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Dramatic Increase of Cesarean Deliveries in the Midst of Health Reforms in Rural China
Mälardalen University, School of Health, Care and Social Welfare. Karolinska institutet. (Global health Department of Public Health Sciences)ORCID iD: 0000-0003-0368-050X
Anhui Medical University.
Xi'an Jiaotong University.
Chongqing Medical University.
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2010 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 70, no 10, p. 1544-1549Article in journal (Refereed) Published
Abstract [en]

Cesarean delivery (CD) rates were until recently low in rural China where the population lacked healthinsurance. In July 2003 the New Cooperative Medical Scheme (NCMS) was introduced. We report findingsfrom a health systems study carried out in the EC-funded project ‘‘Structural hinders to andpromoters of good maternal care in rural China’’ in central and western China. The purpose was toanalyze how CD rates changed with the increased level of funding of the NCMS.The research design was a natural experiment. Quantitative demographic, administrative and accountsdata for 2001–2007 were collected in five counties from the county public health bureaux, the countyNCMS offices, the county statistical offices and the Maternal and Child Health (MCH) hospitals, usinga structured data collection form. We found that the CD rates increased in four of the five counties in theperiod 2004–2007 by 36%, 53%, 61% and 131% respectively. In the fifth county the CD rate remained highat 60%. The revenue from CD made up 72–85% of total delivery fee revenue. CD fee revenue increased by97%, 239% and 408% in the three counties with available data; a higher increase than in general healthcare revenue. Our conclusion is that the design of NCMS, the provider payment systems, and therevenue-related bonus systems for doctors need to be studied to rein in the unhealthy increases in ruralCD rates.

Place, publisher, year, edition, pages
Elsevier, 2010. Vol. 70, no 10, p. 1544-1549
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Care Sciences within Health and Welfare
Identifiers
URN: urn:nbn:se:mdh:diva-7973DOI: 10.1016/j.socscimed.2010.01.026ISI: 000277815000013Scopus ID: 2-s2.0-77951652294OAI: oai:DiVA.org:mdh-7973DiVA, id: diva2:292989
Projects
EU/CHIMACA
Funder
EU, European Research CouncilAvailable from: 2011-02-03 Created: 2010-02-10 Last updated: 2017-12-12Bibliographically approved

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Bogg, Lennart

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