Are “Obstetrically Underserved Areas” really underserved? Role of a government support program in the context of changing landscape of maternal service utilization in South Korea: A sequential mixed method approach

Objectives: The Korean government has been providing financial support to open and operate the maternal hospital in Obstetrically Underserved Areas (OUAs) since 2011. Our study aims to assess the effectiveness of the government-support program for OUAs and to suggest future directions for it. Methods: We performed sequential-mixed method approach. Descriptive analyses and multi-level logistic regression were performed based on the 2015 Korean National Health Insurance claim data. Data for the qualitative analysis were obtained from in-depth interviews with health providers and mothers in OUAs. Results: Descriptive analyses indicated that the share of babies born in the hospitals located in the area among total babies ever born from mothers residing in the area (Delivery concentration Index: DCI) was lower in government-supported OUAs than other areas. Qualitative analyses revealed that physical distance is no longer a barrier in current OUAs. Mothers travel to neighboring big cities to seek elective preferences only available at specialized maternal hospitals rather than true medical need. Increasing one-child families changed the mother’s perception of pregnancy and childbirth, making them willing to pay for more expensive services. Concern about an emergency for mothers or infants, especially of high-risk mothers was also an important factor to make mothers avoid local government-supported hospitals. Adjusted multi-level logistic regression indicated that DCIs of government-supported OUAs were higher than the ones of their counterpart areas. Conclusion: Our results suggest that current OUAs do not reflect reality. Identification of true OUAs where physical distance is a real barrier to the use of obstetric service and focused investment on them is necessary. In addition, more sophisticated performance indicator other than DCI needs to be developed.