Supply-Side Impact of Supporting Obstetrically Underserved Areas: A Nationwide Cross-Sectional Study

There is limited evidence on the effectiveness of financial incentives in improving the shortage of obstetrics/gynecology (OB/GYN) specialists in underserved areas. This study aimed to examine whether the financial incentives for OB/GYN clinics were associated with improved availability of OB/GYN specialists in obstetrically underserved areas (OUA) and potentially obstetrically underserved areas (POUA) in South Korea.

A cross-sectional study design was employed to observe all cities (n = 240) in South Korea for a period of 10 years (2011-2020). The cities were divided into intervention groups (cities designated as OUA and POUA) and control groups (all other rural districts). A two-way fixed-effects linear regression was used to explore the policy's association with the number of specialists at the city level. The availability of OB/GYN specialists was evaluated based on the number of total/full-time/part-time OB/GYN specialists and facilities with full-time OB/GYN specialists per 1,000 females of reproductive age. The exposures considered were grant incentives for facility and equipment costs, human resources, and additional reimbursement rates for deliveries.

A total of 240 South Korean cities were identified as analytic samples from 2011 to 2020 (2,400 city-year observations). The number of total OB/GYN specialists decreased (-3.390 per 1,000 females of reproductive age; P < 0.001) in cities designated as OUA and POUA (intervention group) after the introduction of combined financial incentives (grant and additional reimbursement since 2016). Results showed that the number of full-time OB/GYN specialists increased (0.083 per 1,000 females of reproductive age; P = 0.007). However, that of part-time OB/GYN specialists decreased (-3.473 per 1,000 females of reproductive age; P < 0.001). The number of facilities with full-time OB/GYN specialists also increased (5.775 per 100,000 females of reproductive age; P = 0.036).

This cross-sectional study revealed that financial incentives, including grants and reimbursement rates, were insufficient to improve the availability of OB/GYN specialists in underserved areas of South Korea. Therefore, multidimensional financial and nonfinancial approaches are required to ensure a stable supply of specialists at vulnerable sites.