Factors associated with child delivery expenditure during the transition to the national implementation of the two-child policy in China

Spatial distribution patterns of human resources allocation in maternal and child healthcare institutions in China from 2016 to 2021

BACKGROUND

In China, economic, urbanization, and policy differences between the eastern and western regions lead to uneven healthcare resources. This disparity is more pronounced in the west due to fewer healthcare personnel per thousand individuals and imbalanced doctor-to-nurse ratios, which exacerbates healthcare challenges. This study examines the spatial distribution of human resources in maternal and child healthcare from 2016 to 2021, highlighting regional disparities and offering insights for future policy development.

METHODS

The data were sourced from the "China Health and Family Planning Statistical Yearbook" (2017) and the "China Health and Health Statistics Yearbook" (2018-2022). This study utilized GeoDa 1.8.6 software to conduct both global and local spatial autocorrelation analyses, using China's administrative map as the base dataset.

RESULTS

From 2016 to 2021, there was an upward trend in the number of health personnel and various types of health technical personnel in Chinese maternal and child healthcare institutions. The spatial distribution of these personnel from 2016 to 2021 revealed clusters characterized as high-high, low-low, high-low and low-high. Specifically, high-high clusters were identified in Guangxi, Hunan, Jiangxi, and Guangdong provinces; low-low in Xinjiang Uygur Autonomous Region and Inner Mongolia Autonomous Region; high-low in Sichuan province; and low-high in Fujian and Anhui provinces.

CONCLUSIONS

From 2016 to 2021, there was evident spatial clustering of health personnel and various health technical personnel in Chinese maternal and child healthcare institutions, indicating regional imbalances.

Comparison of hospital delivery costs between cesarean section and natural delivery and analysis of influencing factors

OBJECTIVES

The increasing costs of hospital delivery have increased the economic burden of pregnant women, and the mode of delivery is the main factor affecting the costs of hospital delivery. This study aims to explore the difference in costs between cesarean section and natural delivery, and to provide reference for controlling the increase of hospital delivery costs.

METHODS

The data of inpatient delivery in the Hunan Maternal and Child Health Care Hospital from January 2016 to December 2020 were selected to compare the total inpatient costs and average daily costs of cesarean section and natural delivery. The linear trend model was used to analyze the trend change of inpatient delivery costs and the generalized linear model was used to analyze the influential factors for inpatient delivery costs.

RESULTS

The average hospitalization costs of cesarean section (10 447.25 yuan) were higher than that of natural delivery (5 567.95 yuan), and the average daily costs of cesarean section (1 902.57 yuan) were higher than those of natural delivery (1 666.40 yuan). There was no significant increase or decrease in trend for cesarean section, while the average annual growth rate of the costs of natural delivery was 11.79%. The main factors affecting the hospitalization costs of cesarean section and natural delivery included age, occupation, medical insurance, route of admission, length of stay, premature delivery and complications (all P<0.05).

CONCLUSIONS

The total hospitalization costs and average daily costs of cesarean section are higher than those of natural delivery, but the costs of natural delivery show a faster growth trend, and the hospitalization costs of cesarean section and natural delivery should be controlled by targeted measures.

Sooner, later, or never: Changing fertility intentions due to Covid-19 in China's Covid-19 epicentre

Using survey data collected from Hubei province, China's Covid-19 epicentre, in August 2020, this study examines how fertility intentions of Chinese citizens changed during the Covid-19 pandemic. We consider not only whether people changed their fertility plans due to Covid-19 but also distinguish three types of change: bringing forward ('sooner'), postponing ('later'), and abandoning ('never') planned fertility. Over half of those who planned to have a child intended to change their fertility plans due to Covid-19. Younger individuals, those of non-Han ethnicities, urban residents, those with one child already, and those with ever-infected family members were more likely to change their fertility plans. While the effects of some characteristics seem to be short term, other characteristics such as age and number of children show more consequential influences. Older individuals and those planning their second child were particularly prone to abandoning their childbearing plans due to Covid-19. The pandemic may thus complicate China's latest efforts to boost its low fertility.

Medical expenditure of women during pregnancy, childbirth and puerperium at the beginning of China's universal two-child policy enactment: a population-based retrospective study

OBJECTIVES

To describe and explore women's medical expenditures during pregnancy, childbirth and puerperium at the beginning of the universal two-child policy enactment in China.

DESIGN

Population-based retrospective study.

SETTING

Dalian, China.

PARTICIPANTS

Under the System of Health Accounts 2011 framework, the macroscopic dataset was obtained from the annual report at the provincial and municipal levels in China. The research sample incorporated 65 535 inpatient and outpatient records matching International Classification of Diseases, 10th Revision codes O00-O99 in Dalian city from 2015 through 2017.

PRIMARY AND SECONDARY OUTCOME MEASURES

The study delineates women's current curative expenditure (CCE) during pregnancy, childbirth and puerperium at the beginning of the universal two-child policy in China. The temporal changes of medical expenditure of women during pregnancy, childbirth and puerperium at the beginning of China's universal two-child policy enactment were assessed. The generalised linear model and structural equation model were used to test the association between medical expenditure and study variables.

RESULTS

Unlike the inverted V-shaped trend in the number of live newborns in Dalian over the 3 studied years, CCE on pregnancy, childbirth and puerperium dipped slightly in 2016 (¥260.29 million) from 2015 (¥263.28 million) and saw a surge in 2017 (¥288.65 million). The ratio of out-of-pocket payment/CCE reduced year by year. There was a rapid increase in CCE in women older than 35 years since 2016. Length of stay mediated the relationship between hospital level, year, age, reimbursement ratio and medical expenditure.

CONCLUSIONS

The rise in CCE on pregnancy, delivery and puerperium lagged 1 year behind the surge of newborns at the beginning of China's universal two-child policy. Length of stay acted as a crucial mediator driving up maternal medical expenditure. Reducing medical expenditure by shortening the length of stay could be a feasible way to effectively address the issue of cost in women during pregnancy, childbirth and puerperium.

Multidisciplinary Team Managements and Clinical Outcomes in Patients With Pulmonary Arterial Hypertension During the Perinatal Period

Background: Pulmonary arterial hypertension (PAH) patients with pregnancy have high maternal mortality. This study aimed to provide clinical evidence with multidisciplinary team (MDT) management and to evaluate the clinical outcomes in PAH patients during the perinatal period.

Methods: We conducted a retrospective evaluation of PAH patients pregnant at the First Affiliated Hospital of Chongqing Medical University between May 2015 and May 2021.

Results: Twenty-two patients (24 pregnancies) were included in this study and received MDT management, and 21 pregnancies chose to continue pregnancy with cesarean section. Nine (37.5%) were first-time pregnancies at 27.78 ± 6.16 years old, and 15 (62.5%) were multiple pregnancies at 30.73 ± 3.71 years old. The average gestational week at hospitalization and delivery were 29.38 ± 8.63 weeks and 32.37 ± 7.20 weeks, individually. Twenty-one (87.5%) pregnancies received single or combined pulmonary vasodilators. The maternal survival rate of PAH patients reached 91.7%. Fifteen (62.5%) pregnancies were complicated with severe adverse events. Patients with complicated adverse events showed lower percutaneous oxygen saturation (SpO₂), lower albumin, lower fibrinogen, higher pulmonary artery systolic pressure (PASP), higher blood pressure, longer activated partial thromboplastin time, and longer coagulation time. Fourteen (66.7%) pregnancies with cesarean sections were prematurely delivered and 85.7% newborns who survived after the operation remained alive.

Conclusion: The survival rate of parturients with PAH was improved in relation to MDT and pulmonary vasodilator therapy during the perinatal period compared with previous studies. SpO₂, albumin, PASP, blood pressure, and coagulation function should be monitored carefully in PAH patients during pregnancy.

Spatio-Temporal Distribution and Demographic Characteristics of Congenital Heart Defects in Guangdong, China, 2016-2020

BACKGROUND

Congenital heart defects are the most common type of birth defects and bring a heavy disease burden in China. Examining the temporal and spatial trends of congenital heart defects epidemics can give some elementary knowledge for succeeding studies.

OBJECTIVE

To characterize the spatial-temporal patterns of the prevalence of congenital heart defects based on a substantial cohort of the perinatal fetus in south China in 2016-2020.

METHODS

This study was a retrospective population-based cohort study conducted in Guangdong, China from 2016 to 2020. Pregnant women and their infants received birth defect surveillance during pregnancy and seven days after delivery in more than 1,900 midwifery hospitals in 21 cities. Perinatal infants with congenital heart defects were identified and enrolled. The prevalence of congenital heart defects was calculated according to cities, years, urban and rural areas, regions of Guangdong, categories of maternal age at delivery, seasons of delivery, and infant's gender.

RESULTS

A total of 8,653,206 perinatal infants and 53,912 total congenital heart defects were monitored in Guangdong, including 46,716 (86.65%) without other defects and 7,736 (13.35%) with other defects. The average prevalence of total congenital heart defects was 62.30/10,000 (95% CI, 61.78/10,000-62.83/10,000), congenital heart defects without other defects was 53.36/10,000 (95% CI, 52.88/10,000-53.85/10,000), and congenital heart defects with other defects was 8.94/10,000 (95%CI, 8.74/10,000-9.14/10,000). From 2016 to 2020, the prevalence of total congenital heart defects was 54.92/10,000, 54.23/10,000, 63.79/10,000, 73.11/10,000, 68.20/10,000, respectively. We observed geographical variations within the prevalence of congenital heart defects. The prevalence of congenital heart defects was much higher in the Pearl River Delta region than in the non-Pearl River Delta region, as well as higher in urban areas than in rural areas.

CONCLUSION

The findings of this study are helpful to the understanding of the etiology and epidemiology characteristics of congenital heart defects in south China. Our data likely reflect a better estimate of the spatiotemporal trends in congenital heart defects prevalence than reported previously.