Evidence map›Paper›PMID 31088443›Full record

ArticleBMC public health2019

Cesarean delivery rates, costs and readmission of childbirth in the new cooperative medical scheme after implementation of an episode-based bundled payment (EBP) policy.

Zhaolin Meng, Kun Zou, Ning Ding, Min Zhu, Yuanyi Cai, Huazhang Wu

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In one paragraph

Article in BMC public health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Zhaolin MengDepartment of Health Service Management, School of Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang, 110122, Liaoning, China.
Kun ZouDepartment of Health Policy and Management, West China School of Public Health and Fourth West China Hospital, West China Research Centre for Rural Health Development, Sichuan University, Chengdu, Sichuan, China.
Ning DingInstitute for International Healthcare Professionals Education and Research, China Medical University, Shenyang, Liaoning, China.
Min ZhuDepartment of Health Service Management, School of Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang, 110122, Liaoning, China.
Yuanyi CaiDepartment of Health Service Management, School of Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang, 110122, Liaoning, China.
Huazhang WuDepartment of Health Service Management, School of Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang, 110122, Liaoning, China. hzwu@cmu.edu.cn.

Funding

National Health and Family Planning Commission of the People's Republic of China entrusted by National Health and Family Planning Commission of the People's Republic of China
6 · The paper itself

Abstract

backgroundIn the past decade, the rate of cesarean delivery increased dramatically in rural China under the fee-for-service (FFS) system. In September 2011, the New Cooperative Medical Scheme (NCMS) agency in Yong'an county in Fujian province of China adopted a policy of reforming payment for childbirth by transforming the FFS payment into episode-based bundled payment (EBP), which made the cesarean deliveries less profitable. Thus, this study was conducted to determine the effect of EBP policy on reducing cesarean use and controlling delivery costs for rural patients in the NCMS.

methodsData from the inpatient information database of the NCMS agency from January 2010 to March 2013 was collected, in which Yong'an county was employed as a reform county and 2 other counties as controls. We investigated the effects of EBP on cesarean delivery rate, costs of childbirth and readmission for rural patients in the NCMS using a natural experiment design and difference in differences (DID) analysis method.

resultsThe EBP reform was associated with 33.97% (p<0.01) decrease in the probability of cesarean delivery. The EBP reform, on average, reduced the total spending per admission, government reimbursement expenses per admission, and out-of-pocket (OOP) payments per admission by ¥ 649.61, ¥ 575.01, and ¥ 74.59, respectively. The OOP payments had a net decrease of 14.24% (p<0.01); whereas the OOP payments as a share of total spending had a net increase of 8.72% (p<0.01). There was no evidence of increase in readmission rates.

conclusionsThese results indicate that the EBP policy has achieved at least a short-term success in lowering the increase of cesarean delivery rate and costs of childbirth. Considering both the cesarean rate and the OOP payments as a share of total spending after the reform were still high, China still has a long way to go to achieve the ideal level of cesarean rate and improve the benefits of deliveries for rural population.

Indexed as

AdultCesarean SectionChinaCompensation and RedressDatabases, FactualFemaleHealth ExpendituresHealth Plan ImplementationHealth PolicyHospitalizationHumansInpatientsPatient ReadmissionPregnancyRural PopulationCesarean deliveryCostEpisode-based bundled paymentNew cooperative medical scheme

Identifiers

PMID31088443
PMCPMC6515611

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.