上海市外来流动人口平价分娩点政策调整浅析

Analysis of policy-adjusting in designated maternity hospitals for floating pregnant women in Shanghai

目的为探索外来孕产妇保健管理服务模式,上海市先后设立、扩大和取消了流动人口孕产妇特约分娩点。该文旨在研究2007年以来分娩点扩大之后政策的实施情况和影响因素,分析特约分娩点政策的调整效果。方法对2007年至2012年特约分娩点的二手资料进行定量分析;2012年10月对特约分娩点所在区(县)的妇幼保健所所长进行定性访谈。结果 6年来上海共有687 319名外来产妇分娩,而25家分娩点(占全市接产医院总数的30.5%)共接受338 192名外来产妇分娩,占同期全市总量的49.20%(即接近一半);上海市外地户口孕产妇死亡率则高达77.42/10万;从产科出血死亡专率看,外地户口者有33.66/10万,为本市户口(4.99/10万)的6.75倍。上海市卫生和计生委及时进行卫生政策调整后,外来人口孕产妇享受"农村孕产妇住院分娩项目"和"基本公共卫生服务"等项目补助,服务提供方扩展到所有助产医疗机构。结论政策调整进一步促进了基本公共卫生服务的均等化,加强了上海市流动人口在内的基本产前保健服务。

Objective To explore the implementation and influencing factors of policy for designated maternal hospitals for floating pregnant women in Shanghai and to analyze the effect of policy-adjusting. Methods Quantitative analysis was conducted on secondary data of maternity hospitals from 2007 to 2012. The directors of maternity and child heahhcare institutes where the designated hospitals located were qualitatively reviewed in October 2012. Results In these 6 years there were 687 319 floating pregnant women in Shanghai. Twenty-five designated maternity hospitals （30.5% of hospitals in the whole city） accepted 338 192 for hospital-delivery, which accounted for 49.20% of the total number. The mortality rate of floating pregnant women iu Shanghai reached 77.42/100 000. Viewing from the aspect of obstetric bleeding, the mortality rate was 33.66/100 000, which was 6.75 times of the Shanghai registered pregnant women （4.99/ 100 000 ）. Shanghai Health and Family Planning Commission adjusted policies promptly. Floating pregnant women could enjoy allowance from Rural Maternal Hospital-delivery Project and Basic Public Health Services Project. The service provider extended to all maternity hospitals in Shanghai. Conclusion Policy-adjusting can further promote the equalization of basic public health services and strengthen basic prenatal care services for floating women.