title: Utilization of prenatal care services in larger townships in Israel: should the service be reorganized?
abstract: BACKGROUND
  In Israel, preventive services for mothers and children are provided mainly by the Ministry of Health through a network of Maternal and Child Health clinics, and partly by municipalities and health maintenance organizations. Utilization of the MCH clinics for prenatal care has declined during the last decades.
  
  
  OBJECTIVE
  To study the utilization and satisfaction with prenatal care services following the introduction of the National Health Insurance Law.
  
  
  METHODS
  The study population comprised a national sample of Jewish and Arab women who were interviewed by telephone regarding the following: main service utilized for prenatal care, physician and nursing visits, satisfaction with care, and demographic and other characteristics. The response rate was 92% among Jewish women and 88% among Arab women.
  
  
  RESULTS
  Twenty percent of the Jewish and 52% of the Arab women selected MCH clinics as the main service for prenatal care. The great majority of the study population attended the HMO services (clinics, independent physicians, women's health centers), while 7% of the Jewish and 4% of the Arab women visited a private clinic. The predisposing factors affecting the women's choice were educational level, ethnic group, religiosity, district of residence, and type of HMO. The mean number of physician visits was more than the eight visits recommended. Forty percent of the sample visited with three or more physicians at different services. More than 40% of the women had no appointment with a nurse, mainly those who chose the services of an HMO clinic, independent physician, or private physician. Satisfaction with the physician, nurse, and physical structure of the main service chosen for prenatal care was high.
  
  
  CONCLUSIONS
  Since the majority of women preferred the HMO services, the merging of prenatal care with curative care provided by the HMOs has to be considered. Public health nurses should be integrated in the service, and their specific role needs to be defined.
authors.affiliation: Braun School of Public Health and Community Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. hpalti@vms.huji.ac.il
authors.forename: Hava
authors.initials: H
authors.lastname: Palti
authors.forename: Rosa
authors.initials: R
authors.lastname: Gofin
authors.forename: Bella
authors.initials: B
authors.lastname: Adler
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000592:standards / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D004522:Educational Status; D005260:Female; D019538:Health Care Surveys; D006279:Health Maintenance Organizations / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007557:Israel; D016015:Logistic Models; D008423:Maternal Age; D008427:Maternal Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D009313:National Health Programs / Q000592:standards* / Q000639:trends; D017060:Patient Satisfaction / Q000208:ethnology / Q000706:statistics & numerical data*; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D011295:Prenatal Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D012307:Risk Factors; D012494:Sampling Studies; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires