School of Nursing, China Medical University, Shenyang, China.
Humanity and Management College, Shaanxi University of Chinese Medicine, Xianyang, China.
Health Qual Life Outcomes. 2021 Jan 22;19(1):30. doi: 10.1186/s12955-021-01678-z.
This study aimed to analyze the status of birthrates and the characteristics of child delivery expenditure under the Chinese two-child policy's transition period. We evaluated the socioeconomic factors associated with child delivery and provide evidence for decisions relating to health support for childbirth.
Child delivery expense data were obtained from 2015 to 2017 in Dalian, China. A total of 13,535 obstetric records were enrolled using stratified random sampling and the proportional probability to size method. First, we calculated the current curative expenditure of child delivery and health financing in childbirth costs based on the System of Health Accounts 2011 (SHA 2011). Second, univariate analysis of variance and generalized linear modeling were performed to examine factors associated with child delivery expenditure. Third, we classified the included hospitals into the county, district, and municipal hospitals and compared maternal characteristics between these categories.
Overall, out-of-pocket payments accounted for more than 35% of the total expenditure on child delivery. Median (interquartile range) delivery expenditure at the county and district level hospitals [county-level: 5128.50 (3311.75-5769.00) CNY; district-level: 4064.00 (2824.00-6599.00) CNY] was higher than that at the municipal level hospitals: 3824.50 (2096.50-5908.00) CNY. The increase of child delivery expenditure was associated with an increased ratio of reimbursement, admissions to county and district level hospitals, cesarean sections, and length of stay, as well as a decline in average maternal age (p < 0.05).
Health financing for childbirth expenditure was not rational during the transition period of the family planning policy in China. Higher delivery expenditure at county and district level hospitals may indicate variations in medical professionalism. Poorly managed hospitalization expenditure and/or nonstandard medical charges for childbirth, all of which may require the development of appropriate public health policies to regulate such emerging phenomena.
本研究旨在分析中国二孩政策过渡期的出生率状况和生育支出特征。评估与分娩相关的社会经济因素，为生育健康支持决策提供依据。
本研究于 2015-2017 年在大连市收集分娩费用数据，采用分层随机抽样和比例概率规模法，共纳入 13535 份产科病历。首先，基于 2011 年卫生核算体系（SHA 2011）计算当前分娩直接医疗费用和筹资在分娩费用中的占比。其次，采用单因素方差分析和广义线性模型分析分娩费用的影响因素。再次，根据医院级别将纳入的医院分为县级、区级和市级医院，并比较各级医院产妇特征。
总体而言，自费支付占分娩总费用的 35%以上。县级和区级医院的分娩支出中位数（四分位间距）[县级：5128.50（3311.75-5769.00）元；区级：4064.00（2824.00-6599.00）元]高于市级医院：3824.50（2096.50-5908.00）元。分娩支出的增加与报销比例的增加、县级和区级医院住院人数、剖宫产率和住院天数的增加以及产妇平均年龄的降低有关（p < 0.05）。
中国计划生育政策转型期的生育筹资还不够合理。县级和区级医院较高的分娩支出可能表明医疗专业性的差异。住院费用管理不善和/或分娩收费不规范，这些都可能需要制定适当的公共卫生政策来规范这些新出现的现象。
