J Korean Soc Matern Child Health.  2023 Apr;27(2):51-59. 10.21896/jksmch.2023.27.2.51.

Can an Increase in Delivery Medical Fees Prevent the Collapse of the Maternity Infrastructure System?

• Ahn TK
• Hwang JY

• KMID: 2542186
• DOI: http://doi.org/10.21896/jksmch.2023.27.2.51

Abstract

In an era of low fertility, the maternity infrastructure system has collapsed steeply and the number of obstetrically underserved areas has increased. To improve the maternity infrastructure, the Yoon Suk Yeol administration has announced the introduction of an essential medical support policy centered on introducing an additional delivery medical fee. The core of the essential medical policy for labor and delivery is the addition of regional medical fees, safety policy additional fees, and infectious disease-controll policy additional fees to the existing labor and delivery medical fees. The government's delivery medical additional fees will vary according region, with 200% increase in metropolitan cities, 300% increase in nonmetropolitan cities, and an additional 100% increase in the event of an infectious disease outbreak. After analyzing the government's plan to support additional fees, it is estimated that the total delivery expenses will be increased by Korean won (KRW) 236,619,748,266, and KRW 485,872,173 per maternity hospital. Even though this support plan is expected to help maintain maternity hospitals, this plan has limitations in small maternity hospitals in metropolitan cities and maternity hospitals for high-risk pregnant women. This is because the government's support policy is based on the "medical payment system by action," which is less effective in rural maternity hospitals with fewer deliveries and in training hospitals that mainly treat high-risk pregnant women rather than simple deliveries. Additionally, given the expected decline in the number of births in the future, it is estimated that the total delivery medical fees will steadily decline, as will the income per maternity hospital. To maintain a sustainable maternity infrastructure, it is essential to introduce the medical fees for operating a maternity delivery room that can be maintained, the medical fees for high-risk pregnancies, and various salary and protection support policies for obstetricians and nurses in addition to delivery medical fees.

Keyword

Maternity system; Medical fee; Low fertility

Figure

• 

  Fig. 1. Change of delivery medical fee based on goverment support plan.

Reference

Ahn TG., Hwang JY. Secure plan of appropriate obstetricians and nurses for safe childbirth in Korea. J Korean Soc Matern Child Health. 2017. 21:14–23. https://doi.org/10.21896/jksmch.2017.21.1.14 .

Ahn TG., Kim TY., Kim YJ., Hwang JY. The current state of maternity care and suggestions for improvement in the management of high-risk pregnancies in South Korea. J Korean Soc Matern Child Health. 2018. 22:134–41. https://doi.org/10.21896/jksmch.2018.22.3.134 .

Choi S., Lee KS. The spatial accessibility of women in childbearing age for delivery services in Gangwon-do. Health Policy Manag. 2017. 27:229–40. https://doi.org/10.4332/KJHPA.2017.27.3.229 .

Choi YH., Na BJ., Lee JY., Hwang JH., Lim NG., Lee SK. Obstetric com-plications by the accessibility to local obstetric service. J Agric Med Community Health. 2013. 38:14–24. https://doi.org/10.5393/JAMCH.2013.38.1.014 .

Kwak MY., Lee SM., Lee TH., Eun SJ., Lee JY., Kim Y. Accessibility of prenatal care can affect inequitable health outcomes of pregnant women living in obstetric care underserved areas: a nationwide population-based study. J Korean Med Sci. 2018. 34:e8.

Lee SJ., Li L., Hwang JY. After 20 years of low fertility, where are the obstetrician-gynecologists? Obstet Gynecol Sci. 2021. 64:407–18. https://doi.org/10.5468/ogs.21138 .

Shin SM., Chang YS., Chang MY., Lee CH., Kim GG., Oh SY, et al. Re-search on the operation of professional staff and systemic support for the maternal and child healthcare support project. Sejong (Korea): Ministry of Health and Welfare;2021. https://policy.nl.go.kr/search/searchDetail.do?rec_key=SH1_UMO20211292347&kwd=.

Statistics Korea. Korean statistcal information service [Internet]. Daejeon (Korea): Statistics Korea;2022. [cited 2023 Mar 14]. Available from: https://www.index.go.kr/unity/potal/indicator/IndexInfo.do?cdNo=2&clasCd=10&idxCd=F0008 .