Dramatic increase of Cesarean deliveries in the midst of health reforms in rural China
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.
Volume (Year): 70 (2010)
Issue (Month): 10 (May)
|Contact details of provider:|| Web page: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description|
|Order Information:|| Postal: http://www.elsevier.com/wps/find/supportfaq.cws_home/regional|
References listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- 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.
- Wagstaff, Adam & Lindelow, Magnus & Gao Jun & Xu Ling & Qian Juncheng, 2007. "Extending health insurance to the rural population : an impact evaluation of China's new cooperative medical scheme," Policy Research Working Paper Series 4150, The World Bank.
- 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.
- Wagstaff, Adam & Lindelow, Magnus, 2005. "Can insurance increase financial risk ? The curious case of health insurance in China," Policy Research Working Paper Series 3741, The World Bank.
When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:70:y:2010:i:10:p:1544-1549. See general information about how to correct material in RePEc.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dana Niculescu)
If references are entirely missing, you can add them using this form.