title: Effect of the new maternity insurance scheme on medical expenditures for caesarean delivery in Wuxi, China: a retrospective pre/post-reform case study.
abstract: Aiming to control rising medical expenditures and help improve China's healthcare systems, this study examined whether a cap-based medical insurance scheme with shared financial interest between the insurance and healthcare providers is effective in containing hospitals' C-section medical expenditures. We used 6547 caesarean delivery case records from a teaching tertiary-level general public hospital located in Wuxi, China (2004-2013), and used the Chow test to investigate the possibility of significant variation in mean medical expenditures for caesarean deliveries pre- and post-reform. We also used paired sample t-tests and linear regression models to compare the mean medical expenditures between insured and uninsured women undergoing caesarean delivery during the post-reform period. After the scheme's implementation, medical expenditures for caesarean deliveries declined and the medical expenditures of women covered by the scheme were significantly lower than those of uninsured patients. These findings indicated the scheme's effectiveness in minimizing caesarean delivery expenditures. The cap-based medical insurance scheme with shared financial interest between insurance and healthcare providers would likely steer healthcare providers' behaviors in a more cost-effective direction.
authors.affiliation: School of Public Health and Management, Wenzhou Medical University, Wenzhou, 325035, China.|Research Institute of Health Development Strategies, Fudan University, Shanghai, 200032, China.
authors.forename: Chun
authors.initials: C
authors.lastname: Chen
authors.affiliation: Affiliated Hospital, Jiangnan University, Wuxi, 214062, China.
authors.forename: Zhihong
authors.initials: Z
authors.lastname: Cheng
authors.affiliation: Affiliated Hospital, Jiangnan University, Wuxi, 214062, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Jiang
authors.affiliation: Research Institute of Health Development Strategies, Fudan University, Shanghai, 200032, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Sun
authors.affiliation: School of Community and Environmental Health, Old Dominion University, Norfolk, VA, 23529, USA. qzhang@odu.edu.
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Research Institute of Health Development Strategies, Fudan University, Shanghai, 200032, China. lujun@shmu.edu.cn.
authors.forename: Jun
authors.initials: J
authors.lastname: Lv
mesh_terms: D002585:Cesarean Section / Q000191:economics*; D002681:China; D005260:Female; D018166:Health Care Reform / Q000592:standards*; D005102:Health Expenditures / Q000639:trends*; D006779:Hospitals, Public / Q000191:economics*; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D016014:Linear Models; D011247:Pregnancy; D012189:Retrospective Studies
keywords: China; caesarean delivery; financial incentive; maternity insurance scheme; medical expenditure