title: Giving birth at a health-care facility in rural China: is it affordable for the poor?
abstract: OBJECTIVE
  To investigate changes in the expenditure of giving birth in health-care facilities in rural China during 1998-2007, to examine the financial burden on households, particularly poor ones, and to identify factors associated with out-of-pocket expenditure.
  
  
  METHODS
  Cross-sectional data on births between 1998 and 2007 were obtained from national household surveys conducted in 2003 and 2008. Descriptive statistics and log-linear models were used to identify factors associated with out-of-pocket expenditure on delivery.
  
  
  RESULTS
  During 1998-2007, the proportion of facility-based deliveries increased from 55% to 90%. In 2007, 60% of births occurred at county-level or higher-level facilities. The Caesarean delivery rate increased from 6% to 26%. Total expenditure on a facility-based delivery increased by 152%, with a marked rise from 2002 onwards with the introduction of the New Cooperative Medical Scheme. In 2007, out-of-pocket expenditure on a facility-based delivery equalled 13% of the mean annual household income for low-income households. This proportion had decreased from 18% in 2002 and differences between income groups had narrowed. Regression models showed that Caesarean delivery and delivery at a higher-level facility were associated with higher expenditure in 2007. The New Cooperative Medical Scheme was associated with lower out-of-pocket expenditure on Caesarean delivery but not on vaginal delivery.
  
  
  CONCLUSIONS
  Expenditure on facility-based delivery greatly increased in rural China over 1998-2007 because of greater use of higher-level facilities, more Caesarean deliveries and the introduction of the New Cooperative Medical Scheme. The financial burden on the rural poor remained high.
authors.affiliation: Department of Public Health, University of Helsinki, PO Box 41, Mannerheiminitie 172, FI-00014 Helsinki, Finland. qian.long@thl.fi
authors.forename: Qian
authors.initials: Q
authors.lastname: Long
authors.forename: Yaoguang
authors.initials: Y
authors.lastname: Zhang
authors.forename: Joanna
authors.initials: J
authors.lastname: Raven
authors.forename: Zhuochun
authors.initials: Z
authors.lastname: Wu
authors.forename: Lennart
authors.initials: L
authors.lastname: Bogg
authors.forename: Shenglan
authors.initials: S
authors.lastname: Tang
authors.forename: Elina
authors.initials: E
authors.lastname: Hemminki
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs; D019538:Health Care Surveys; D005102:Health Expenditures; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000191:economics* / Q000706:statistics & numerical data; D006304:Health Status; D006771:Hospitals, Maternity / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D009774:Obstetrics / Q000191:economics* / Q000706:statistics & numerical data; D011203:Poverty / Q000191:economics* / Q000706:statistics & numerical data; D011247:Pregnancy; D011787:Quality of Health Care / Q000191:economics / Q000706:statistics & numerical data; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D016387:Women's Health; D055815:Young Adult