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Dramatic increase of Cesarean deliveries in the midst of health reforms in rural China

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  • Bogg, Lennart
  • Huang, Kun
  • Long, Qian
  • Shen, Yuan
  • Hemminki, Elina

Abstract

Cesarean delivery (CD) rates were until recently low in rural China where the population lacked health insurance. In July 2003 the New Cooperative Medical Scheme (NCMS) was introduced. We report findings from a health systems study carried out in the EC-funded project "Structural hinders to and promoters of good maternal care in rural China" in central and western China. The purpose was to analyze how CD rates changed with the increased level of funding of the NCMS. The research design was a natural experiment. Quantitative demographic, administrative and accounts data for 2001-2007 were collected in five counties from the county public health bureaux, the county NCMS offices, the county statistical offices and the Maternal and Child Health (MCH) hospitals, using a structured data collection form. We found that the CD rates increased in four of the five counties in the period 2004-2007 by 36%, 53%, 61% and 131% respectively. In the fifth county the CD rate remained high at 60%. The revenue from CD made up 72-85% of total delivery fee revenue. CD fee revenue increased by 97%, 239% and 408% in the three counties with available data; a higher increase than in general health care revenue. Our conclusion is that the design of NCMS, the provider payment systems, and the revenue-related bonus systems for doctors need to be studied to rein in the unhealthy increases in rural CD rates.

Suggested Citation

  • Bogg, Lennart & Huang, Kun & Long, Qian & Shen, Yuan & Hemminki, Elina, 2010. "Dramatic increase of Cesarean deliveries in the midst of health reforms in rural China," Social Science & Medicine, Elsevier, vol. 70(10), pages 1544-1549, May.
    • Handle: RePEc:eee:socmed:v:70:y:2010:i:10:p:1544-1549
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    References listed on IDEAS

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    1. Wagstaff, Adam & Lindelow, Magnus, 2008. "Can insurance increase financial risk?: The curious case of health insurance in China," Journal of Health Economics, Elsevier, vol. 27(4), pages 990-1005, July.
    2. Wagstaff, Adam & Yu, Shengchao, 2007. "Do health sector reforms have their intended impacts?: The World Bank's Health VIII project in Gansu province, China," Journal of Health Economics, Elsevier, vol. 26(3), pages 505-535, May.
    3. Wagstaff, Adam & Lindelow, Magnus & Jun, Gao & Ling, Xu & Juncheng, Qian, 2009. "Extending health insurance to the rural population: An impact evaluation of China's new cooperative medical scheme," Journal of Health Economics, Elsevier, vol. 28(1), pages 1-19, January.
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    Cited by:

    1. Panos Kanavos & Olivier Wouters & Wei Yang & Xun Wu, 2017. "Providing Comprehensive Health Insurance Coverage in Rural China: a Critical Appraisal of the New Cooperative Medical Scheme and Ways Forward," Global Policy, London School of Economics and Political Science, vol. 8(s2), pages 110-116, March.
    2. Berta, P.; & Martini, G.; & Piacenza, M.; & Turati, G.;, 2019. "The strange case of appropriate C-sections:DRG-tariff regulation, hospital ownership, and market concentration," Health, Econometrics and Data Group (HEDG) Working Papers 19/02, HEDG, c/o Department of Economics, University of York.
    3. Shafik Hebous, 2014. "Money at the Docks of Tax Havens: A Guide," FinanzArchiv: Public Finance Analysis, Mohr Siebeck, Tübingen, vol. 70(3), pages 458-485, September.
    4. repec:bla:glopol:v:8:y:2017:i::p:110-116 is not listed on IDEAS
    5. Long, Qian & Klemetti, Reija & Wang, Yang & Tao, Fangbiao & Yan, Hong & Hemminki, Elina, 2012. "High caesarean section rate in rural China: Is it related to health insurance (New Co-operative Medical Scheme)?," Social Science & Medicine, Elsevier, vol. 75(4), pages 733-737.
    6. Paolo Berta & Gianmaria Martini & Massimiliano Piacenza & Gilberto Turati, 2020. "The strange case of less C‐sections: Hospital ownership, market concentration, and DRG‐tariff regulation," Health Economics, John Wiley & Sons, Ltd., vol. 29(S1), pages 30-46, October.

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