Influence of China’s 2009 healthcare reform on the utilisation of continuum of care for maternal health services: evidence from two cross-sectional household surveys in Shaanxi Province

Fan, Xiaojing; Kumar, Meghan Bruce; Zhou, Zhongliang; Lee, Ching Hung; Wang, Duolao; Liu, Haixia; Dang, Shaonong; Gao, Jianmin

doi:10.1186/s12939-020-01179-3

Cited by 5 publications

(5 citation statements)

References 41 publications

(48 reference statements)

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“…The RMMENT program, the Chinese version of the Safe Motherhood Program, reflected the government's strong political will and contributed to institutional births, thus narrowing the maternal health gap between urban and rural areas. Consistent with other studies, this study showed that the government-funded BPHS project contributed to prenatal examination rates [38], CMHS rates [31], and the hospital birth rate. We identified that the BPHS project was not significantly associated with postpartum visits, which is not in line with the findings of another study [38].…”

Section: The Determinants Of Maternal Healthcare Utilizationsupporting

confidence: 91%

“…Adequate CMHS are critical for reducing maternal mortality [28]. Although there are many cross-sectional studies on ANC [29], hospital deliveries [24], or PNC [30], few articles explore the utilization of CMHS [31] and analyze the change in characteristics in different periods. Inadequate utilization of maternal health services remains severe in remote ethnic minority areas [32].…”

Section: Introductionmentioning

confidence: 99%

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Changes and Determinants of Maternal Health Services Utilization in Ethnic Minority Rural Areas in Central China, 1991–2015: An Ecological Systems Theory Perspective

Zhang

Lü

2023

Healthcare

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Background: Universal maternal health coverage is a proven, effective strategy for maternal survival. This study aimed to describe the changes and determinants of maternal health service use between 1991 and 2015 in central China. Methods: The study was conducted in Enshi Prefecture. Women were eligible for inclusion if they were rural women who lived in villages, had live births during 1991–2015, could recall their maternal care histories, and had no communication problems. This retrospective study included 470 rural women in 9 villages and collected 770 records. The conceptual framework was designed based on the Society Ecosystem Theory. The determinants included micro-factors (individual characteristics), meso-factors (family factors, community factors, healthcare factors), and macro-factors (government-run maternal and child health programs, abbreviated as MCH programs). Multivariate logistic regressions were applied to analyze the determinants of maternal health service utilization. Results: The utilization of maternal healthcare has improved in Enshi. The hospital birth rate was 98.1% in 2009 and mostly 100% in subsequent years. The prenatal examination rate, the postpartum visit rate, and the continuum of maternal health service (CMHS) rate increased to 73.3%, 67.7%, and 53.4%, respectively, in 2009–2015. The utilization of maternal health services was affected by macro-factors, meso-factors, and micro-factors, with macro-factors being the most notable contributors. Conclusions: Despite the remarkable improvements in antenatal care (ANC) use and hospital birth, gaps in postpartum visits remain. Promoting the integrated continuum of maternal and child healthcare in ethnic minority rural areas requires the joint efforts of the government, health and other sectors, communities, families, and individuals.

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Section: The Determinants Of Maternal Healthcare Utilizationsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Changes and Determinants of Maternal Health Services Utilization in Ethnic Minority Rural Areas in Central China, 1991–2015: An Ecological Systems Theory Perspective

Zhang

Lü

2023

Healthcare

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“…In other words, the portion of the low-income population that is unemployed or informally employed bears more of the burden of health care costs, which clearly results in inequity in the distribution of medical resources due to inequitable health insurance [31][32][33]. Moreover, some studies have found that the type of the health insurance affects equity in the use of health care services, such that the use of health care services differs among residents covered by different insurance policies [34][35][36][37].…”

Section: Gender Differences In Health Insurance and Health Statusmentioning

confidence: 99%

Gender Differences in Health Insurance Coverage in China

Zhou

Zhao

2020

Preprint

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Background: China initiated a reform of the health insurance system in the late 1990s. The new insurance, urban Employee basic medical insurance (UEBMI), is employment-based, which makes it more difficult than it used to be for those unemployed or informal employed (most of whom are women) to be covered by health insurance. Methods: based on three large sample of micro datasets, we first use statistical methods to identify gender differences in health insurance. Next, we construct a logistic regression model to capture the differences in insurance coverage across age groups using the parameter of interaction terms for gender and age groups.Results: Based on data from a demographic survey that covers a large sample, we find that in the below 50 (in 2005) or 60 (in 2015) years age group, the coverage gap of UEBMI between men and women was relatively smaller, while a larger disparity existed in the above 50 (in 2005) or 60 (in 2015) group. Moreover, gender differences in health insurance were more significant in the low-education group, while no gender differences were found in the high-education group.Conclusions: This paper explains the gender gap in health insurance and the reason for the wider gap among older people. Our study indicates that because the UEBMI in China mainly covers people with formal jobs, a lower labor participation rate (even much lower in formal jobs) of women has led to their greater difficulty in obtaining health insurance. Since the older women’s greater difficulty in obtaining jobs or susceptibility to lay-offs during the period of the UEBMI’s implementation, the possibility of being covered was even much lower. In fact, it was because of the combined effects of the UEBMI system and the labor market condition at that time that older women had a lower proportion of being covered under the UEBMI.

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“…According to the China National Health Services Survey, the concentration index for outpatient and inpatient health service utilization in China in 2008 was 0.015 and 0.197, respectively, with higher-income groups using more outpatient and inpatient services [14]. This phenomenon is also present in outpatient and inpatient services for middle-aged and elderly groups [15], dental care for preschool children [16], and maternal health services for rural women [17].…”

Section: Introductionmentioning

confidence: 99%

Horizontal inequity trends of health care utilization in rural China after the medicine and healthcare system reform: based on longitudinal data from 2010 to 2018

Tian

Sun³

et al. 2023

Int J Equity Health

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Background To assess the effectiveness of China's medicine and health care reform in promoting equity in health care utilization among rural residents, it is necessary to analyze temporal trends in equity in health care utilization among rural residents in China. This study is the first to assess horizontal inequity trends in health care utilization among rural Chinese residents from 2010 to 2018 and provides evidence for improving government health policies. Methods Longitudinal data obtained from China Family Panel Studies from 2010 to 2018 were used to determine trends in outpatient and inpatient utilization. Concentration index, concentration curve, and horizontal inequity index were calculated to measure inequalities. Decomposition analysis was applied to measure the contribution of need and non-need factors to the unfairness. Results From 2010 to 2018, outpatient utilization among rural residents increased by 35.10%, while inpatient utilization increased by 80.68%. Concentration indices for health care utilization were negative in all years. In 2012, there was an increase in the concentration index for outpatient utilization (CI = -0.0219). The concentration index for inpatient utilization decreased from -0.0478 in 2010 to -0.0888 in 2018. Except for outpatient utilization in 2012 (HI = 0.0214), horizontal inequity indices for outpatient utilization were negative in all years. The horizontal inequity index for inpatient utilization was highest in 2010 (HI = -0.0068) and lowest in 2018 (HI = -0.0303). The contribution of need factors to the inequity exceeded 50% in all years. Conclusions Between 2010 and 2018, low-income groups in rural China used more health services. This seemingly pro-poor income-related inequality was due in large part to the greater health care need among low-income groups. Government policies aimed at increasing access to health services, particularly primary health care had helped to make health care utilization in rural China more equitable. It is necessary to design better health policies for disadvantaged groups to reduce future inequities in the use of health services by rural populations.

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Influence of China’s 2009 healthcare reform on the utilisation of continuum of care for maternal health services: evidence from two cross-sectional household surveys in Shaanxi Province

Cited by 5 publications

References 41 publications

Changes and Determinants of Maternal Health Services Utilization in Ethnic Minority Rural Areas in Central China, 1991–2015: An Ecological Systems Theory Perspective

Changes and Determinants of Maternal Health Services Utilization in Ethnic Minority Rural Areas in Central China, 1991–2015: An Ecological Systems Theory Perspective

Gender Differences in Health Insurance Coverage in China

Horizontal inequity trends of health care utilization in rural China after the medicine and healthcare system reform: based on longitudinal data from 2010 to 2018

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