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User charges for antenatal care and ultrasound--an unwillingness to pay
Objective:
The aim of this study was to evaluate attitudes towards user charges in specialized antenatal care, as well as if ultrasound for dating and antenatal care provided by a midwife or family doctor had been charged.
Subjects And Methods:
Participants included all women delivering and registered for antenatal care at the Umeå University Hospital from September 15th-December 20th, 1995. Questionnaires, used to measure attitudes towards specialist fees, and the influence these user charges have on the utilization of services, were mailed two weeks post partum.
Results:
Few mothers, 4%, actually hesitated or refrained from charged care, while 19%-50% would have hesitated or refrained from care if being charged. Bad economy was the significant risk factor for unwillingness to pay for care by midwife OR 2.7 (95% CI 1.4-5.6) and family doctor OR 2.5 (95% CI 1.3-5.0), referral charged for specialist care OR 4.2 (95% CI 0.5-38) and if charged early ultrasound OR 4.6 (95% CI 2.4-9.2). When adjusted for economy neither young maternal age, father's unemployment or low birth weight were significantly associated to a unwillingness to pay.
Conclusions:
The attitudes expressed implied that user charges could lower attendance of pregnancy ultrasound and antenatal care. This could add a substantial negative impact on perinatal outcome to an already affected group of infants with an increased risk of a low birth weight and preterm delivery, and interfere with the benefits of early dating by ultrasound.