初析京沪妇女保健管理运行机制的完善程度

A Comprehensive Analysis of the Operation Mechanism of Maternal Health Care Management in Beijing and Shanghai

目的:综合分析京沪两地妇女保健体系管理运行机制的完善情况与效果,并验证量化评价的可行性。方法:穷尽收集两地公开发布的妇保管理制度文件,综合量化形成管理运行机制的完善程度,并运用卫生系统宏观模型、Spearman相关、线性回归等方法,分析其与孕产妇死亡率之间的关系。结果:目前京沪两地管理运行机制完善程度分别达到45.9%与57.9%,其中筹资与补偿机制(72.4%vs72.4%)、计划与评价机制(60.1%vs68.5%)的健全程度较好,而管理与监控机制的健全程度(33.4%vs35.1%)较低,协调与激励机制的健全程度(24.6%vs60.9%)两地差异明显。从趋势看,两地机制完善程度一直稳定提升,与孕产妇死亡率呈现显著负相关关系(P<0.05)。结论:京沪两地一直致力于完善妇保体系的管理运行机制,机制的完善能够促进妇保体系健康结果的改善,上海的促进作用更为明显,如何保障机制落实是两地机制进一步完善的重点。适宜的妇保体系应具有"完善的管理运行机制"。经验证,本研究对管理运行机制完善情况的综合量化具备可行性。

Objective The aim of this study is to analyze the complete situation and effect of maternal health care management and operation mechanisms in Beijing and Shanghai,and to verify the feasibility of quantitative evaluation.Methods Exhausting the collection of the maternal insurance management system documents publicly released in the two places,based on comprehensive evaluation to form the complete degree of the management and operation mechanisms.The health system macro model,Spearman correlation,linear regression and other methods were used to analyze the relationship between the results and maternal mortality.Results At present,the complete degree of health management and operation mechanism of women in the two places has achieved to 45.9% and 57.9%,respectively,of which the complete degree of financing and compensation mechanisms(72.4%vs72.4%)and planning and evaluation mechanisms are better,while management and monitoring mechanism(33.4%vs35.1%)is lower.There was a significant difference of coordination and incentive mechanism(24.6%vs60.9%)between the two places.From the perspective of trend,the improvement of mechanism between the two regions has been steadily increasing,showing a significant negative correlation with maternal mortality(P<0.05).Conclusion Beijing and Shanghai have been committed to improving the management and operation mechanism of the maternal health care system.The improvement of the mechanism can promote the improvement of the health results of the system.Shanghai has a more obvious promotion effect and how to ensure the implementation of the mechanism is the focus of further improvement of the two mechanisms.A "perfect management operation mechanism" is needed for appropriate maternal health care system.It is proved that the comprehensively quantify the perfection of management operation mechanism in this study is feasible.