title: Comparing Maternal Services Utilization and Expense Reimbursement before and after the Adjustment of the New Rural Cooperative Medical Scheme Policy in Rural China.
abstract: BACKGROUND
  The New Rural Cooperative Medical Scheme (NCMS) includes a maternal care benefits package that is associated with increasing maternal health services. The local compensation policies have been frequently adjusted in recent years. This study examined the association between the NCMS maternal-services policy adjustment and expense reimbursement in Yuyao, China.
  
  
  METHODS
  Two household surveys were conducted in Yuyao in 2008 and 2011 (before and after the NCMS policy adjustment, respectively). Local women (N = 154) who had delivery history in the past three years were recruited. A questionnaire was used to collect information about delivery history, maternal health services utilization (prenatal care, postnatal care, and the grade of delivery institutions), NCMS participation, and reimbursement status. Logistic regression analyses were used to predict the association between policy adjustment and maternal health utilization and the association between policy adjustment and out-of-pocket proportion. Next, t-tests and covariance analyses adjusting for household income were used to compare the out-of-pocket proportion between 2008 and 2011.
  
  
  RESULTS
  Results revealed that compensation policy adjustment was associated with an increase in postnatal visits (adjusted OR = 3.32, p = 0.009) and the use of second level or above institutions for delivery (adjusted OR = 2.32, p = 0.03) among participants. In 2008, only 9.1% of pregnant women received reimbursement from the NCMS; however, this rate increased to 36.8% in 2011. After policy adjustment, there were no significant changes in the proportion of out-of-pocket expenses shared in delivery fee (F = 0.24, p = 0.63) and in household income (F = 0.46, p = 0.50).
  
  
  CONCLUSIONS
  Financial compensation increase improved maternal health services utilization; however, this effect was limited. Although the reimbursement rate was raised, the out-of-pocket proportion was not significant changed; therefore, the compensation design scheme must be adjusted in practice.
authors.affiliation: Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China.|Center for Health Management and Care Security Policy Research, School of Government, Nanjing University, Nanjing, China.
authors.forename: Hua
authors.initials: H
authors.lastname: You
authors.affiliation: Center for Health Management and Care Security Policy Research, School of Government, Nanjing University, Nanjing, China.
authors.forename: Hai
authors.initials: H
authors.lastname: Gu
authors.affiliation: Department of Women Health Care, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Weiqing
authors.initials: W
authors.lastname: Ning
authors.affiliation: Department of Child Health Care, Maternal and Child Health Hospital of Changzhou, Changzhou, Jiangsu, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Zhou
authors.affiliation: Center for Health Policy Studies, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Hengjin
authors.initials: H
authors.lastname: Dong
mesh_terms: D000328:Adult; D002681:China; D003625:Data Collection; D005260:Female; D005380:Financing, Government / Q000191:economics; D017048:Health Care Costs; D005102:Health Expenditures / Q000706:statistics & numerical data; D006291:Health Policy; D006306:Health Surveys; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics* / Q000458:organization & administration* / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000191:economics*; D012424:Rural Population; D011795:Surveys and Questionnaires