became stable. The annual hospitalization utilization ratio averaged 5.4%. After hospitalization, 89.5% of SCGFD suffering from a serious illness fully recovered from their illness or were discharged after turning for the better. The average outpatient expenses per time, hospitalization expenses per day and per time of SCGFD respectively dropped 32.1%, 21.5% and 30.4%, as compared with the group of senior citizens enjoying free medical care. The authors hold that the social help network for the medical care of SCGFD in Luwan District is an easy to operate and effective community based medical security system for SCGFD. It has produced sound social repercussions after being put into practice. The controlled use of medical funds has ensured the normal operation of the network.