Komsomolskaya Pravda found out how the availability of medical care for the expectant mother and child affects the health of children
HOW PREGNANCY IS MANAGED
Today in Russia, 5,000 neonatologists (doctors who monitor newborns), as well as anesthesiologists and resuscitators, neurologists, ophthalmologists and pediatric surgeons ensure the health of babies. Plus, they make sure everything is in order even before your birth. Therefore, to prevent possible complications and take care of the health of the future mother, our doctors recommend registering before 12 weeks, and the state pays everyone who has done so a monthly allowance, the average in Russia is 16,800 per month . .
The expectant mother is then examined by gynecologists (at least seven times), therapists and dentists (at least a couple of times), as well as otorhinolaryngologists and ophthalmologists, and also undergoes an ultrasound three times (between 11 and 14 weeks). , 18). -21 and 30-34 weeks), carry out blood tests for biochemistry, hepatitis, HIV, etc., in addition, they may prescribe an ECG and other examinations, and prescribe medications. Everything is within the framework of compulsory health insurance, that is, free of charge.
There is also no need to pay for delivery; priority is given to natural births; Caesarean sections are performed for medical reasons; Even state clinics often offer couple birth services, when the husband can be at his wife’s side. After birth, the baby falls into the hands of specialized specialists. If everything is in order, he and his mother are discharged home 3 or 4 days after the baby is born. And the woman receives federal maternity benefits, popularly called “maternity benefits,” which depend on the salary the mother previously received.
In the United States, a pregnant woman can register at any stage and undergoes a series of tests; She is normally seen by the doctor once a month until week 26, then a couple of times a month until week 35 and then. once a week. Ultrasounds are performed, as in Russia, three times a week (at 8, 24 and 32 weeks). And then the most interesting thing: childbirth can be carried out not only by doctors in clinics, but also by midwives (Midwives) at home, the first, in addition, give the option: natural childbirth or cesarean section (even if there are no indications doctors for the second), midwives only accept natural childbirth without any type of painkiller.
At the same time, infant mortality in the USA is 5.4 ‰, and in Russia – 4.2 ‰ (according to WHO data for 2023, this takes into account deaths of children from the 22nd week of pregnancy until the end of the first week of life per 1,000 people). Experts attribute this to the fact that qualified medical care in the United States is not available to everyone. Hence the imbalance: Black women experience premature births almost 50% more often than others, and their infant mortality rate is twice as high (often caused by the same premature birth). There are insurance programs, but they do not cover the entire population. For many, the insurance does not consider childbirth as an insured event, so it has to be paid separately: an average of 2,000 dollars (194,000 rubles at the current exchange rate), if the cesarean section, anesthesia and a pair are taken into account. of days in the clinic, the total 5,000 dollars (485,000 rubles). In Russia, such a price can be paid for childbirth in private clinics in Moscow or St. Petersburg with personal doctors, midwives and an anesthesiologist of your choice, accommodation in a suite, 6 meals a day, partner births, etc.
China also has compulsory health insurance, including three: compulsory basic health insurance for urban workers, basic health insurance for urban residents, and health care for rural cooperatives. There is also separate insurance for low-income people. And all of them, in theory, should include obstetrics and neonatal care, that is, specialized nursing care for the newborn. In fact, each province decides for itself what to include in the catalog of free services for women in labor. And as it turns out, compulsory medical insurance will not cover the costs if complications suddenly arise. On average, a birth in China alone will cost 20,000 yuan (271,000 rubles).
In the United Kingdom, prenatal care for pregnant women, childbirth and postnatal care are free for citizens, so approximately 10% of the budget is allocated to the National Health Service (NHS). There are also private obstetric centers, but they are few and their services are quite expensive: a medical care package will cost from £5,000 (633,000 rubles at the current exchange rate), and you will have to pay more for a cesarean section.
In France, during the first five months of pregnancy, the health system covers approximately 70% of all expenses, the rest is paid by the family itself or by private health insurance (“mutuelle”), if contracted. From the sixth month until the 12th day after birth, the State fully covers all expenses of the mother and child.
In the United Arab Emirates everything depends on the type of insurance. Compulsory health insurance provides a minimum set: eight visits to the gynecologist, three prenatal examinations and blood tests. The cost of the birth itself, including prenatal and postnatal care, varies from 20,000 to 30,000 dirhams (530,000 – 790,000 rubles), if anesthesia is not performed, it is cheaper, because this service is included only in the extended insurance (and in maternity insurance, as the case may be). the set of services can cost between 6,000 and 27,000 dirhams or between 158,000 and 713,000 rubles). Additionally, if a woman becomes pregnant outside of marriage, or when she exceeds the age specified in the insurance limit, or within 40 days of the policy being issued, the insurance will pay nothing.
PAYMENTS TO MOTHERS
Private healthcare is very popular in India. It is simply inaccessible to the majority of the population because it is too expensive, this problem is especially relevant for rural areas. For the poor sections of the population, the Rashtriya Swasthya Bima Yojana (RSBY) insurance scheme was introduced, funded 75% by the central government and 25% by state governments, costs of childbirth, medicines and diagnostics, even in complex situations. In some cases, it often covers completely. The policyholder only needs to pay a registration fee of 30 rupees (35 rubles) to receive a smart card with biometric data (photo and fingerprints). In addition, Employee State Insurance (ESI) also includes maternity benefits. To make this possible, the employer pays 3.25% of the employee’s salary and the employee himself pays 0.75%. The State pays for the poor.
In Germany, insurance covers both home births and births in a hospital or maternity hospital. The insurance even includes postpartum exercises and help at home if necessary, in addition to the supply of medicines from the list of available medicines prescribed by a doctor. In addition, there is a maternity benefit, “Mutterschaftsgeld”, which pays money to pregnant women in a short period of time: 6 weeks before childbirth and 8 weeks after. The amount of payments depends on the salary, and if the woman did not work or was registered as a self-employed worker, she will not be paid anything.
In South Korea, pregnant women receive electronic vouchers; The more children there are in the family, the more services the State will pay for (except separate rooms, a group of parents or special meals). In addition, parents can also receive up to 600,000 won (approximately 43,000 rubles) for prenatal expenses and then, during the year, a monthly child benefit of up to 1,000,000 won (71,000 rubles). Again, the more children in the family, the higher the amount. Postpartum vouchers provide the opportunity to receive advice on child care and psychological support. Community postpartum care centers have also been created, where women live in comfortable rooms for 1 or 2 weeks, receive nutritious meals, childcare, massages, beauty treatments and even a spa. This pleasure costs 1.5 million won (107,000 rubles), while the state can offer low-income families a 50-70% discount. And to ease the workload in kindergartens, women are offered an additional allowance for home care until the child turns 7, that is, between 100,000 and 200,000 won, or between 7,000 and 14,000 rubles. per month per child, depending on their age. and the place of residence of the family (somewhere there may be surcharges).
In Russia, as of February 1, 2024, parents receive maternity capital of 631 thousand for the first child and another 202 thousand for the second. They can be spent on improving living conditions, on children’s education or on parents’ funded pension.
WHAT’S THE SCORE?
The general level of sociodemographic development of the country is now determined, including by the so-called infant mortality rate (indicated by the sign ‰), because it actually shows how developed the health system is and whether the state is ready to take care of its citizens. One of the highest levels of infant mortality was recorded in Nigeria (73 ‰), the lowest was recorded in Sweden (1.9 ‰).
In 2004, the UN created an interdepartmental group to evaluate child mortality rates based on statistics. The ultimate goal is to reduce the number of child deaths worldwide to 12 per 1,000‰ by 2030. And it is already worth taking advantage of the experience of some countries.
In Germany, for example, over the last decade and a half, the infant mortality rate has been reduced from 3.5‰ to 3.1‰ thanks to a special calculation system based on diagnosis-related groups (DRG). The system assumes that reimbursement to clinics depends on the health of the baby: what weight he was born, whether he needed emergency care, whether he was on a ventilator, whether he survived, etc. The long-term outlook and risk factors are also being studied depending on the baby’s treatment strategies. According to the results of a large-scale analysis in this area of medicine, it was possible to reduce the number of deaths in children’s intensive care units, as the standards of care were gradually changed.
The results obtained in Russia are even more indicative: in 20 years, the infant mortality rate in our country has decreased from 15.3% to 4.2 ‰. A very important role in this was played by the creation of a 3-tier system for the provision of obstetric care (basic, special and highly specialized), the construction of modern perinatal centers and the development of regional route schemes for pregnant women at risk. Doctors act according to previously understood algorithms, regularly attend advanced training courses and use modern equipment that allows them to identify potential problems in advance and respond to them promptly. The current system is actively developing, as it is planned to reduce the infant mortality rate in Russia to 3.4 ‰.
WHAT ELSE
How the world fights infertility
In Russia, since 2013, the in vitro fertilization (IVF) procedure has been included in compulsory health insurance and can be performed free of charge. And in 2023 alone, 108,700 procedures of this type were carried out in the country. In total, since 2013, more than 800 thousand procedures have been carried out under the mandatory medical insurance policy. According to compulsory health insurance, it is also possible to cryopreserve eggs, sperm and developed embryos, in addition to the “reimplantation” of the latter into the uterine cavity.
And starting this year in Russia, reproductive health checks are available for women and men who dream of having a child under the compulsory health insurance policy.
“In the first half of 2024, around 600 thousand people insured by compulsory health insurance underwent reproductive health tests and the demand for such diagnostics increases every month,” said MHIF President Ilya Balanin.
In the United States, these procedures cost between 12,000 and 20,000 dollars (1.2 to 1.9 million rubles) and most are not covered by insurance.
In France, the State insures almost the entire population (including non-residents) against infertility treatment through the national health insurance system.
In Sweden, infertility is treated at the expense of taxes, IVF and ICSI (when a sperm is injected into an egg using special microinstruments under a microscope) are carried out according to the same scheme.
