gms | German Medical Science

4th International Conference of the German Society of Midwifery Science (DGHWi)

Deutsche Gesellschaft für Hebammenwissenschaft e. V.

16.02.2018, Mainz

Individual health services (IGeL) in pregnancy – experiences of women with low financial resources

Meeting Abstract

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  • corresponding author Annette Berthold - University of Applied Sciences (Hochschule für Gesundheit), Bochum, Germany
  • Renate Zwicker-Pelzer - Catholic University of Applied Sciences North Rhine-Westphalia, Cologne, Germany

German Association of Midwifery Science. 4th International Meeting of the German Association of Midwifery Science (DGHWi). Mainz, 16.-16.02.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. Doc18dghwiP03

doi: 10.3205/18dghwi09, urn:nbn:de:0183-18dghwi096

This is the English version of the article.
The German version can be found at: http://www.egms.de/de/meetings/dghwi2018/18dghwi09.shtml

Published: February 13, 2018

© 2018 Berthold et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Background: As far as the pregnant women are members of the German statutory health insurance (GKV), all costs for sufficient, appropriate and efficient health care services are defrayed [1].

However, practice and research experiences show that gynaecologists and midwives as well offer and conduct a set of individual health services (IGeL), which are not part of the GKV's conventional care provision during pregnancy. In absence of medical indication, pregnant women have to pay extra [2]. This applies to 3D/4D ultrasounds, special blood tests or partner fees for antenatal classes. Indeed, pregnant women request and make use of IGeL irrespective of their socio-economic situation [2], [3].

Research questions: The following questions were conducted regarding the handling of IGeL for women with low financial resources: 1. How do women living in poverty experience the offer of IGeL in pregnancy? 2. Which wishes and expectations have pregnant women with low financial resources regarding IGeL in pregnancy?

Methods: In order to a qualitative approach, a personally guided interview is carried out to ten women with low financial resources (Hartz IV-Bezug). The interviews are conducted in three cities in North Rhine-Westphalia, Germany, and are recorded, transcribed and qualitative content analysed acc.to Mayring [4].

Results: Women of sample feel stressed by the offer of IGeL. By this, they are confronted with their financial distress in the context of medical supply structure, and must decide about the handling of these extra services. Pregnant women feel burdened by both, complete waiver or selection of IGeL, because they fear the exclusion from medical services. One result of the analysis shows, that women, who are not able to afford partner fees for antenatal classes, which must be paid privately, abstain from courses, because statutory health insurances defray costs of pregnant women, but only exceptionally of partner’s or alternative companions. Another result clarifies, that high-quality ultrasound images are connected to women with medical screening, but as well with social appreciation and personal recollection of pregnancy.

Relevance: Within the framework of qualitative study, pregnant women living in financial poverty have the option to comment on IGeL in pregnancy for the first time.

Conclusions: The results provide a first insight into subjective wishes, expectations, and coping strategies of affected women, and may serve a basis for discussion among midwives and gynaecologists, and further qualitative or quantitative studies.

Ethical criteria and conflict of interests: The research / project was not submitted to an ethics committee for the following reasons: Research ethical principles have been adhered to and implemented on the basis of the Code of Ethics of the German Sociological Association (DGS) and the Helsinki Declaration. It was financed from own resources. There is no conflict of interest.


References

1.
Bundesministerium der Justiz und für Verbraucherschutz. Sozialgesetzbuch (SGB) Fuenftes Buch (V) – Gesetzliche Krankenversicherung – (Artikel 1 des Gesetzes vom 20.12.1988, BGBI. I S. 2477), zuletzt geändert durch Art. 30 G v. 27.6.2017. I 1966.
2.
Schaefers R, Kolip P. Zusatzangebote in der Schwangerschaft: Sichere Rundumversorgung oder Geschäft mit der Unsicherheit? In: Böcken J, Braun B, Meierjürgen R, Hrsg. Gesundheitsmonitor 2015: Bürgerorientierung im Gesundheitswesen – Kooperationsprojekt der Bertelsmann Stiftung und der BARMER GEK. Gütersloh: Bertelsmann Stiftung; 2015. p. 119–50.
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Siegmund-Schultze E, Kielblock B, Bansen T. Schwangerschaft und Geburt: Was kann die Krankenkasse tun? Gesundh ökon Qual manag. 2008;13(4):210-5. DOI: 10.1055/s-2008-1027223 External link
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Mayring P. Qualitative Inhaltsanalyse: Grundlagen und Techniken. Weinheim Basel: Beltz; 2010.