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Published on: February 23, 2011
Utilisation of supplementary prenatal screening and diagnostics in Germany: cross-sectional study using data from the
Johanna Mayer1,2,3, Susanne Brandstetter1,4, Christina Tischer3,5
1University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, Steinmetzstr., 1-3, 93049, Regensburg, Germany.
Insights
Private health insurance significantly increases the use of supplementary prenatal screening, while need factors have a smaller impact. This highlights potential inequities in maternal healthcare access.
Area of Science:
- Maternal and child health
- Health services research
- Prenatal diagnostics
Background:
- Appropriate health system utilization during pregnancy is crucial for maternal and child well-being.
- Understanding the use and determinants of supplementary prenatal screening and diagnostics is essential in Germany.
Purpose of the Study:
- To investigate the factors influencing the uptake of supplementary prenatal screening and diagnostics in Germany.
- To analyze predisposing, enabling, and need factors associated with prenatal screening utilization.
Main Methods:
- Utilized data from the prospective KUNO Kids Health Study in Germany.
- Applied Andersen's Behavioral Model of health system use for analysis.
- Employed logistic regression to examine associations with screening and diagnostic use.
Main Results:
- 1886 mothers participated; one-fifth used no supplementary screening.
- Private health insurance (OR 2.336) and maternal age (OR 1.038) increased usage.
- Environmental tobacco smoke exposure (OR 1.465) and at-risk pregnancy (OR 1.688) were also associated with increased use.
Conclusions:
- The type of health insurance plays a significant role in accessing supplementary prenatal care.
- Need factors showed a relatively smaller influence than expected, raising concerns about healthcare equity.
Background:
Appropriate health system utilisation during pregnancy is fundamental for maintaining maternal and child's health. To study the use and determinants of supplementary prenatal screening and diagnostics in Germany this study provides comprehensive data.
Methods:
We obtained data from a recently established prospective German birth cohort study, the KUNO Kids Health Study. Analyses are based on Andersen's Behavioural Model of health system use, which distinguishes between predisposing (e.g. country of birth), enabling (e.g. health insurance) and need factors (e.g. at-risk pregnancy). We examined bi- and multivariate association with the use of supplementary prenatal screening and diagnostics using logistic regression.
Results:
The study has a sample size of 1886 participating mothers. One fifth of the mothers investigated did not use any supplementary prenatal screening or diagnostics. Notably, the chance of using supplementary prenatal screening and diagnostics more than doubled if the pregnant woman had a private health insurance (OR 2.336; 95% CI 1.527-3.573). Higher maternal age (OR 1.038; 95% CI 1.006-1.071) and environmental tobacco smoke exposure (OR 1.465 95% CI 1.071-2.004) increased the use of supplementary prenatal screening and diagnostics. However, regarding need factors only having an at-risk-pregnancy (OR 1.688; 95% CI 1.271-2.241) showed an independent association.
Conclusion:
The important role of the type of health insurance and the relatively small influence of need factors was surprising. Especially with respect to equity in accessing health care, this needs further attention.
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