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

Abstract

Background: Continuum of care for maternal health services (CMHS) is a proven approach to improve health and safety for mothers and newborns. This study aims to explore the influence of China’s 2009 healthcare reform on improving the CMHS utilisation. Methods: This population-based cross-sectional quantitative study included 2332 women drawn from the fourth and fifth National Health Service Surveys of Shaanxi Province, conducted in 2008 and 2013 respectively, before and after China’s 2009 healthcare reform. A generalised linear mixed model (GLMM) was applied to analyse the influence of this healthcare reform on utilisation of CMHS. Concentration curves, concentration indexes and its decomposition method were used to analyse the equity of changes in utilisation. Results: This study showed post-reform CMHS utilisation was higher in both rural and urban women than the CMHS utilisation pre-reform (according to China’s policy defining CMHS). The rate of CMHS utilisation increased from 24.66% to 41.55% for urban women and from 18.31% to 50.49% for rural women (urban: χ 2 =20.64, P<0.001; rural: χ 2 =131.38, P<0.001). This finding is consistent when the WHO’s definition of CMHS is applied for rural women after reform (12.13% vs 19.26%; χ 2 =10.99, P=0.001); for urban women, CMHS utilisation increased from 15.70% to 20.56% (χ 2 =2.57, P=0.109). The GLMM showed that the rate of CMHS utilisation for urban women post-reform was five times higher than pre-reform rates (OR=5.02, 95%CL: 1.90, 13.31); it was close to 15 times higher for rural women (OR=14.70, 95%CL: 5.43, 39.76). The concentration index for urban women decreased from 0.130 pre-reform (95%CI: -0.026, 0.411) to -0.041 post-reform (95%CI: -0.096, 0.007); it decreased from 0.104 (95%CI: -0.012, 0.222) to 0.019 (95%CI: -0.014, 0.060) for rural women. The horizontal inequity index for both groups of women also decreased (0.136 to -0.047 urban and 0.111 to 0.019 for rural). Conclusions: China’s 2009 healthcare reform has positively influenced utilisation rates and equity of CMHS’s utilisation among both urban and rural women in Shaanxi Province. Addressing economic and educational attainment gaps between the rich and the poor may be effective ways to improve the persistent health inequities for rural women. Keywords: Healthcare Reform; Continuum of care for Maternal Health Services; Equity; National Health Service Surveys; China

Complete continuum of maternity care and associated factors among mothers who gave birth in the last twelve months in Mekane Selam town North-East Ethiopia: A community-based cross-sectional study,2021

“…The results of this study were lower than those of studies conducted in Egypt (50.4%) and Cambodia (60%) respectively [25,28]. The differences might be explained by variation in geographic location, settings, access to health facilities, outcome ascertainment and eligibility criteria used.…”

“…In this study, educated women had a better chance of receiving a complete continuum of maternity care than women with no formal education. Studies in Debre Berhan, South Asia and Sub-Saharan Africa, Pakistan, Cambodia, and Nepal backed with this conclusion [2,15,25,27]. This could be explained by the fact that education can improve women's understanding, access to information, and capacity to grasp information about healthcare services from the media and healthcare workers.…”

“…A structured face-to-face interviewer administered questionnaire developed from a prior study was used to collect data [2,7,10,12,13,19,[22][23][24][25][26][27][28]. English version was translated to Amharic version by two native speakers of Amharic language (one was reproductive health and the other was English language and literatures in professions).…”

Gender differences in health insurance coverage in China

“…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 [30][31][32]. 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 [33][34][35][36].…”