京沪妇女保健领域协调与激励机制健全程度分析
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摘要
目的:探讨协调与激励机制健全程度的内涵与意义,分析其与孕产妇死亡率的相关性,探索基于协调与激励机制健全程度评估妇女保健工作效果的可行性。方法:利用中国知网等系统收集所有涉及妇保体系协调与激励机制相关政策文件,综合量化其健全程度,运用线性回归分析健全程度与孕产妇死亡率之间的关系。结果:2000～2017京沪两地协调与激励机制逐渐健全。2017京沪健全程度(24.56%vs60.94%)差异明显。其中,协调机制覆盖程度(0%vs91.88%)、激励机制覆盖程度(66.66%vs72.34%)、协调机制权威程度(17.74%vs52.13%)、激励机制可行程度(16.16%vs17.91%)均是上海领先北京;两地的孕产妇死亡率与健全程度呈负相关(P<0.01),上海协调与激励机制健全程度对孕产妇死亡率影响的解释程度为42.2%,北京为19.5%。结论:京沪协调与激励机制均已逐步完善;健全的协调与激励机制能够更好地促进体系目标的实现;上海机制健全所发挥的作用优于北京,京沪妇保领域协调与激励机制尚需健全。
Objective The significance of degree of soundness of coordination and incentive mechanism of maternal care was revealed by analyzing the trend of degree of soundness of coordination and incentive mechanism of maternal care and its differences in Beijing and Shanghai, and to discuss the feasibility of quantifying the degree of soundness of health care of women from the perspective of policy documents. Methods The public policy documents on maternal care in Beijing and Shanghai were collected. The Delphi method and the comprehensive quantitative method were used to quantify the degree of soundness. Linear regression was used to analyze the relationship between the degree and maternal mortality. Results The coordination and incentive mechanism of Beijing and Shanghai had become more and more perfect from 2000 to 2017. The difference between the degree of soundness of coordination and incentive mechanism of the two cities was obvious(24.56% vs 60.94%). Among them, the coverage of coordination mechanism(0% vs 91.88%), the authority of coordination mechanism(17.74% vs 52.13%), the coverage of incentive mechanism(66.66% vs 72.34%) of Shanghai was higher than that of Beijing. There was little difference in the degree of feasibility between the two cities(16.16% vs 17.91%). The trend of the maternal mortality showed significant negative correlation to that of the degree of soundness in these two cities(P<0.01). The degree of Shanghai explained the impact of the maternal mortality rate was 42.2%, Beijing was 19.5%. Conclusion The coordination and incentive mechanism of maternal care of the two cities needs to be further improved, so that the objectives of maternal care system can be better realized. It is feasible to comprehensively quantify the degree of soundness of coordination and incentive mechanism.
Objective The significance of degree of soundness of coordination and incentive mechanism of maternal care was revealed by analyzing the trend of degree of soundness of coordination and incentive mechanism of maternal care and its differences in Beijing and Shanghai, and to discuss the feasibility of quantifying the degree of soundness of health care of women from the perspective of policy documents. Methods The public policy documents on maternal care in Beijing and Shanghai were collected. The Delphi method and the comprehensive quantitative method were used to quantify the degree of soundness. Linear regression was used to analyze the relationship between the degree and maternal mortality. Results The coordination and incentive mechanism of Beijing and Shanghai had become more and more perfect from 2000 to 2017. The difference between the degree of soundness of coordination and incentive mechanism of the two cities was obvious(24.56% vs 60.94%). Among them, the coverage of coordination mechanism(0% vs 91.88%), the authority of coordination mechanism(17.74% vs 52.13%), the coverage of incentive mechanism(66.66% vs 72.34%) of Shanghai was higher than that of Beijing. There was little difference in the degree of feasibility between the two cities(16.16% vs 17.91%). The trend of the maternal mortality showed significant negative correlation to that of the degree of soundness in these two cities(P<0.01). The degree of Shanghai explained the impact of the maternal mortality rate was 42.2%, Beijing was 19.5%. Conclusion The coordination and incentive mechanism of maternal care of the two cities needs to be further improved, so that the objectives of maternal care system can be better realized. It is feasible to comprehensively quantify the degree of soundness of coordination and incentive mechanism.
引文
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[2] 张翔.中国政府部门间协调机制研究[D].南开大学,2013.
[3] 张开诚.医院激励机制的作用和途径[J].中国卫生事业管理,2001,17(9):565-566.
[4] 岳慧,岳霞.创新激励机制,促进妇幼保健机构的发展[J].现代预防医学,2008,35(9):1661-1662.
[5] Johnson K.Addressing women’s health needs and improving birth outcomes:results from a peer-to-peer state Medicaid learning project[J].Issue Brief.2012(21):1.
[6] Lannes L,Meessen B,Soucat A,et al.Can performance-based financing help reaching the poor with maternal and child health services?The experience of rural Rwanda[J].International Journal of Health Planning & Management,2015,31(3):309-348.
[7] 陈丽,王进朝.基于心理收入的知识型员工激励与企业绩效关系研究[J].华东经济管理,2009,23(9):119-121.
[8] 靳梅梅.市场经济体制下的妇幼保健工作运行机制探讨[J].中国妇幼保健,2001(02):79-80.
[9] Das A,Gopalan S S,Chandramohan D.Effect of pay for performance to improve quality of maternal and child care in low- and middle-income countries:a systematic review[J].Bmc Public Health.2016,16(1):1-11.
[10] 项目组.《上海现代化国际大都市公共卫生绩效体系构建》结题报告[R].2018.
[11] 健康相关重大社会风险预警协同创新中心.三年行动计划研究简报一流的公共卫生体系及其定位[EB/OL].[2017-01-14](第2期).http://srghealth.fudan.edu.cn/
[12] 关于印发《上海市公共卫生工作联席会议2009年工作要点》的通知.[EB/OL].2018-04-17.http://www.wsjsw.gov.cn/wsj/n429/n432/n1485/n1496/u1ai80316.html.
[13] Lannes L,Meessen B,Soucat A,et al.Can performance-based financing help reaching the poor with maternal and child health services?The experience of rural Rwanda[J].International Journal of Health Planning & Management,2015,31(3):309-348.
[14] Das A,Gopalan S S,Chandramohan D.Effect of pay for performance to improve quality of maternal and child care in low- and middle-income countries:a systematic review[J].Bmc Public Health,2016,16(1):1-11.
[15] Avi Yacar Ellencweig.Analyzing Health Systems:a modular approach[M].London:Oxford University Press,1992.
[16] 郝模,吴延风,王志锋,等.与社会协调解决问题:卫生事业可持续发展的基石[J].中华医院管理杂志,1998(01):3-6.
[17] 张艳春,秦江梅.将健康融入所有政策视角下慢性病防控的挑战与对策——基于我国健康城市的典型调查[J].中国卫生政策研究,2014,7(01):65-69.
[18] 上海市宝山区人民政府办公室关于建立公共卫生工作联席会议制度的通知.[EB/OL].2018-04-17.http://www.baoshan.sh.cn/xxgk_website/HTML/bsxxgk/bsxxgk_zfgb_2004dsq_qzfbgswj/2008-03-27/Detail_286344.htm
[19] 胡琼伟.上海某公立医院正向激励机制研究[D].山东大学,2015.
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