Background This study aimed to analyze the status of birthrates and the characteristics of child delivery expenditure under the Chinese two-child policy's transition period. We evaluated the socioeconomic factors associated with child delivery and provide evidence for decisions relating to health support for childbirth. Methods Child delivery expense data were obtained from 2015 to 2017 in Dalian, China. A total of 13,535 obstetric records were enrolled using stratified random sampling and the proportional probability to size method. First, we calculated the current curative expenditure of child delivery and health financing in childbirth costs based on the System of Health Accounts 2011 (SHA 2011). Second, univariate analysis of variance and generalized linear modeling were performed to examine factors associated with child delivery expenditure. Third, we classified the included hospitals into the county, district, and municipal hospitals and compared maternal characteristics between these categories. Results Overall, out-of-pocket payments accounted for more than 35% of the total expenditure on child delivery. Median (interquartile range) delivery expenditure at the county and district level hospitals [county-level: 5128.50 (3311.75-5769.00) CNY; district-level: 4064.00 (2824.00-6599.00) CNY] was higher than that at the municipal level hospitals: 3824.50 (2096.50-5908.00) CNY. The increase of child delivery expenditure was associated with an increased ratio of reimbursement, admissions to county and district level hospitals, cesarean sections, and length of stay, as well as a decline in average maternal age (p < 0.05). Conclusions Health financing for childbirth expenditure was not rational during the transition period of the family planning policy in China. Higher delivery expenditure at county and district level hospitals may indicate variations in medical professionalism. Poorly managed hospitalization expenditure and/or nonstandard medical charges for childbirth, all of which may require the development of appropriate public health policies to regulate such emerging phenomena.
基金：
National Natural Science Foundation of ChinaNational Natural Science Foundation of China (NSFC) [71673299]
语种：
外文
被引次数：
WOS：
PubmedID：
中科院(CAS)分区：
出版当年[2020]版：
大类|4 区医学
小类|3 区卫生保健与服务
最新[2025]版：
大类|2 区医学
小类|2 区卫生保健与服务2 区卫生政策与服务
JCR分区：
出版当年[2019]版：
Q2HEALTH CARE SCIENCES & SERVICESQ2HEALTH POLICY & SERVICES
最新[2023]版：
Q1HEALTH CARE SCIENCES & SERVICESQ1HEALTH POLICY & SERVICES
第一作者单位：[1]China Med Univ, Sch Nursing, Shenyang, Peoples R China
通讯作者：
推荐引用方式(GB/T 7714)：
Zang Shuang,OuYang Jing,Zhao Meizhen,et al.Factors associated with child delivery expenditure during the transition to the national implementation of the two-child policy in China[J].HEALTH AND QUALITY OF LIFE OUTCOMES.2021,19(1):doi:10.1186/s12955-021-01678-z.
APA：
Zang, Shuang,OuYang, Jing,Zhao, Meizhen,Zhu, Yalan,Liu, Jia&Wang, Xin.(2021).Factors associated with child delivery expenditure during the transition to the national implementation of the two-child policy in China.HEALTH AND QUALITY OF LIFE OUTCOMES,19,(1)
MLA：
Zang, Shuang,et al."Factors associated with child delivery expenditure during the transition to the national implementation of the two-child policy in China".HEALTH AND QUALITY OF LIFE OUTCOMES 19..1(2021)
