Utilisation of maternity care in rural China: Affordability and Quality
Year: 2012
Type: dissertation
Study design: Observational Study
Abstract: Objective: China, like other transitional countries, is encountering socioeconomic-related inequality in maternal and child health. The principal aim of this study was to investigate the utilisation, contents, and costs of maternity care and its related financial burden on households in rural China, particularly in relation to a rural health insurance established in 2003. Materials and methods: This study was conducted in the context of the project Structural hinders to, and promoters of, good maternal care in rural China-CHIMACA . Data were obtained from the National Household Health Services surveys and its additional western surveys in ten western provinces in 2003 and 2008, and a population-based survey on women giving birth in 2008-2009 in five rural counties in three central and western provinces, and qualitative interviews in one of the five study counties. Logistic and linear regressions were used to study factors associated with the use of maternity care and out-of-pocket expenditure. Results: Between 2002 and 2007, the use of maternity care increased, particularly facility-based delivery rising from 45% to 80% in less developed western rural China; the difference in the use of maternity care between income groups became smaller. In 2002-2007, the out-of-pocket expenditure on facility-based delivery increased too, which was 13% of annual household income for the low-income household in 2007. The health insurance was associated with reduced out-of-pocket expenditure for caesarean section (CS), but not for vaginal delivery. The contents of prenatal care were studied in three of the five study counties. In all three counties, the proportions of women having the number of hemoglobin and urine tests recommended by the national guidelines were low, but 90% of women received two or more ultrasound examinations. The qualitative interviews were conducted in one county, which included prenatal care in the health insurance. Several women reported that doctors suggested them to take expensive examinations. In the five rural counties studied, 46% of all births were by CS with 13% occurring as an (self-reported) emergency CS and 33% of a non-emergency CS. Women reported that half of the non-emergency CSs were recommended by a doctor and half were requested by themselves. The health insurance was associated with having CS, in particular having non-emergency CS. Conclusion: Coinciding with the rural health insurance development, the use of maternity care in rural China has greatly improved. Nevertheless, more expensive examinations or procedures were often recommended by doctors. The financial burden relating to the use of maternity care for the rural poor remained high. The current health insurance lacks the tools required to control costs and to encourage good quality of care.
Source: Työväentutkimus Vuosikirja
Author: Qian Long
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1525651426