京沪妇女保健管理与监控机制可行程度研究
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摘要
目的:分析京沪两地妇女保健工作管理与监控机制可行程度的变迁,阐明适宜可行程度的重要意义并验证其量化方法。方法:系统收集京沪两地所有涉及妇保工作的政策文献,在对"管理与监控机制覆盖部门""部门职责清晰可考核"和"部门职责清晰可考且有考核主体"进行分析的基础上综合量化形成可行程度,运用Spearman相关、线性回归等分析可行程度与孕产妇死亡率之间的关系。结果:两地妇保领域管理与监控机制可行程度提升明显,上海由2.20%提升至19.67%,北京由1.80%提升至17.76%,但关键支撑部门的职责不清且无法落实。两地的可行程度与孕产妇死亡率均呈负相关,并对其有显著影响(上海r~2=0.354,P=0.005,北京r~2=0.309,P=0.010)。结论:适宜的妇保体系需确保管理与监控机制能够有效落实、严格约束各方行为;上海市妇保领域管控机制可行程度提高的程度略优于北京市,但两地总体仍处于较低水平,人力等关键支撑部门职责仍较为不清;分析结果表明对可行程度的量化方法科学可行。
Objective To analyze the changes in the feasibility degree of management and monitoring mechanisms of maternal health care in Beijing and Shanghai,and clarify the importance of appropriateness and feasibility and to verify the quantitative methods of feasibility. Methods Systematic collect all policy documents related to maternal work in Beijing and Shanghai. On the basis of the analysis of"management and monitoring mechanism cover departments","departments' responsibilities are clear and assessable"and"departments' responsibilities are clear and have examination subject",we use synthetically quantifying to obtain the feasibility degree. Spearman correlation and linear regression were used to analyze the relationship between the feasibility degree and maternal mortality. Results The feasibility of management and monitoring mechanisms in the area of maternal health care in Beijing and Shanghai has increased significantly( Shanghai increased from 2. 20% to 19. 67%,Beijing increased from 1. 80%to 7. 76%),but the responsibilities of the key support departments are unclear and cannot be implemented. In particular,the responsibilities of the external strong support department of the health system are unclear and cannot be implemented. The feasibility degree has a significant negative correlation with maternal mortality between the two places( Shanghai r2= 0. 354,P = 0. 005,Beijing r2= 0. 309,P = 0. 010). Conclusion Appropriate maternity insurance system needs to ensure that the management and monitoring mechanism can effectively implement and strictly restrict the behavior of all parties,the feasibility of improving the control mechanism in Shanghai is slightly better than Beijing,but the overall level is still at a low level and support department responsibilities are still relatively unclear. This study is scientific and feasible for the quantitative method of feasibility degree.
Objective To analyze the changes in the feasibility degree of management and monitoring mechanisms of maternal health care in Beijing and Shanghai,and clarify the importance of appropriateness and feasibility and to verify the quantitative methods of feasibility. Methods Systematic collect all policy documents related to maternal work in Beijing and Shanghai. On the basis of the analysis of"management and monitoring mechanism cover departments","departments' responsibilities are clear and assessable"and"departments' responsibilities are clear and have examination subject",we use synthetically quantifying to obtain the feasibility degree. Spearman correlation and linear regression were used to analyze the relationship between the feasibility degree and maternal mortality. Results The feasibility of management and monitoring mechanisms in the area of maternal health care in Beijing and Shanghai has increased significantly( Shanghai increased from 2. 20% to 19. 67%,Beijing increased from 1. 80%to 7. 76%),but the responsibilities of the key support departments are unclear and cannot be implemented. In particular,the responsibilities of the external strong support department of the health system are unclear and cannot be implemented. The feasibility degree has a significant negative correlation with maternal mortality between the two places( Shanghai r2= 0. 354,P = 0. 005,Beijing r2= 0. 309,P = 0. 010). Conclusion Appropriate maternity insurance system needs to ensure that the management and monitoring mechanism can effectively implement and strictly restrict the behavior of all parties,the feasibility of improving the control mechanism in Shanghai is slightly better than Beijing,but the overall level is still at a low level and support department responsibilities are still relatively unclear. This study is scientific and feasible for the quantitative method of feasibility degree.
引文
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[3] 方海清,周东华,王曼丽,等.国家基本公共卫生服务乡村两级职责分工研究[J].中国公共卫生,2015,31(04):405-408.
[4] 张富霞.明确妇幼保健机构功能切实履行公共卫生职责[J].中国妇幼保健,2007,22(31):4357-4359.
[5] World Health Organization.The global strategy for women’s,children’s and adolescents’ health 2016-2030[EB/OL].[2018-04-15].http://www.who.int/life-course/partners/global-strategy/global-strategy-2016-2030/en/.
[6] 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.
[7] 卫生部.关于进一步加强妇幼卫生工作的指导意见[EB/OL].[2018-04-16].http://www.nhfpc.gov.cn/zwgkzt/wsbysj/200804/18805.shtml.
[8] 国务院.关于印发“十三五”卫生与健康规划的通知[EB/OL].[2018-4-16].http://www.gov.cn/zhengce/content/2017-01/10/content_5158488.htm.
[9] 郝模.卫生政策学[M].第2版.北京:人民卫生出版社,2013.
[10] Avi Yacar Ellencweig.Analyzing Health Systems:a modularApproach[M].London:Oxford University Press,1992.
[11] 《上海市孕产妇系统保健工作规范》[Z].上海市卫生局.2012.
[12] 《北京市增补叶酸预防神经管缺陷项目实施方案(试行)》[Z].北京市卫生局.2011.
[13] 《孕产期保健工作管理办法》[Z].卫生部.2011.
[14] 《孕产期保健工作规范》[Z].卫生部.2011.
[15] 《上海市孕产妇保健工作规范》[Z].上海市卫生局.2013.
[16] 《上海市母婴保健条例》[Z].上海市卫生局.1996.
[17] 《北京市实施<中华人民共和国母婴保健法>办法》[Z].北京市十届人大常委会.1997-04-14.
[18] Greer,Scott L.et al.Beyond leadership:Political strategies for coordination in health policies[J].Health Policy ,2014,116 (1),12-17.
[19] 沈荣华.政府间公共服务职责分工[M].北京:国家行政学院出版社,2007.
[20] 孙梅,吴丹,施建华,等.我国突发公共卫生事件应急处置政策变迁:2003—2013年[J].中国卫生政策研究,2014,7(7):24-29.
[21] 郝模.卫生政策学[M].第2版.北京:人民卫生出版社,2013.
[22] Greer,Scott L.et al.Beyond leadership:Political strategies for coordination in health policies[J].Health Policy ,2014,116 (1),12 – 17.
[23] 程诗洋,陈莉.上海市长宁区26例危重孕产妇孕产期保健管理情况分析[J].中国妇幼保健,2016,31(15):2998-3001.