Journal List > Korean J Perinatol > v.25(3) > 1013710

TOOLS
Kim and Moon: Integrated Care Center for High Risk Pregnancy and Neonate - An Analysis of Process and Problems in Obstetrics
Original Article

Korean J Perinatol 2014;25(3):140-152.

Published online: 21 September 2014

DOI: https://doi.org/10.14734/kjp.2014.25.3.140

Integrated Care Center for High Risk Pregnancy and Neonate - An Analysis of Process and Problems in Obstetrics

Ho-Yeon Kim, M.D., Chong Soo Moon, M.D.

Department of Obstetrics and Gynecology, College of Medicine, Hallym University, Seoul, Korea

Received 2 July 201414 August 2014       Accepted 28 August 2014

Copyright © 2014 Korean Society of Perinatology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The medical environment of obstetric field has been deteriorated seriously, which is caused by sharply declined birth rates and several other causes in Korea. Inversely, the prevalence of high risk pregnancy is continuously going to explode, and human resources and facilities in delivery unit are still in shortage. It is greatly needed to be reinforced, but rather diminished substantively. Finally, maternal death rate of Korea has been extremely increased. It is time that the policies for treatment of high risk maternity in national level, no more leave the situation unchanged. The integrated care system which treats high risk maternity and neonate sequentially is very important in their disease characteristics. It is sure that the integrated management of high risk pregnancy and neonate can make an important role in the improvement of perinatal and maternal death rate and maternal-neonatal health care. Therefore, Ministry of Health and Welfare made a policy that establishes ‘Integrated Care Center for High Risk Pregnancy and Neonate’ for high risk maternity and neonate. It is supposed to start from four centers as a demonstration project in 2014, and will finally establish 17 centers in 11 broad territories of the country in 2017. It will accomplish a task of emergency center, and carry out treatment and emergency operation at all times. In addition, it will take the roll of emergency transfer system, data collection and analysis, and preventive management service through public education and relations. In the future, Integrated Care Center will play an important role in improving maternal health care as well as obstetric infrastructure.

Keywords: Maternal death rate, High risk pregnancy, Integrated Care Center for High Risk Pregnancy and Neonate

REFERENCES

1.National Statistics Korea. National health medical survey. Cause of death statistics, maternal death rate. 2012.
2.OECD Family database. 2012.
3.Choi EH. Integrated care center for high risk pregnancy and neonate, direction of policy. Public hearing by Korean Society of Perinatology and Ministry of Health and Welfare. Konkuk University Hospital. 2013.
4.Kim YH. Integrated care center for high risk pregnancy and neonate, establishment. Public hearing by Korean Society of Perinatology and Ministry of Health and Welfare. Konkuk University Hospital. 2013.
5.Ministry of Health and Welfare. Answer for advisory opinion about Integrated care center for high risk pregnancy and neonate. Ministry of Health and Welfare. 2013.
6.Ministry of Health and Welfare. 2014 Support project guidance about Integrated care center for high risk pregnancy and neonate. Ministry of Health and Welfare. 2014.
7.National Statistics Korea. National health medical survey. Census statics survey, total birth rate.2008–2012.
8.Korean Society of Maternal Fetal Medicine. The survey on the actual conditions of delivery room and delivery of high-risk pregnancy, definition and classification of high pregnancy. Korean Society of Maternal Fetal Medicine and Ministry of Health and Welfare. 2012.
9.Health Insurance Review and Assessment Service. National health medical survey. Rate of high risk pregnancy. 2012.
10.National Statistics Korea. Census statics survey, Current state according maternal aging. 2012.
11.Health Insurance Review and Assessment Service. National health medical survey. Medical fee for system. 2012.
12.Oh SY. Assessment of emergency charge and night delivery fee in delivery unit. 2nd maternal and child health promotion subject. Public hearing by Ministry of Health and Welfare. 2013.
13.Moon CS. Installation of internet based high risk maternal and neonatal delivery system. 2nd maternal and child health promotion subject. Public hearing by Ministry of Health and Welfare. 2013.
14.Korean Society of Obstetrics and Gynecology. National health medical survey. Current state of the residentship and specialist of Obstetrics and Gynecology. 2013.
15.Korean Medical Association. National health medical survey. Current state of medical specialists according medical department. 2013.
16.Korean Hospital Association. National health medical survey. Current state of residentship supply and demand on medical departments. 2013.
17.Ministry of Health and Welfare. National health medical survey. Current state of medical vulnerable area. 2012.
18.Lee YJ., Kim SH., Seol HJ., Chung SH., Choi YS., Lee KS, et al. Changes in statics of maternal death in Korea (1995-2010). Korean J Perinatol. 2012. 23:179–87.
19.Sullivan SA., Hill EG., Newman RB., Menard MK. Maternal-fetal medicine specialist density is inversely associated with maternal mortality ratio. Am J Obstet Gynecol. 2005. 193:1083–8.
20.Ministry of Health and Welfare. National health medical survey. Maternal death rate by regional group. 2012.
21.Korean Society of Maternal Fetal Medicine. The survey on the actual conditions of delivery room and delivery of high-risk pregnancy, Medical current status –medical delivery system and medical vulnerable area. Korean Society of Maternal Fetal Medicine and Ministry of Health and Welfare. 2012.

Fig. 1.
The number of live birth and birth rate in Korea.1
kjp-25-140-f1.tif
Fig. 2.
Advanced maternal age in Korea.7
kjp-25-140-f2.tif
Fig. 3.
High risk pregnancy rate according to maternal age in Korea.9
kjp-25-140-f3.tif
Fig. 4.
The change of obstetricians in Korea.14 A) The chronological change of new members of the specialist of obstetrics and gynecology. B) The chronological change of sexual difference of the specialist of obstetrics and gynecology. C) Comparison of age distribution between the specialist of obstetrics and gynecology and internal medicine (%).
kjp-25-140-f4.tif
Fig. 5.
Change of maternal death ratio and number of new Obstetrician in Korea.1,11,14,18
kjp-25-140-f5.tif
Fig. 6.
Comparison of maternal death ratio and number of Obstetrician in tertiary hospital in 2002 Korea.1, 7, 20 A) Local difference of maternal death rate. B) Local difference of Obstetrician number in tertiary hospital.
kjp-25-140-f6.tif
Fig. 7.
Structural components of Integrated Care Center of High Risk Pregnancy and Neonate.3, 4, 6
kjp-25-140-f7.tif
Table 1.
OECD major countries birth rate in 20102
Countries France Sweden UK Denmark Finland Netherlands Korea OECD average
Birth rate 1.99 1.98 1.98 1.88 1.87 1.80 1.22 1.74
Table 2.
The number of live birth and birth rate in Korea7
Year 2000 2005 2010 2012
Live births 635,000 435,000 470,000 484,000
Total birth rate 1.46 1.07 1.22 1.30
Table 3.
The definition and classification of high risk pregnancy5
Obstetrics risk factors Medical risk factors Physical risk factors Current pregnancy risk factors
Grade I 㟼㡰叼㙣㢨 匄厐䟛 䴇丘䌯㢨 吀㞏䟛 䏬匄㨔 ο ο 口
(mild) ⼤㪼凐⧫㢨 匄厐䟛 ⢟㨐 ≤1 pack/㢄
Hb ≤9 g/dL 䆸⧸
㟫㴠匠ᅡ㟿 䓈㟤
Grade II 䏨䌋䯤 㣠㽐 叼㘸 㽐䕘 佨㢌 (35-39, ≤15㻈) 㪃䓄/㪴ガ㧔 佘㥗
(moderate) 㡰叼㙣㢨 匄厐䟛 NYHA class ᅵ 㴔䊀㟼 匠匄㍌㛯 (BMᅵ <30 kg/m2) 㴠㥐㴠㨄
㢌㟼 㟤㦫㟸古㷠 ⧸㍓⪧厀㽔㼿㻏䘜古 㘸⦨ ⧯匘䏨 Hb ≤9 g/dL 䆸⧸
㢌㟼 㡰剿㟸古㷨㷠 ⰰ㘸⦨ 䴜䉼䘴䊀 (>3) 䏬㢌䠔㵜 㘸⦨ 台㨄
可㼿㻠 㘸⦨ 䘴凐 ⤼ 㡼㴠 (≥42wks)
㡰吀䖌㨓㘸⦨ 䆼㟫㼿 ⼤㣼
㩯㷨匄䴜㙣
㩯㷨匄㹴㙣
㣋䕘㩯䘷㨄
⼤㪼凐⧫
Grade III 㢌㟼 㽔㽐 凐㦫䟛 䘴㻏 匠⧸㪫 㡰剿千匀 䓌䟛㙣 㞐凐䉼䘴㘼⹋ (<34㜄)
(severe) 㢌㟼 㴠㼣㪼㽔䘣 凐㦫䟛 NYHA class ᅵ 㴔䊀㟼 㡰剿凐⧫ 㞐凐㩯䘷⳴㷨 (<34㜄)
㥗⧸㻏 㘸⦨ ⼤㪼 㷨⧸ 䴇丘䌯 㽐䕘 佨㢌 (≥40㻈) 㡰剿佌 㻏㡛 㟤⪤
㛯䬏䰼 䏱 㛯㙣 㴠 㘸⦨ 厐厐䴀㪼
㡼㴠㻏 匠⧸㪫
䴜⼤㡼㴠
⼤䏨㞐凐䏫䙔
㟼ㆨ⼤䏨
㡰剿⳴㨌
㽐⤼㉤⧸
㼷㟼㙣
Table 4.
High risk pregnancy rate in Korea9
㟼㍌㽐䕘 (䕻) 匠㣼⨨㽐䕘 (䕻) 䆼㣘 (%)
2008 451,790 179,465 39.7
2009 431,698 174,243 40.3
2010 457,664 193,593 42.3
2011 459,239 196,740 42.8
Table 5.
The charge for medical insurance fee in Korea11
㴤㷠䕻㆓ 匠㴤 㷨吀
㟤㦫㟸古䘴㉤㷠 (1⼤㪼 㡼㴠, ㋸㽐) - ㋸⥴ 280,080
㟤㦫㟸古䘴㉤㷠 (1⼤㪼 㡼㴠ô千㽐) - ㋸⥴ 238,920
㟤㦫㟸古䘴㉤㷠 (䴜⼤㪼 㡼㴠ô㋸㽐) - ㋸⥴ 315,960
䉼䘴 (㋸㽐) 266,150
䉼䘴 (千㽐) 216,610
12㜄 䐈䘴 匼䚨㣠㽐 63,680
㉗㷨㟸㟤㷠 (䴘㷤ô㦈匄㟼䓈㢨) 311,737
䴌体㟸㟤㷠 (㦈匄㟼䓈㣄ᅵ) 583,622
ㆨ⪋刄ㆨ㷠 (㦈匄㟼䓈㢨) 308,789
㻤⧤䊀 ⨸䴸㪼 刄䌈㷨㷠 (凐⽀, 㦈匄㟼䓈㣄ᅵ) 405,310
Tonsilectomy (㩯㇟) 201,875
Table 6.
The change of obstetrics institutions in Korea11,16
A. The chronological change of obstetrics institutions opening and closing
2008 2009 2010 2011 2㢌2
古㨻 ⰰ㨻 古㨻 ⰰ㨻 古㨻 ⰰ㨻 古㨻 ⰰ㨻 古㨻 ⰰ㨻
㋣⪗匼 148 203 118 156 93 148 102 148 64 90
㼿凷㝻⪗䌯㤰 1 1
㝻⪗䌯㤰 19 14 8 7 13 11 13 14 8 8
䌯㤰 41 33 26 24 26 23 34 19 18 17
㢨㤰 87 155 84 125 54 114 55 115 38 65
B. The Chronological change of obstetrics institutions which take delivery
2001 2008 2009 2010 2011 2012
㟼㍌ 䉼䘴䏤㼣凐匀 1,570 839 772 732 701 656
䉼䘴䐈䏤㼣凐匀 1,137 1,376 1,361 1,346 1,365
㢨㤰 䉼䘴䏤㼣凐匀 1,161 561 501 465 435 391
䉼䘴䐈䏤㼣凐匀 1,108 1,127 1,103 1,073 1,090
Table 7.
The change of obstetrics residents in Korea14-16
A. The chronological secure and abandonment rate of obstetrics residents in training hospital
㨐䰼 㟫㤰 㙀㤰 ⪗南 ⦫䌌㣘 (%) 㷨䟘 㛯䰼 Ⱄ凐㡰 㷨䟘 㛯䰼 Ⱄ凐㣘 (%) 㴜刄䓌 㢈㤰 㴜刄䓌㣘 (%)
2003 237 293 236 99.6 30 12.7 206 86.9
2004 223 239 211 94.6 34 16.1 177 79.4
2005 216 202 188 87.0 50 26.6 138 639
2006 217 144 139 64.1 31 22.3 108 49.8
2007 194 120 120 61.9 24 20.0 96 49.5
2008 193 111 106 54.9 16 15.1 90 46.6
2009 191 144 145 75.9 29 20.0 116 60.7
2010 193 131 124 64.2 11 8.9 113 58.5
2011 186 124 122 65.6 14 11.5 108 58.1
2012 170 121 119 70.0 18 15.1 101 59.4
B. The secure rate of obstetrics residents in training hospital in 2010
Secure rate 0 < 25% < 50% < 75% < 100% 100 %
Hospital number 25 24 29 12 7 10
(%) 23 22 27 11 7 9
Table 8.
A local governments lacking childbirth hospital in Korea 201217
劔䉼 㴤 劐 劔 (2012亼 12㤬 䘰)
䊀㽐 ⑵ 叫㻤劔, 凐㡛劐
千凐 (3) 匄㍤㴤, 㢨㦫㴤, 㨐㍤劐
叫㤰 (6) 匠㻏劐, 㩯劔劐, 㩯㩯劐, 㢈㟤劐, ⰷ㏃劐, ⦬㍤劐
㉗䉿 (6) 勌㽐劐, 䴘㩯劐, 䌌㣀劐, 㧛㍤劐, 㢴㻏劐, 㙣ⰷ劐
㉗佘 (4) 匼䜟㴤, 䊀㨔劐, ㍓㩯劐, ⼤㪸劐
㟼䉿 (凐 匠㏃劐, 䓌㜄劐, 㷤㏃劐, 㦼㜄劐, 㡼㴜劐, 㡛㷨劐, 㘼㪸劐
㟼佘 (8) 匠㻤劔 劔䟀劔 䴜㪄劔 䌌㻤劔 㴤㪼劔 㨔㪄劔 㡰㻤
劔 ⪘ⰷ劔
千䉿 (10) 匠䟇劐, 劐㣼劐, 䋷⦬劐, 㻏㜄劐, 㧿䲫劐, 㧿㩯劐, 㥈䙷
劔 㢌㻤劔 ㍓䰼劐 ㍓㹟劐
千佘 (10) 匠㻏劐, 佘⪌劐, 㽐㍓劐, 㢨䟇劐, ㏃享劐, ⪨䰧劐, ⪘㪸
劐, ⪘㩯劐, ⪗㍤劐
㋣匼 55

㜄) 㽐䊀㢈匄 䌯㢨㤰㢌 㨺䵬 㙀㨓 32匍, 㽐䊀㢈匄吀 㡸㣄佨 䉼䘴㴜 㢌 㨺䵬 㙀㨓 23匍

Table 9.
Required Manpower and Essential Facility in Integrated Care Center6
A. Required manpower in Integrated Care Center
㻄⻐ ⪼㷨 㢈䟛
㽐䕘·⼤㪼ㆨ䜴㻄⻐ 㽐䊀㢈匄 㢨㽔 7䕻 㢌㼿(㽐匄㟼䴌 㟼䓈㢨 4䕻 㢌㼿 Ⱄ⪘)
䘸㈘⹋㙣㢨⪧匄 㟼䓈㢨 2䕻
叼⧈㽔 25䕻 㢌㼿
㴠㼣㪼ㆨ䜴㻄⻐ 㴠㼣㪼 䴌䴇 㢨㽔 4䕻 㢌㼿(㴠㼣㪼 㻈䊀㟼䓈㢨 2䕻 㢌㼿 Ⱄ⪘)
叼⧈䬏凷 1䬏凷, 叼⧈㽔㷨 : 䌯㼿㷨 = 1 : 0.8
匠㣼⨨㡼㴠 㽐䕘㢌㹟㻄⻐ 叼⧈㽔 4䕻(㢌㹟 㼿䴌, 匠㣼⨨䉼䘴 㟫䌌 㷨㘯, 匋匋䌌厌㽔㨻)
匠㣼⨨㡼㴠 㢨䜴㟫䌌㻄⻐ 㪐䈈䠐㵜 㥌㟼凐㽔 2䕻
匠㣼⨨㡼㴠 㧸䏗匀䙔㻄⻐ ⩷㟫㢈䟛 2䕻(㎻㡼㨐劔㤰 1䕻, 㨐劔㤰 1䕻, 匋匋䌌厌㽔㨻)
B. Essential facility in Integrated Care Center
㻄⻐ 㴤㻜 凐㜀
㽐䕘·⼤㪼ㆨ䜴㻄⻐ 㽐䕘 㟼㥗 㷨㷠㴜 1古 㢌㼿
匠㣼⨨㡼㴠 㽐䕘 䉼䘴㴜 2古 㢌㼿
㽐䕘-⼤㪼㘯㛯ㆨ䜴㴜 6䌯㼿 㢌㼿
㴠㼣㪼ㆨ䜴㻄⻐ 㴠㼣㪼 㹴㼣㴜 1古 㢌㼿
㴠㼣㪼㘯㛯ㆨ䜴㴜 20䌯㼿 㢌㼿
TOOLS
Similar articles