RESUMO
UNLABELLED: Utilization of care is very important because of its link to access, quality of care and because of its importance to outcome. The aim of the study was to clarify the barriers towards accessibility to the Health Insurance of the Medical Union plan and to explain reasons why participants covered by other health insurance systems are using the Health Insurance Medical Union (HIMU). The study was carried out at the health insurance project situated in Alexandria Medical Syndicate. The insured members of HIMU included four specialties namely; physicians, pharmacists, dentists and veterinarians and their families. The sample amounted to 782 members. The highest reasons for participation in the project were freedom of choice of laboratory and/or radiology clinics 73.9%, affiliated providers (physicians and hospitals) offer good quality care to members 62.6%, and simplicity of getting services and/or referral system 59.2%. Whereas the highest reasons for not participating or continuing with the project were high premiums for members: high premium of parents accounted for the highest percentage (13.8%) followed by that of the spouse 9.3%, then high premium for members 5%, and high premium for children 4.9%. The reason that the period of participation was unsuitable for members (October-November-December) accounted for 4.9%. RECOMMENDATIONS: as a result of reviewing the system of determining premiums there were possibilities of a decrease in the annual premium for those beneficiaries who revealed low subsidies, decreasing cost sharing paid by beneficiaries for both outpatient and inpatient services in some essential services e.g. pregnancy and delivery, as well as vigorous control procedures regarding quality of medical care provided, art of care and price of medical services.
RESUMO
Puerperal infections are an important cause of maternal morbidity and mortality in developing nations. Investigators have noted several risk factors for developing puerperal sepsis. However, the relative importance of these risk factors varies and has to be determined for each setting. Therefore the aim of the present work was to determine the risk factors for puerperal sepsis in Alexandria, Egypt. A case-control design was used to study the risk factors of puerperal sepsis in Alexandria. The study included 160 puerperal sepsis cases and 160 controls. Puerperal sepsis cases were recruited from the fever hospital as well as from 3 rural health units and three urban health offices in Alexandria. A pre-designed interviewing questionnaire was used to collect data about risk factors of puerperal sepsis. Logistic regression analysis indicated that very low socio-economic score (OR = 6.4), no ANC (OR = 4.5), delivery at a governmental maternity hospital (OR = 203.4), frequent vaginal examinations (OR = 5.1), anemia during puerperium (OR = 4.3), unsanitary vaginal douching during puerperium (OR = 19.9) and unhygienic preparation of diapers used immediately after delivery (OR = 12.1) were significantly related to the occurrence of puerperal sepsis. Improving infection control measures during delivery, limiting the frequency of vaginal examinations, and avoiding all unhygienic practices related to delivery are strongly recommended.