Details

Autor(en) / Beteiligte

• Rump, A.
• Schöffski, O.

Titel

Pregnancy care in Germany, France and Japan: an international comparison of quality and efficiency using structural equation modelling and data envelopment analysis

Ist Teil von

• Public health (London), 2018-07, Vol.160, p.129-142

Ort / Verlag

Netherlands: Elsevier Ltd

Erscheinungsjahr

2018

Link zum Volltext

Quelle

Applied Social Sciences Index & Abstracts (ASSIA)

Beschreibungen/Notizen

• Healthcare systems in developed countries may differ in financing and organisation. Maternity services and delivery are particularly influenced by culture and habits. In this study, we compared the pregnancy care quality and efficiency of the German, French and Japanese healthcare systems. Comparative healthcare data analysis. In an international comparison based mainly on Organisation for Economic Co-operation and Development (OECD) indicators, we analysed the health resources significantly affecting pregnancy care and quantified its quality using structural equation modelling. Pregnancy care efficiency was studied using data envelopment analysis. Pregnancy output was quantified overall or separately using indicators based on perinatal, neonatal or maternal mortality. The density of obstetricians, midwives, paediatricians and the average annual doctor's consultations were positively and the caesarean delivery rate negatively associated with pregnancy outcome. In the international comparison at an aggregate level, Japan ranked first for pregnancy care quality, whereas Germany and France were positioned in the second part of the ranking. Similarly, at an aggregate level, the Japanese system showed pure technical efficiency, whereas Germany and France revealed mediocre efficiency results. Perinatal, neonatal and maternal care quality and efficiency taken separately were quite similar and mediocre in Germany and France. In Japan, there was a marked difference between a highly effective and efficient care of the unborn and newborn baby, and a rather mediocre quality and efficiency of maternal care. Germany, France, and Japan have to struggle with quality and efficiency issues that are nevertheless different: in Germany and France, disappointing pregnancy care quality does not correspond to the high health care expenditures and lead to low technical efficiency. The Japanese system shows a high variability in outcomes and technical efficiency. Maternal care quality during delivery seems to be a particular issue that could possibly be addressed by legally implementing quality assurance systems with stricter rules for reimbursement in obstetrics. •Structural equation modelling can be used to score pregnancy care quality and to identify relevant healthcare resources.•Efficiency of pregnancy care depends whether physical or monetary inputs are entered in the analysis.•Among 24 countries, pregnancy care quality and efficiency in Germany and France revealed mediocre.•At an aggregate level, pregnancy care quality and technical efficiency is top in Japan.•In Japan, maternal care is less developed than neonatal or perinatal care.