京沪妇女保健法律体系完备程度
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摘要
目的评价京沪两地妇女保健领域法律体系的完备程度及其与孕产妇死亡率的关系,验证适宜的法律体系完备程度的定位及其于京沪的意义。方法系统收集两地所有妇女保健相关的规范性法律文件,摘录"文件类型""发布主体"等内容,量化计算法律体系完备程度,并使用Spearman秩相关和线性回归模型分析妇女保健法律体系完备程度与孕产妇死亡率的关系。结果京沪两地妇女保健法律体系完备程度均呈现逐步上升的趋势,其中北京由1990年的35.7%上升至2017年的72.0%;上海由1990年的53.2%上升至2017年的74.9%。两地的法律体系完备程度与孕产妇死亡率均呈负相关关系(相关系数均> 0.7)。拟合回归方程显示,京沪法律体系完备程度对孕产妇死亡率变化的解释程度分别为46.2%和79.1%。结论完备的法律体系应框架和内容形式齐全,且覆盖相关部门、专业机构及其他组织等。两地已经形成了较为完备的法律体系,但缺少公共卫生领域的统合法,规范各方的作用尚未充分发挥。
Objective To evaluate the completeness of maternal health care-related legal regulations and its relationship with maternal mortality in Beijing and Shanghai and to verify appropriate completeness of maternal health care-related legal regulations and its significance. Methods We systematically collected all normative legal documents related to maternal health issued by governmental agencies of the two cities and quantitatively assessed the completeness of the legal regulations based on the documents' type and main releaser. Spearman rank correlation and one-way linear regression were used to analyze the relationship between the completeness of the legal regulations and maternal mortality in the two cities. Results The completeness of maternal health care-related legal regulations released by the administrations in Beijing and Shanghai showed a gradual yearly upward trend. From 1990 to 2017, the proportion of the legal regulations with complete feature(in accordance with national legal provisions, involving a variety of maternal healthcare aspects) increased from 35.7% to 72.0%in Beijing and from 53.2% to 74.9% in Shanghai and the proportion was inversely associated with the maternal mortality in both the cities, with the correlation coefficients of greater than 0.70. The results of fitted regression analysis demonstrated that 46.2% and 79.1% of the variation in the maternal mortality for the women in Beijing and Shanghai could be interpreted by the completeness of maternal health care-related legal regulations. Conclusion Complete legal regulations related to maternal health care should have a systemic framework and various aspects and relevant departments, professional institutions and other organizations. At present, there are relatively complete legal regulations related to maternal health care in Beijing and Shanghai, but there is no a universal law for public health and the legal regulations are not brought into a full play in numerous aspects of maternal healthcare.
Objective To evaluate the completeness of maternal health care-related legal regulations and its relationship with maternal mortality in Beijing and Shanghai and to verify appropriate completeness of maternal health care-related legal regulations and its significance. Methods We systematically collected all normative legal documents related to maternal health issued by governmental agencies of the two cities and quantitatively assessed the completeness of the legal regulations based on the documents' type and main releaser. Spearman rank correlation and one-way linear regression were used to analyze the relationship between the completeness of the legal regulations and maternal mortality in the two cities. Results The completeness of maternal health care-related legal regulations released by the administrations in Beijing and Shanghai showed a gradual yearly upward trend. From 1990 to 2017, the proportion of the legal regulations with complete feature(in accordance with national legal provisions, involving a variety of maternal healthcare aspects) increased from 35.7% to 72.0%in Beijing and from 53.2% to 74.9% in Shanghai and the proportion was inversely associated with the maternal mortality in both the cities, with the correlation coefficients of greater than 0.70. The results of fitted regression analysis demonstrated that 46.2% and 79.1% of the variation in the maternal mortality for the women in Beijing and Shanghai could be interpreted by the completeness of maternal health care-related legal regulations. Conclusion Complete legal regulations related to maternal health care should have a systemic framework and various aspects and relevant departments, professional institutions and other organizations. At present, there are relatively complete legal regulations related to maternal health care in Beijing and Shanghai, but there is no a universal law for public health and the legal regulations are not brought into a full play in numerous aspects of maternal healthcare.
引文
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[2]徐缓.美国州公共卫生法律示范项目对我国立法启示[J].中国公共卫生,2007,23(5):637-638.
[3]World Health Organization.The global strategy for women′s,children′s and adolescents′health 2016-2030[EB/OL][2017-08-31].http://www.who.int/life-course/partners/global-strategy/ewec-gs-brochure-eng.pdf?ua=1.
[4]中华人民共和国中央人民政府.国务院关于印发“十三五”卫生与健康规划的通知[EB/OL].[2016-12-27].http://www.gov.cn/zhengce/content/2017-01/10/content_5158488.htm.
[5]郝模,李程跃,于明珠,等.新时代公共卫生体系的思考与研究[J].上海预防医学,2017,29(12):905-910.
[6]卫生部.妇幼卫生工作条例[EB/OL].[1986-04-20].https://baike.baidu.com/item/%E5%A6%87%E5%B9%BC%E5%8D%AB%E7%94%9F%E5%B7%A5%E4%BD%9C%E6%9D%A1%E4%BE%8B/18567554?fr=aladdin.
[7]北京市人民代表大会常务委员会.北京市人口与计划生育条例[EB/OL].[2016-03-24].http://www.bjrd.gov.cn/tzgg/201603/t20160325_161814.html.
[8]北京市人民代表大会常务委员会.北京市实施《中华人民共和国母婴保健法》办法[EB/OL].[1995-04-14].http://zhengce.bei jing.gov.cn/library/192/33/50/438650/75546/index.html.
[9]全国人民代表大会.中华人民共和国母婴保健法[EB/OL].[2017-11-28].http://www.npc.gov.cn/npc/xinwen/2017-11/28/content_2032724.htm.
[10]北京市卫生和计划生育委员会.北京市医疗卫生服务体系规划(2016―2020年)[EB/OL].[2017-03-19].http://zfxxgk.beijing.gov.cn/110088/zzqgh33/2017-03/19/content_786260.shtml.
[11]上海市人民政府.上海市女职工劳动保护办法[EB/OL].[1990-09-21].http://www.shanghai.gov.cn/nw2/nw2314/nw2319/nw2407/nw26170/u26aw27234.html.
[12]上海市人民代表大会常务委员会.上海市母婴保健条例[EB/OL].[1996-12-19].http://www.wsjsw.gov.cn/wsj/n2373/n2374/n2378/userobject1ai62856.html.
[13]上海市人民政府.上海市妇女儿童发展“十三五”规划[EB/OL].[2016-06-21].http://www.shanghai.gov.cn/nw2/nw2314/nw2319/nw12344/u26aw47890.html.
[14]刘晓宁,胡琳琳,卫李梅,等.我国医疗卫生领域行业组织的现状、问题及政策建议[J].中国卫生政策研究,2016,9(12):23-28.
[15]Ellencweig AY.Analyzing health systems:a modular approach[M].London:Oxford University Press,1992.
[16]胡善联.用基本卫生法来统领改革[J].中国卫生,2015(2):77.
[17]安洪武.卫生行政处罚中若干法律问题探讨[J].上海预防医学,2004,16(1):34-35.
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