Giving birth at a health-care facility in rural China: is it affordable for the poor?

Long, Qian, Zhang, Yaoguang, Raven, Joanna ORCID: https://orcid.org/0000-0002-4112-6959, Wu, Zhuochun, Bogg, Lennart, Tang, Shenglan and Hemminki, Elina (2010) 'Giving birth at a health-care facility in rural China: is it affordable for the poor?'. Bulletin of the World Health Organization, Vol 89, pp. 144-152.

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Abstract

Objective To investigate changes in the expenditure of giving birth in health-care facilities in rural China during 1998–2007, to examine the financial burden on households, particularly poor ones, and to identify factors associated with out-of-pocket expenditure.
Methods Cross-sectional data on births between 1998 and 2007 were obtained from national household surveys conducted in 2003 and 2008. Descriptive statistics and log-linear models were used to identify factors associated with out-of-pocket expenditure on delivery.
Findings During 1998–2007, the proportion of facility-based deliveries increased from 55% to 90%. In 2007, 60% of births occurred at county-level or higher-level facilities. The Caesarean delivery rate increased from 6% to 26%. Total expenditure on a facility-based delivery increased by 152%, with a marked rise from 2002 onwards with the introduction of the New Cooperative Medical Scheme. In 2007, out-of-pocket expenditure on a facility-based delivery equalled 13% of the mean annual household income for low-income households. This proportion had decreased from 18% in 2002 and differences between income groups had narrowed. Regression models showed that Caesarean delivery and delivery at a higher-level facility were associated with higher expenditure in 2007. The New Cooperative Medical Scheme was associated with lower out-of-pocket expenditure on Caesarean delivery but not on vaginal delivery.
Conclusion Expenditure on facility-based delivery greatly increased in rural China over 1998–2007 because of greater use of higher-
level facilities, more Caesarean deliveries and the introduction of the New Cooperative Medical Scheme. The financial burden on the rural poor remained high.

Item Type:	Article
Uncontrolled Keywords:	China; Health care facilities; Maternal welfare; Childbirth; Maternity units
Subjects:	WA Public Health > WA 20.5 Research (General) WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare WQ Obstetrics > WQ 100 General works
Digital Object Identifer (DOI):	https://doi.org/10.2471/BLT.10.079434
Depositing User:	Faye Moody
Date Deposited:	24 Aug 2011 13:29
Last Modified:	21 Nov 2024 11:19
URI:	https://archive.lstmed.ac.uk/id/eprint/2059

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