Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2018

Open Access 01-12-2018 | Research article

Caesarean section rate and cost control effectiveness of case payment reform in the new cooperative medical scheme for delivery: evidence from Xi County, China

Authors: Shuang Liu, Jing Wang, Liang Zhang, Xiang Zhang

Published in: BMC Pregnancy and Childbirth | Issue 1/2018

Login to get access

Abstract

Background

In China, increases in both the caesarean section (CS) rates and delivery costs have raised questions regarding the reform of the medical insurance payment system. Case payment is useful for regulating the behaviour of health providers and for controlling the CS rates and excessive increases in medical expenses. New Cooperative Medical Scheme (NCMS) agencies in Xi County in Henan Province piloted a case payment reform (CPR) in delivery for inpatients. We aimed to observe the changes in the CS rates, compare the changes in delivery-related variables, and identify variables related to delivery costs before and after the CPR in Xi County.

Methods

Overall, 28,314 cases were selected from the Xi County NCMS agency from 2009 to 2010 and from 2014 to 2015. One-way ANOVA and chi-square tests were used to compare the distributions of CS and vaginal delivery (VD) before and after the CPR under different indicators. We applied multivariate linear regressions for the total medical cost of the VD and CS groups and total samples to identify the relationships between medical expenses and variables.

Results

The CS rates in Xi County increased from 26.1% to 32.5% after the CPR. The length of stay (LOS), total medical cost, and proportion of county hospitals increased in the CS and VD groups after the CPR, which had significant differences. The total medical cost in the CS and VD groups as well as the total samples was significantly influenced by inpatient age, LOS, and hospital type, and had a significant correlation with the CPR in the VD group and the total samples.

Conclusion

The CPR might fail to control the growth of unreasonable medical expenses and regulate the behaviour of providers, which possibly resulted from the unreasonable compensation standard of case payments, prolonged LOS, and the increasing proportion of county hospitals. The NCMS should modify the case payment standard of delivery to inhibit providers’ motivation to render CS services. The LOS should be controlled by implementing clinical guidelines, and a reference system should be established to guide patients in choosing reasonable hospitals.
Literature
1.
WHO. Monitoring emergency obstetric care: a handbook. Journal of Obstetrics & Gynaecology. 2010;30(4):430.
2.
Robson SJ, de Costa CM. Thirty years of the World Health Organization's target caesarean section rate: time to move on. Med J Aust. 2017;206(4):181.CrossRefPubMed
3.
Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The increasing trend in caesarean section rates: global, regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.CrossRefPubMedPubMedCentral
4.
5.
Hellerstein S, Feldman S, Duan T. China’s 50% caesarean delivery rate: is it too high? BJOG Int J Obstet Gynaecol. 2015;122(2):160.CrossRef
6.
Li HT, Luo S, Trasande L, Hellerstein S, Kang C, Li JX, Zhang Y, Liu JM, Geographic Variations BJ. Temporal trends in cesarean delivery rates in China, 2008-2014. JAMA. 2017;317(1):69–76.CrossRefPubMed
7.
Lumbiganon P, Laopaiboon M, Gülmezoglu AM, Souza JP, Taneepanichskul S, Ruyan P, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08. Lancet. 2010;375(9713):490.CrossRefPubMed
8.
Long Q, Klemetti R, Wang Y, Tao F, Yan H, Hemminki E. High caesarean section rate in rural China: is it related to health insurance (new co-operative medical scheme)? Soc Sci Med. 2012;75(4):733–7.CrossRefPubMed
9.
Kruk ME, Galea S, Prescott M, Freedman LP. Health care financing and utilization of maternal health services in developing countries. Health Policy Plan. 2007;22(5):303–10.CrossRefPubMed
10.
Gibbons L, Belizán JM, Lauer JA, Betrán AP, Merialdi M, Althabe F. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World health report. 2010;30:1–31.
11.
Eriksen HM, Saether AR, Løwer HL, Vangen S, Hjetland R, Lundmark H, et al. Infections after caesarean sections. Journal of the Norwegian Medical Association. 2009;129(7):618–22.PubMed
12.
Li HT, Trasande L, Zhu LP, Ye RW, Zhou YB, Liu JM. Association of cesarean delivery with anemia in infants and children in 2 large longitudinal Chinese birth cohorts. Am J Clin Nutr. 2015;101(3):523–9.CrossRefPubMed
13.
Tang S, Li X, Wu Z. Rising cesarean delivery rate in primiparous women in urban China: evidence from three nationwide household health surveys. American Journal of Obstetrics & Gynecology. 2006;195(6):1527–32.CrossRef
14.
15.
Hellerstein S, Feldman S, Duan T. Survey of obstetric care and cesarean delivery rates in shanghai, China. Birth. 2016;43(3):193–9.CrossRefPubMed
16.
Bogg L, Huang K, Long Q, Shen Y, Hemminki E. Dramatic increase of cesarean deliveries in the midst of health reforms in rural China. Soc Sci Med. 2010;70(10):1544–9.CrossRefPubMed
17.
Hu S, Tang S, Liu Y, Zhao Y, Escobar ML, de Ferranti D. Reform of how health care is paid for in China: challenges and opportunities. Lancet. 2008;372(9652):1846–53.CrossRefPubMed
18.
Stafford RS. Alternative strategies for controlling rising cesarean section rates. JAMA. 1990;263(5):683–7.CrossRefPubMed
19.
Yip WC, Hsiao W, Meng Q, Chen W, Sun X. Realignment of incentives for health-care providers in China. Lancet. 2010;375(9720):1120–30.CrossRefPubMed
20.
Yip WC-M, Hsiao WC, Chen W, Hu S, Ma J, Maynard A. Early appraisal of China's huge and complex health-care reforms. Lancet. 2012;379(9818):833–42.CrossRefPubMed
21.
Eggleston K, Ling L, Qingyue M, Lindelow M, Wagstaff A. Health service delivery in China: a literature review. Health Econ. 2008;17(2):149–65.CrossRefPubMed
22.
McCue MJ, Thompson JM. Early effects of the prospective payment system on inpatient rehabilitation hospital performance. Arch Phys Med Rehabil. 2006;87(2):198–202.CrossRefPubMed
23.
Usman AU, Hassan SA, Tukur K. Application of dummy variables in multiple regression analysis. International Journal of Recent Scientific Research. 2015;7(11):7440–2.
24.
Sapkota S, Kobayashi T, Kakehashi M, Baral G, Yoshida I. In the Nepalese context, can a husband’s attendance during childbirth help his wife feel more in control of labour? Bmc Pregnancy & Childbirth. 2012;12(1):1–10.CrossRef
25.
Cavalieri M, Gitto L, Guccio C. Reimbursement systems and quality of hospital care: an empirical analysis for Italy. Health policy. 2013;111(3):273–89.CrossRefPubMed
26.
Rosko MD, Mutter RL. Inefficiency differences between critical access hospitals and prospectively paid rural hospitals. J Health Polit Policy Law. 2010;35(1):95–126.CrossRefPubMed
27.
Althabe F, Belizán JM, Villar J, Alexander S, Bergel E, Ramos S, et al. Mandatory second opinion to reduce rates of unnecessary caesarean sections in Latin America: a cluster randomised controlled trial. Lancet. 2004;363(9425):1934–40.CrossRefPubMed
28.
Wei JW, Heeley EL, Jan S, Huang YN, Huang QF, Wang JG, et al. Variations and determinants of hospital costs for acute stroke in China. PLoS One. 2010;5(9):4439–51.
29.
Taheri PA, Butz DA, Greenfield LJ. Length of stay has minimal impact on the cost of hospital admission. J Am Coll Surg. 2000;191(2):123.CrossRefPubMed
30.
Eggleston K, Ling L, Quingyue M, Lindelow M, Wagstaff A. Health service delivery in China: a literature review. Health Econ. 2008;17(2):149.CrossRefPubMed
31.
Petrou S, Henderson J, Glazener C. Economic aspects of cesarean section and alternative modes of delivery. Best Practice & Research Clinical Obstetrics & Gynaecology. 2001;15(1):145.CrossRef
32.
Yip WCM, Hsiao W, Meng Q, Chen W, Sun X. Realignment of incentives for health-care providers in China. Lancet. 2010;375(9720):1120.CrossRefPubMed
33.
Grabich SC, Robinson WR, Engel SM, Konrad CE, Richardson DB, Horney JA. County-level hurricane exposure and birth rates: application of difference-in-differences analysis for confounding control. Emerging Themes in Epidemiology. 2015;12(1):19.CrossRefPubMedPubMedCentral
Metadata
Title
Caesarean section rate and cost control effectiveness of case payment reform in the new cooperative medical scheme for delivery: evidence from Xi County, China
Authors
Shuang Liu
Jing Wang
Liang Zhang
Xiang Zhang
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2018
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-018-1698-0

Other articles of this Issue 1/2018

BMC Pregnancy and Childbirth 1/2018 Go to the issue

Research article

Long-term significant seasonal differences in the numbers of new-borns with an orofacial cleft in the Czech Republic – a retrospective study

Research article

Factors associated with caesarean deliveries among child-bearing women in Pakistan: secondary analysis of data from the Demographic and Health Survey, 2012–13

Research article

Maternal ‘near miss’ collection at an Australian tertiary maternity hospital

Case report

Undiagnosed maternal diaphragmatic hernia – a management dilemma

Research article

“I’m used to doing it by myself”: exploring self-reliance in pregnancy

Research article

Gestational weight gain in Chinese women -- results from a retrospective cohort in Changsha, China