Medical expenditure of women during pregnancy, childbirth and puerperium at the beginning of China’s universal two-child policy enactment: a population-based retrospective study
Objectives To describe and explore women’s medical expenditures during pregnancy, childbirth and puerperium at the beginning of the universal two-child policy enactment in China.Design Population-based retrospective study.Setting Dalian, China.Participants Under the System of Health Accounts 2011 fr...
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BMJ Publishing Group
2022-03-01
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| Series: | BMJ Open |
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| author | Xin Wang Ying Zhang Yu Chen Shuang Zang Meizhen Zhao Yalan Zhu |
| author_facet | Xin Wang Ying Zhang Yu Chen Shuang Zang Meizhen Zhao Yalan Zhu |
| author_sort | Xin Wang |
| collection | DOAJ |
| description | Objectives To describe and explore women’s medical expenditures during pregnancy, childbirth and puerperium at the beginning of the universal two-child policy enactment in China.Design Population-based retrospective study.Setting Dalian, China.Participants Under the System of Health Accounts 2011 framework, the macroscopic dataset was obtained from the annual report at the provincial and municipal levels in China. The research sample incorporated 65 535 inpatient and outpatient records matching International Classification of Diseases, 10th Revision codes O00–O99 in Dalian city from 2015 through 2017.Primary and secondary outcome measures The study delineates women’s current curative expenditure (CCE) during pregnancy, childbirth and puerperium at the beginning of the universal two-child policy in China. The temporal changes of medical expenditure of women during pregnancy, childbirth and puerperium at the beginning of China’s universal two-child policy enactment were assessed. The generalised linear model and structural equation model were used to test the association between medical expenditure and study variables.Results Unlike the inverted V-shaped trend in the number of live newborns in Dalian over the 3 studied years, CCE on pregnancy, childbirth and puerperium dipped slightly in 2016 (¥260.29 million) from 2015 (¥263.28 million) and saw a surge in 2017 (¥288.65 million). The ratio of out-of-pocket payment/CCE reduced year by year. There was a rapid increase in CCE in women older than 35 years since 2016. Length of stay mediated the relationship between hospital level, year, age, reimbursement ratio and medical expenditure.Conclusions The rise in CCE on pregnancy, delivery and puerperium lagged 1 year behind the surge of newborns at the beginning of China’s universal two-child policy. Length of stay acted as a crucial mediator driving up maternal medical expenditure. Reducing medical expenditure by shortening the length of stay could be a feasible way to effectively address the issue of cost in women during pregnancy, childbirth and puerperium. |
| format | Article |
| id | doaj-art-8e213eb467e34f9bbbfc905144a2f7ee |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-03-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-8e213eb467e34f9bbbfc905144a2f7ee2025-08-20T01:48:02ZengBMJ Publishing GroupBMJ Open2044-60552022-03-0112310.1136/bmjopen-2021-054037Medical expenditure of women during pregnancy, childbirth and puerperium at the beginning of China’s universal two-child policy enactment: a population-based retrospective studyXin Wang0Ying Zhang1Yu Chen2Shuang Zang3Meizhen Zhao4Yalan Zhu51the University of Manchester, AV Hill Building 5th Floor, Manchester, MAN M13 9PT, UKUniversity of Sydney, Sydney, New South Wales, AustraliaDepartment of Medical Oncology, Fujian Medical University Cancer Hospital, Fuzhou, Fujian, ChinaDepartment of Community Nursing, China Medical University, Shenyang, Liaoning, ChinaNursing Department, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, ChinaCollege of Health Management, Research Center for Health Development-Liaoning New Type Think Tank for University, China Medical University, Shenyang, Liaoning, ChinaObjectives To describe and explore women’s medical expenditures during pregnancy, childbirth and puerperium at the beginning of the universal two-child policy enactment in China.Design Population-based retrospective study.Setting Dalian, China.Participants Under the System of Health Accounts 2011 framework, the macroscopic dataset was obtained from the annual report at the provincial and municipal levels in China. The research sample incorporated 65 535 inpatient and outpatient records matching International Classification of Diseases, 10th Revision codes O00–O99 in Dalian city from 2015 through 2017.Primary and secondary outcome measures The study delineates women’s current curative expenditure (CCE) during pregnancy, childbirth and puerperium at the beginning of the universal two-child policy in China. The temporal changes of medical expenditure of women during pregnancy, childbirth and puerperium at the beginning of China’s universal two-child policy enactment were assessed. The generalised linear model and structural equation model were used to test the association between medical expenditure and study variables.Results Unlike the inverted V-shaped trend in the number of live newborns in Dalian over the 3 studied years, CCE on pregnancy, childbirth and puerperium dipped slightly in 2016 (¥260.29 million) from 2015 (¥263.28 million) and saw a surge in 2017 (¥288.65 million). The ratio of out-of-pocket payment/CCE reduced year by year. There was a rapid increase in CCE in women older than 35 years since 2016. Length of stay mediated the relationship between hospital level, year, age, reimbursement ratio and medical expenditure.Conclusions The rise in CCE on pregnancy, delivery and puerperium lagged 1 year behind the surge of newborns at the beginning of China’s universal two-child policy. Length of stay acted as a crucial mediator driving up maternal medical expenditure. Reducing medical expenditure by shortening the length of stay could be a feasible way to effectively address the issue of cost in women during pregnancy, childbirth and puerperium.https://bmjopen.bmj.com/content/12/3/e054037.full |
| spellingShingle | Xin Wang Ying Zhang Yu Chen Shuang Zang Meizhen Zhao Yalan Zhu Medical expenditure of women during pregnancy, childbirth and puerperium at the beginning of China’s universal two-child policy enactment: a population-based retrospective study BMJ Open |
| title | Medical expenditure of women during pregnancy, childbirth and puerperium at the beginning of China’s universal two-child policy enactment: a population-based retrospective study |
| title_full | Medical expenditure of women during pregnancy, childbirth and puerperium at the beginning of China’s universal two-child policy enactment: a population-based retrospective study |
| title_fullStr | Medical expenditure of women during pregnancy, childbirth and puerperium at the beginning of China’s universal two-child policy enactment: a population-based retrospective study |
| title_full_unstemmed | Medical expenditure of women during pregnancy, childbirth and puerperium at the beginning of China’s universal two-child policy enactment: a population-based retrospective study |
| title_short | Medical expenditure of women during pregnancy, childbirth and puerperium at the beginning of China’s universal two-child policy enactment: a population-based retrospective study |
| title_sort | medical expenditure of women during pregnancy childbirth and puerperium at the beginning of china s universal two child policy enactment a population based retrospective study |
| url | https://bmjopen.bmj.com/content/12/3/e054037.full |
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