Giving birth at a health-care facility in rural China: is it affordable for the poor?
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 b...
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The World Health Organization
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| Series: | Bulletin of the World Health Organization |
| Online Access: | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862011000200014&lng=en&tlng=en |
| _version_ | 1827332888491720704 |
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| author | Qian Long Yaoguang Zhang Joanna Raven Zhuochun Wu Lennart Bogg Shenglan Tang Elina Hemminki |
| author_facet | Qian Long Yaoguang Zhang Joanna Raven Zhuochun Wu Lennart Bogg Shenglan Tang Elina Hemminki |
| author_sort | Qian Long |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-07T17:10:28Z |
| format | Article |
| id | doaj.art-21c8399e83db496fbc62328e2135d6bf |
| institution | Directory Open Access Journal |
| issn | 0042-9686 |
| language | English |
| last_indexed | 2024-03-07T17:10:28Z |
| publisher | The World Health Organization |
| record_format | Article |
| series | Bulletin of the World Health Organization |
| spelling | doaj.art-21c8399e83db496fbc62328e2135d6bf2024-03-03T01:16:03ZengThe World Health OrganizationBulletin of the World Health Organization0042-968689214415210.1590/S0042-96862011000200014S0042-96862011000200014Giving birth at a health-care facility in rural China: is it affordable for the poor?Qian Long0Yaoguang Zhang1Joanna Raven2Zhuochun Wu3Lennart Bogg4Shenglan Tang5Elina Hemminki6University of HelsinkiMinistry of HealthLiverpool School of Tropical MedicineFudan UniversityKarolinska InstituteLiverpool School of Tropical MedicineNational Institute for Health and WelfareOBJECTIVE: 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.http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862011000200014&lng=en&tlng=en |
| spellingShingle | Qian Long Yaoguang Zhang Joanna Raven Zhuochun Wu Lennart Bogg Shenglan Tang Elina Hemminki Giving birth at a health-care facility in rural China: is it affordable for the poor? Bulletin of the World Health Organization |
| title | Giving birth at a health-care facility in rural China: is it affordable for the poor? |
| title_full | Giving birth at a health-care facility in rural China: is it affordable for the poor? |
| title_fullStr | Giving birth at a health-care facility in rural China: is it affordable for the poor? |
| title_full_unstemmed | Giving birth at a health-care facility in rural China: is it affordable for the poor? |
| title_short | Giving birth at a health-care facility in rural China: is it affordable for the poor? |
| title_sort | giving birth at a health care facility in rural china is it affordable for the poor |
| url | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862011000200014&lng=en&tlng=en |
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