Logo do repositório
 
Publicação

The association between china’s primary health care reform and inequalities in primary care utilisation and maternal mortality

2025-12Artigo científico Acesso aberto
Ver registo simples
dc.contributor.authorCai, Chang
dc.contributor.authorMillett, Christopher
dc.contributor.authorXu, Jin
dc.contributor.authorWang, Yanshang
dc.contributor.authorHone, Thomas
dc.contributor.institutionCentro de Investigação em Saúde Pública (CISP/PHRC)
dc.contributor.institutionComprehensive Health Research Centre (CHRC) - Pólo ENSP
dc.contributor.institutionEscola Nacional de Saúde Pública (ENSP)
dc.contributor.pblBioMed Central (BMC)
dc.date.accessioned2025-07-17T21:15:59Z
dc.date.available2025-07-17T21:15:59Z
dc.date.issued2025-12
dc.descriptionPublisher Copyright: © The Author(s) 2025.
dc.description.abstractBackground: China’s maternal health has substantial inequalities across regions, a similar challenge faced by many low- and middle-income countries. The Chinese government launched a comprehensive health reform since 2015 to deliver more affordable and equitable primary health care (PHC), with pregnant women being a priority group of beneficiaries. However, little is known about the impacts of this PHC reform on primary care utilisation among pregnant women or maternal health inequalities. This study aims to examine whether and how China’s PHC reform affected primary care utilisation among pregnant women and maternity deaths differently across regions. Methods: The study employed provincial-level panel data from the China Health Statistic Yearbook and China Statistic Yearbook (2010–2019). Reform implementation by province was identified using web-scrapping of 31 provincial government websites. Firstly, difference-in-differences method examined the reform impacts on visits to PHC facilities, the utilisation of family physician services and prenatal services, and the maternal mortality ratio (MMR). Secondly, fixed-effects panel regression models estimated the association between family physician service use, prenatal care and the MMR. Analyses were stratified by province human development index (HDI) to assess inequalities. Results: The introduction of China’s PHC reform in a province was associated with increased utilisation of family physician services (59.7 per 10,000 people per year, 95% CI 32.8–86.5) and prenatal services (3.2% points per year, 95% CI 1.8–4.6) and reduced maternal death by 9.6 per 100,000 live births per year (95% CI 0.3–19.0) in low-HDI provinces. No reform impact was found in high-HDI provinces. In panel regression models for low-HDI provinces, with a 1.0% point increase in prenatal care utilisation and one increase in family physician visit per 100 people, maternal deaths would decrease by 1.4 (95% CI 0.2–2.5) and 2.4 (95% CI 1.4–3.5) per 100,000 live births per year, respectively. This association was not found in high-HDI provinces. Conclusion: China’s PHC reforms and primary care utilisation were associated with reduction in MMR in less developed regions, suggesting contributions to lower inequalities in maternal health between regions. Community-level family physician services are likely effective for improving maternal health in high burden areas, but further system and quality improvements are needed in areas where maternal mortality is lower.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent1407270
dc.identifier.doi10.1186/s12939-025-02541-z
dc.identifier.issn1475-9276
dc.identifier.otherPURE: 122021242
dc.identifier.otherPURE UUID: 40a79da7-56b7-4f29-bb27-7f9ff2cc6a06
dc.identifier.otherScopus: 105007857243
dc.identifier.otherPubMed: 40514647
dc.identifier.otherPubMedCentral: PMC12164202
dc.identifier.otherWOS: 001507839000001
dc.identifier.urihttp://hdl.handle.net/10362/185275
dc.identifier.urlhttps://www.scopus.com/pages/publications/105007857243
dc.language.isoeng
dc.peerreviewedyes
dc.subjectChina
dc.subjectLongitudinal studies
dc.subjectMaternal health inequalities
dc.subjectPrimary health care
dc.subjectHealth Policy
dc.subjectPublic Health, Environmental and Occupational Health
dc.subjectSDG 3 - Good Health and Well-being
dc.titleThe association between china’s primary health care reform and inequalities in primary care utilisation and maternal mortalityen
dc.title.subtitlea quasi-experimental longitudinal study from 2010 to 2019en
dc.typejournal article
degois.publication.issue1
degois.publication.titleInternational Journal for Equity in Health
degois.publication.volume24
dspace.entity.typePublication
rcaap.rightsopenAccess

Ficheiros

Principais
A mostrar 1 - 1 de 1
Miniatura
Nome:
Cai_2025_Int_J_Equity_Hea_24_174.pdf
Tamanho:
1.34 MB
Formato:
Adobe Portable Document Format
Ver/Abrir

Coleções

Home collection (ENSP)