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Open Access Research article

Utilisation, contents and costs of prenatal care under a rural health insurance (New Co-operative Medical System) in rural China: lessons from implementation

Qian Long134, Tuohong Zhang2*, Elina Hemminki3, Xiaojun Tang4, Kun Huang5, Shengbin Xiao6 and Rachel Tolhurst7

Author Affiliations

1 Department of Public Health, University of Helsinki, Mannerheimintie 172, Helsinki, Finland

2 School of Public Health, Peking University, Beijing, P.R. China

3 National Institute for Health and Welfare, Lintulahdenkuja 4 (P.O. Box 30), FI-00271 Helsinki, Finland

4 School of Public Health, Chongqing Medical University, No.1 Yixueyuan Road, Chongqing, P.R. China

5 School of Public Health, Anhui Medical University, No. 81 Meishan Road Hefei, P.R. China

6 School of Medicine, Xi'an Jiaotong University, No. 76 Yantaxi Road Shaanxi, P.R. China

7 Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK

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BMC Health Services Research 2010, 10:301  doi:10.1186/1472-6963-10-301

Published: 1 November 2010



In China, the New Co-operative Medical System (NCMS), a rural health insurance system, has expanded nationwide since 2003. This study aims to describe prenatal care use, content and costs of care in one county where prenatal care is included in the NCMS and two counties where it is not. It also explores the perceptions of stakeholders of the prenatal care benefit package in order to understand the strengths and weaknesses of the approach in the context of rural China and to draw lessons from early implementation.


This study is based on the data from a cross-sectional survey and a qualitative investigation conducted in 2009. A survey recruited women giving birth in 2008, including 544 women in RC County (which covered prenatal care) and 619, and 1071 in other two counties (which did not). The qualitative investigation in RC included focus group discussions with women giving birth before or after 2007, individual interviews with local policy makers and health managers, NCMS managers and obstetric doctors in township hospitals.


There were no significant differences in prenatal care use between RC County (which covered prenatal care) and other two counties (which did not): over 70% of women started prenatal visits early and over 60% had five or more visits. In the three counties: a small proportion of women received the number of haemoglobin and urine tests recommended by the national guideline; 90% of women received more ultrasound tests than recommended; and the out-of-pocket expenditure for prenatal care consumed a high proportion of women's annual income in the low income group. In RC: only 20% of NCMS members claimed the reimbursement; the qualitative study found that the reimbursement for prenatal care was not well understood by women and had little influence on women's decisions to make prenatal visits; and several women indicated that doctors suggested them taking more expensive tests.


Whether or not prenatal care was included in the NCMS, prenatal care use was high, but the contents of care were not provided following the national guideline and more expensive tests were recommended by doctors. Costs were substantial for the poor.