目的：评估生育医疗服务利用与费用的时间变化趋势,识别生育医疗费用负担的群体差异,为优化生育医疗费用保障政策提供参考。方法：回顾性收集2015年以来区域性的生育医疗费用保障政策、育龄妇女产前检查与住院分娩服务利用及费用资料,采用线性插值与外推法测算产前检查医疗费用,按疾病诊断相关分组分析分娩服务利用与费用,结合居民消费支出资料,分析不同人群和机构的医疗费用个人负担水平。结果：样本区域的生育医疗服务利用的广度和深度持续提升,生育医疗费用呈现出稳定增长趋势,参保职工产检费用个人负担水平约为79%,在二、三级公立医院剖宫产分娩的个人负担水平分别约为49%和58%,生育保险对生育医疗费用的保障水平有待提升。结论：应及时调整产前检查费用报销标准,建立费用保障衔接机制,提升参保人“十月怀胎”期间的医保待遇;将住院分娩费用纳入按疾病诊断相关分组付费管理,引导医院提升生育医疗服务利用和费用的精细化管理水平;完善灵活就业和未就业人员生育医疗费用保障政策,分类施策确保兜底保障。

Objective: The paper attempts to evaluate the temporal changes in maternity healthcare service utilization and costs, to identify population disparities in the associated financial burden, and to offer evidence for refining maternity healthcare cost coverage policies. Methods: A retrospective collection of regional cost coverage policies for maternity expenses, along with data on the utilization and costs of prenatal check-ups and inpatient delivery services among women of reproductive age since 2015, was conducted. Linear interpolation and extrapolation methods were employed to estimate prenatal check-up medical expenses. The utilization and costs of delivery services were analyzed using the Diagnosis-Related Groups framework. By integrating data on household consumption expenditures, the out-of-pocket burden of medical expenses for different populations and types of healthcare institutions was assessed. Results: Both the breadth and depth of maternity healthcare service utilization in the sample regions continued to increase, with maternity medical costs showing a steady upward trend. The out-of-pocket share for prenatal check-up costs among insured employees was approximately 79%, while for cesarean deliveries in secondary and tertiary public hospitals, the out-of-pocket share was about 49% and 58%, respectively. The healthcare security level of maternity insurance for maternity medical expenses requires further enhancement. Conclusion: Timely adjustments should be made to the reimbursement standards for prenatal check-ups, and a cost guarantee coordination mechanism should be established to enhance the medical insurance benefits for insured individuals during their pregnancy. Hospital delivery costs should be incorporated into the Diagnosis-Related Groups payment system to encourage hospitals to improve the management level of maternity medical services and costs. The maternity medical expense guarantee policies for flexible employees and unemployed individuals should be improved, with categorized measures implemented to ensure basic security.