title: Decreased Risk of Preeclampsia After the Introduction of Universal Voucher Scheme for Antenatal Care and Birth Services in the Republic of Korea.
abstract: Objectives A number of interventions to reduce disparities in maternal health have been introduced and implemented without concrete evidence to support them. In Korea, a universal voucher scheme for antenatal care and birth services was initiated in December 2008 to improve Korea's fertility rate. This study explores the risk of preeclampsia after the introduction of a universal voucher scheme. Methods Population-based cohort data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) covering 2002-2013 were analysed. A generalized linear mixed model (GLMM) was used to estimate the relationship between the risk of preeclampsia and voucher scheme introduction. Results The annual age-adjusted incidence of preeclampsia showed no significant unidirectional change during the study period. In the GLMM analysis, the introduction of a voucher scheme was associated with a reduced risk of preeclampsia, controlling for potential confounding factors. The interaction between household income level and voucher scheme was not significant. Conclusions for Practice This finding suggests that the introduction of a voucher scheme for mothers is related to a reduced risk of preeclampsia even under universal health coverage.
authors.affiliation: Department of Preventive Medicine, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.|Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea.
authors.forename: Seung-Ah
authors.initials: SA
authors.lastname: Choe
authors.affiliation: Department of Preventive Medicine, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.
authors.forename: Hye Sook
authors.initials: HS
authors.lastname: Min
authors.affiliation: Department of Epidemiology, Institute for Health and Environment, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, Republic of Korea. persontime@hotmail.com.
authors.forename: Sung-Il
authors.initials: SI
authors.lastname: Cho
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006078:Government Programs / Q000379:methods / Q000592:standards; D006801:Humans; D008427:Maternal Health Services / Q000592:standards* / Q000706:statistics & numerical data; D011225:Pre-Eclampsia / Q000178:diet therapy / Q000453:epidemiology / Q000517:prevention & control*; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D040242:Risk Reduction Behavior; D019472:Universal Health Insurance; D035862:Vulnerable Populations / Q000706:statistics & numerical data
keywords: Korea; National Health Insurance Service–National Sample Cohort; Preeclampsia; Voucher