Chinese Maternal Health in Adjustment: Claim for Life

Abstract

Health sector reforms in China, instituted starting in 1985, have centred on cost recovery, with fee-for-service revenue replacing public budget funding. The share of public funding for maternal health services was reduced greatly, forcing an increasing proportion of pregnant women to pay for deliveries and treatment of pregnancy-related complications out of pocket, as most had no health insurance to cover these costs. This study aimed to identify socio-economic variables associated with utilisation of essential maternal health services and linked to health sector reforms in China, with a focus on cost recovery. A retrospective household survey (n = 5756) was carried out in six counties in three provinces of Central China in 1995. Antenatal service utilisation continued to improve in 1990-95, but only in relation to the number of visits, which were pre-paid if the woman was participating in a maternal pre-payment scheme or covered by another health insurance scheme. Significant decreases were found in the utilisation of skilled attendance at delivery and hospital delivery, as well as differences in adverse pregnancy outcomes (miscarriages and stillbirths) between women paying out of pocket and those covered by insurance. This study confirms a strong association between utilisation of delivery services and financing variables of amount of savings in the bank, maternal pre-payment schemes and health insurance. It also shows the critical importance of out-of-pocket, fee-for-service payments for maternity care as a barrier to the utilisation of these services.

Utilization of maternal care in rural HeBei Province, the People’s Republic of China: individual and structural characteristics

“…services and the costs of unauthorized birth present considerable barriers for the utilization of maternal care services [2,3]. The purpose of this study is to explore the effect of individual attributes and structural characteristics on the utilization of maternal care services among rural women in HeBei Province.…”

Socioeconomic inequalities in hospital births in China between 1988 and 2008

“…[31][32][33] According to many studies, inability to pay is one of the main obstacles to the uptake of maternity care in China, especially among poor rural households. 10,15,18,34 Our analysis suggests that inequalities between socioeconomic regions are more pronounced than between individual households. It did not show household income to be an important determinant of hospital delivery, since the gap between high-and low-income households has nearly disappeared.…”

“…2,3,11,15,18,28,29 The gap in institutional birth rates between urban and rural regions is narrowing, which suggests that China's safe motherhood strategy, with its regional focus, is working. However, in recent years the upward trend has been slowing down among those living in rural region IV.…”

“…[5][6][7][8][9] The market reforms introduced in the 1980s have led to a deterioration of preventive health services and a dramatic increase in health-care expenditure. 4,[10][11][12][13][14][15][16] The central government decentralized fiscal responsibility to local government, and central government transfers in the health sector have declined. 4,[14][15][16][17] As a result, health insurance coverage has decreased sharply and an inability to pay is considered to be the main obstacle for the uptake of maternity care, especially for poor rural households.…”

“…4,[10][11][12][13][14][15][16] The central government decentralized fiscal responsibility to local government, and central government transfers in the health sector have declined. 4,[14][15][16][17] As a result, health insurance coverage has decreased sharply and an inability to pay is considered to be the main obstacle for the uptake of maternity care, especially for poor rural households. 5,6,18 Over the last fifteen years the government has responded to these concerns in several ways.…”