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Increased cesarean section rates and emerging patterns of health insurance in Shanghai, China

Author

Listed:
  • Cai, W.-W.
  • Marks, J.S.
  • Chen, C.H.C.
  • Zhuang, Y.-X.
  • Morris, L.
  • Harris, J.R.

Abstract

Objectives. This study examined the trend in cesarean section deliveries and the factors associated with it in the Minhang District of Shanghai, China. Methods. A representative sample of the members of 2716 households in the district were interviewed in the fall of 1993. This study analyzed the data from 1959 married women of reproductive age with at least one live birth. Results. During the past 3 decades, the proportion of infants born by cesarean section increased from 4.7% to 22.5%. Logistic regression analysis revealed that the highest cesarean section rate, which occurred in the most recent period of 1988 through 1993, was associated with form of medical payment, self-reported complications during pregnancy, higher birthweight, and maternal age. Government insurance pays all costs of cesarean sections and accounted for the highest proportion of the cesarean section rate. Conclusions. The high rates of cesarean sections in China are surprising given the lack of the factors that usually lead to cesarean sections. The increasing cesarean section rates may be an early indication that emerging forms of health insurance and fee-for-service payments to physicians will lead to an excessive emphasis on costly, high-technology medical care in China.

Suggested Citation

  • Cai, W.-W. & Marks, J.S. & Chen, C.H.C. & Zhuang, Y.-X. & Morris, L. & Harris, J.R., 1998. "Increased cesarean section rates and emerging patterns of health insurance in Shanghai, China," American Journal of Public Health, American Public Health Association, vol. 88(5), pages 777-780.
    • Handle: RePEc:aph:ajpbhl:1998:88:5:777-780_9
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    Citations

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    Cited by:

    1. Dan Lin & Chunyang Zhang & Huijing Shi, 2021. "Effects of Clinical Pathways on Cesarean Sections in China: Length of Stay and Direct Hospitalization Cost Based on Meta-Analysis of Randomized Controlled Trials and Controlled Clinical Trials," IJERPH, MDPI, vol. 18(11), pages 1-15, May.
    2. Karen Eggleston & Li Ling & Meng Qingyue & Magnus Lindelow & Adam Wagstaff, 2008. "Health service delivery in China: a literature review," Health Economics, John Wiley & Sons, Ltd., vol. 17(2), pages 149-165, February.
    3. Adam Wagstaff & Winnie Yip & Magnus Lindelow & William C. Hsiao, 2009. "China's health system and its reform: a review of recent studies," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 7-23, July.
    4. Hsu, Kuang-Hung & Liao, Pei-Ju & Hwang, Chorng-Jer, 2008. "Factors affecting Taiwanese women's choice of cesarean section," Social Science & Medicine, Elsevier, vol. 66(1), pages 201-209, January.
    5. David H. Peters & Abdo S. Yazbeck & Rashmi R. Sharma & G. N. V. Ramana & Lant H. Pritchett & Adam Wagstaff, 2002. "Better Health Systems for India's Poor : Findings, Analysis, and Options," World Bank Publications - Books, The World Bank Group, number 14080.
    6. Woonji Jang & Christopher Flatley & Ristan M Greer & Sailesh Kumar, 2017. "Comparison between public and private sectors of care and disparities in adverse neonatal outcomes following emergency intrapartum cesarean at term – A retrospective cohort study," PLOS ONE, Public Library of Science, vol. 12(11), pages 1-12, November.
    7. Marco A. Castaneda & Meryem Saygili, 2021. "The effects of health insurance on the choice of medical procedures: Evidence from heart attacks and childbirths," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(5), pages 1626-1652, September.
    8. Hou, Xiaohui & Coyne, Joseph, 2008. "The emergence of proprietary medical facilities in China," Health Policy, Elsevier, vol. 88(1), pages 141-151, October.

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