title: Utilization of delivery care among rural women in China: does the health insurance make a difference? a cross-sectional study.
abstract: BACKGROUND
  Since 2003, the New Cooperative Medical Scheme (NCMS) has been implemented throughout rural China, usually covering delivery services in its benefit package. The objective of this study was to compare the difference of utilization of delivery services, expenditures, and local women's perceived affordability between women with and without reimbursement from NCMS.
  
  
  METHODS
  A cross-sectional survey was carried out in two rural counties in Shaanxi province, China, during December 2008-March 2009. Women giving birth from April 2008 to March 2009 were interviewed by a structured questionnaire to collect information on utilization of delivery services. Multivariable analyses were used to compare the differences in outcomes between women with and without reimbursement from NCMS.
  
  
  RESULTS
  Of the total 1613 women interviewed, 747(46.3%) got reimbursement to cover their expenditure on delivery care (NCMS group) and 866(53.7%) paid delivery services entirely out of their own pocket (Non-NCMS group). Compared with the Non-NCMS group, the NCMS group had significantly more women who delivered at hospital. The rate of Caesarean section (CS), proportion of women seeking higher level services, and length of hospitalization were similar between the two groups. The total hospital costs for delivery services in the NCMS group was significantly smaller and after being reimbursed, the out-of-pocket payment in the NCMS group was less than a half of that in the Non-NCMS group. Fewer women in the NCMS group than in the Non-NCMS group considered their payment for delivery services expensive.
  
  
  CONCLUSIONS
  There was no evidence of overuse delivery services among the women reimbursed by NCMS. Total hospital costs and women's costs for delivery services were found lower in the NCMS group, subsequently alleviation on women's perceived financial affordability.
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710061, China.
authors.forename: Shengbin
authors.initials: S
authors.lastname: Xiao
authors.forename: Hong
authors.initials: H
authors.lastname: Yan
authors.forename: Yuan
authors.initials: Y
authors.lastname: Shen
authors.forename: Shaonong
authors.initials: S
authors.lastname: Dang
authors.forename: Elina
authors.initials: E
authors.lastname: Hemminki
authors.forename: Duolao
authors.initials: D
authors.lastname: Wang
authors.forename: Qian
authors.initials: Q
authors.lastname: Long
authors.forename: Jianmin
authors.initials: J
authors.lastname: Gao
mesh_terms: D000328:Adult; D002681:China; D003430:Cross-Sectional Studies; D005260:Female; D005102:Health Expenditures / Q000639:trends; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health / Q000706:statistics & numerical data*; D007407:Interviews as Topic; D015999:Multivariate Analysis; D019035:Rural Health Services / Q000706:statistics & numerical data*; D013222:State Medicine; D055815:Young Adult