Department of Public Health, University of Helsinki, PO Box 41, Mannerheiminitie 172, FI-00014 Helsinki, Finland.
Bull World Health Organ. 2011 Feb 1;89(2):144-52. doi: 10.2471/BLT.10.079434. Epub 2010 Dec 2.
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.
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.
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.
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.
调查 1998-2007 年期间中国农村地区医疗机构分娩支出的变化，考察家庭，尤其是贫困家庭的经济负担，并确定与自费支出相关的因素。
本研究使用了 2003 年和 2008 年进行的全国家庭调查中获取的 1998 年至 2007 年期间的分娩横截面数据。使用描述性统计和对数线性模型来确定与分娩自费支出相关的因素。
1998-2007 年间，住院分娩的比例从 55%上升至 90%。2007 年，60%的分娩发生在县级及以上医院。剖宫产率从 6%上升至 26%。住院分娩的总费用增长了 152%，自 2002 年新合作医疗制度推出以来，费用显著增加。2007 年，农村贫困家庭住院分娩自费支出相当于其年均家庭收入的 13%。这一比例从 2002 年的 18%下降，收入组间的差距也在缩小。回归模型显示，2007 年剖宫产和在高级别医疗机构分娩与更高的自费支出相关。新型农村合作医疗制度与剖宫产自费支出降低有关，但与阴道分娩自费支出无关。
由于高级别医疗机构使用增加、更多剖宫产以及新型农村合作医疗制度的推出，1998-2007 年期间中国农村地区的住院分娩支出大幅增加。农村贫困人口的经济负担仍然很高。
