Department of Public Health, University of Helsinki, Helsinki, Finland.
Soc Sci Med. 2012 Aug;75(4):733-7. doi: 10.1016/j.socscimed.2012.03.054. Epub 2012 May 7.
The epidemic of Caesarean section (CS) is worldwide, and it has been argued that it is mainly due to non-medical factors, including healthcare financing patterns. We investigated the use of CS in rural China and the related factors, particularly health insurance in the form of the New Co-operative Medical Scheme introduced in 2003. A cross-sectional survey of women who gave birth in 2008-2009 was conducted in five rural counties in central and western China. Of the 5049 new mothers, 73% were interviewed. The association between health insurance coverage and self-reported CS (divided into emergency and non-emergency CS) were examined by cross-tabulation and logistic regression, adjusting for maternal age, education, occupation, household income, previous abortions, parity and type of birth health facility. We found that 46% of all births (3550) were CSs, with 13% having an emergency and 33% a non-emergency CS. Women reported that half of the non-emergency CSs were recommended by a doctor and half were requested by themselves. In those counties with mid-range CS rates (28%-63%), health insurance coverage was associated with having CS, and particularly with having non-emergency CS. In those counties with the highest (82%) and lowest (13%) rate, there was no statistically significant association. The findings suggest that health insurance coverage may have facilitated the overuse of CS. Further studies are needed to develop appropriate interventions to reduce non-medically indicated CS, focussing on payment mechanisms, healthcare provider practice patterns, and maternal requests.
剖宫产术（CS）的流行是全球性的，有人认为它主要是由于非医学因素引起的，包括医疗保健融资模式。我们调查了中国农村地区 CS 的使用情况及其相关因素，特别是 2003 年引入的新型合作医疗制度形式的健康保险。我们在中国中部和西部地区的五个农村县进行了 2008-2009 年分娩的妇女的横断面调查。在 5049 名新妈妈中，有 73%接受了采访。通过交叉表和逻辑回归，调整了母亲的年龄、教育、职业、家庭收入、以前的堕胎、产次和分娩保健机构类型，研究了健康保险覆盖范围与自我报告的 CS（分为紧急和非紧急 CS）之间的关联。我们发现，所有分娩中有 46%（3550 例）为 CS，其中 13%为紧急 CS，33%为非紧急 CS。妇女报告说，一半的非紧急 CS 是由医生建议的，一半是由她们自己要求的。在 CS 率中等（28%-63%）的县，健康保险覆盖与 CS 有关，特别是与非紧急 CS 有关。在 CS 率最高（82%）和最低（13%）的县，没有统计学上的显著关联。研究结果表明，健康保险覆盖可能促进了 CS 的过度使用。需要进一步研究制定适当的干预措施，以减少非医学指征的 CS，重点是支付机制、医疗服务提供者的实践模式和产妇的要求。
