本文選題：孕產(chǎn)保健 + 規(guī)制　； 參考：《復(fù)旦大學(xué)》2012年博士論文

【摘要】：一、研究背景 健康公平是讓所有社會成員均有機會達(dá)到盡可能高的健康水平,要實現(xiàn)這一目標(biāo),需要有良好的衛(wèi)生服務(wù)系統(tǒng),保證健康權(quán)作為人的一項基本權(quán)利,不受到經(jīng)濟水平、外部環(huán)境等的影響。2000年世界衛(wèi)生組織將衛(wèi)生服務(wù)公平性列為衛(wèi)生系統(tǒng)績效評價的重要指標(biāo),此后各國圍繞健康和衛(wèi)生服務(wù)公平性開展了廣泛研究,來自婦幼保健服務(wù)領(lǐng)域的研究表明,經(jīng)濟發(fā)展水平所導(dǎo)致孕產(chǎn)保健服務(wù)利用不公平,是低收入、中等收入和高收入國家之間孕產(chǎn)婦死亡率形成巨大反差的原因之一。我國學(xué)者對孕產(chǎn)婦健康和服務(wù)利用公平性的研究雖有限,但結(jié)果均提示,我國城鄉(xiāng)之間、東中西部地區(qū)之間孕產(chǎn)保健服務(wù)利用和孕產(chǎn)婦健康存有不公平,而城市流動人口與戶籍人口在孕產(chǎn)保健服務(wù)利用和孕產(chǎn)婦死亡上所表現(xiàn)出來的明顯差距,已成為城市孕產(chǎn)保健服務(wù)系統(tǒng)面臨的挑戰(zhàn)。 經(jīng)濟因素和衛(wèi)生服務(wù)系統(tǒng)是影響我國衛(wèi)生服務(wù)公平性的兩個主要因素。社會經(jīng)濟發(fā)展引起貧富差距增加,影響健康的決定因素變得愈加不公平；而衛(wèi)生服務(wù)改革的市場化傾向,以及政府在矯正市場失靈、改善衛(wèi)生服務(wù)尤其是公共衛(wèi)生服務(wù)公平性上的職能缺位,使得衛(wèi)生服務(wù)公平性進一步下降。規(guī)制的源起之一,是希望達(dá)到公平、實現(xiàn)權(quán)力等社會目標(biāo),世界衛(wèi)生組織明確提出：規(guī)制是政府和衛(wèi)生系統(tǒng)的責(zé)任,是促進衛(wèi)生服務(wù)公平性的重要工具,通過政府制定各種規(guī)則對衛(wèi)生服務(wù)市場進行適度規(guī)制,規(guī)制相關(guān)參與者的行為以確保其履行職責(zé),以強化衛(wèi)生服務(wù)的公平性,保障人人享有健康這項人類的基本權(quán)利。因此,尋找改善我國孕產(chǎn)保健服務(wù)公平性的途徑,將不可避免的涉及我國的衛(wèi)生服務(wù)體系和衛(wèi)生服務(wù)規(guī)制體系。在縮小孕產(chǎn)保健服務(wù)利用的公平性上,我國政府已采取了一系列的措施,近十年來全國住院分娩服務(wù)利用公平性的顯著改善,揭示了有效的政府規(guī)制對促使改善公平的政策達(dá)到預(yù)期目標(biāo)的重要作用。 目前,我國對衛(wèi)生服務(wù)公平性的研究中,針對孕產(chǎn)保健服務(wù)公平性的研究相對較少,且尚未見到從政府規(guī)制的角度深入分析孕產(chǎn)保健服務(wù)規(guī)制對公平性影響的實證研究。本研究正是致力于填補這一空白,以促進孕產(chǎn)保健服務(wù)規(guī)制發(fā)揮更大的作用,推動孕產(chǎn)婦健康公平性的不斷改善。 二、研究目的 本研究在描述與分析我國孕產(chǎn)保健服務(wù)的公平性現(xiàn)況的基礎(chǔ)上,利用規(guī)制理論和規(guī)制效果評價框架,以上海某區(qū)緊急產(chǎn)科保健服務(wù)為實證案例,分析有效的政府規(guī)制如何影響健康公平性,探討規(guī)制的要素對規(guī)制效果的影響,并以此為借鑒,在了解該區(qū)基本孕產(chǎn)保健服務(wù)利用公平性及其相關(guān)規(guī)制的基礎(chǔ)上,以良好治理和有效政府規(guī)制為理論框架,提出進一步改善孕產(chǎn)保健公平性的政策建議。 三、研究內(nèi)容與研究方法 1、以中國衛(wèi)生統(tǒng)計年鑒為二次數(shù)據(jù)來源,采用公平性的評價理論和分析方法,分析2000-2009全國孕產(chǎn)婦健康公平性以及2005-2009全國孕產(chǎn)保健服務(wù)利用和資源配置的公平性,以期對我國孕產(chǎn)保健服務(wù)的公平性現(xiàn)況做出較為全面的描述,并通過分析全國住院分娩服務(wù)利用公平性顯著提高的原因,初步探討有效的政府規(guī)制對落實公平性政策、改善孕產(chǎn)保健服務(wù)利用公平性的作用。 2、采用定性研究的方法,以上海市某中心城區(qū)為研究現(xiàn)場,選擇與上海市緊急產(chǎn)科保健服務(wù)相關(guān)的4類參與者共22人進行關(guān)鍵知情人半結(jié)構(gòu)式訪談,結(jié)合使用文獻(xiàn)分析法,評價緊急產(chǎn)科保健服務(wù)規(guī)制對改善上海市戶籍和非戶籍孕產(chǎn)婦健康公平性的影響,并分析規(guī)制的環(huán)境、過程、參與者和機制對緊急產(chǎn)科保健規(guī)制效果的影響。 3、采用該區(qū)2004-2011年婦幼衛(wèi)生報表作為二次數(shù)據(jù)來源,分析戶籍和非戶籍孕產(chǎn)婦對基本孕產(chǎn)保健服務(wù)利用的公平性,并通過現(xiàn)場調(diào)查的方法在全區(qū)13個社區(qū)衛(wèi)生服務(wù)中心對436名產(chǎn)后6個月內(nèi)的婦女進行問卷調(diào)查,進一步分析2011年該區(qū)戶籍和非戶籍孕產(chǎn)婦對保健服務(wù)利用的公平性和影響因素,通過定性研究的關(guān)鍵知情人半結(jié)構(gòu)式訪談,了解通過規(guī)制進一步改善孕產(chǎn)保健服務(wù)公平性的方向和關(guān)鍵環(huán)節(jié),并以良好治理和有效規(guī)制為理論框架,提出進一步改善公平性的政策建議。 四、主要研究結(jié)果 1.2000-2009年的10年間,全國的MMR持續(xù)下降,并以西部地區(qū)下降趨勢最顯著,2003-2009年間,東部和中部地區(qū)的MMR分別下降了44%和52%,而西部地區(qū)的MMR下降了62%。以極差法衡量2000-2009年全國及不同地區(qū)孕產(chǎn)婦健康公平性,東部與中部地區(qū)的孕產(chǎn)婦死亡差距變化不大,10年間MMR的率差約維持在10-20/10萬之間,雖然東部和西部地區(qū)的孕產(chǎn)婦死亡率差距最大,但這種差距縮小的趨勢卻最明顯,由2003年的65.43/10萬縮小至2009年的27.80/10萬。以集中指數(shù)反應(yīng)健康公平性,無論是省際還是地區(qū)間,2000-2009年的集中指數(shù)全為負(fù)值,表明孕產(chǎn)婦死亡集中于人均GDP較低的省份或地區(qū)；10年間,省際和地區(qū)間的集中指數(shù)均在-0.2～-0.3之間波動,與2000年相比,2009年的集中指數(shù)絕對值變化極小,提示10年里全國孕產(chǎn)婦的健康公平性未得到明顯的改善。 2.2005-2009全國產(chǎn)前檢查、住院分娩、產(chǎn)后訪視和系統(tǒng)管理四類孕產(chǎn)保健服務(wù)的集中指數(shù)均大于零,表明服務(wù)利用存有不公平,按人均GDP衡量,經(jīng)濟水平越低的省市,孕產(chǎn)婦對保健服務(wù)利用越差。四類孕產(chǎn)保健服務(wù)中,系統(tǒng)管理的集中指數(shù)絕對值最大,表明公平性最低；產(chǎn)前檢查的集中指數(shù)絕對值最小,公平性最好。2005-2009年,除住院分娩服務(wù)外,其他三類服務(wù)的集中指數(shù)變化很小,公平性未見明顯改善,而住院分娩服務(wù)利用的集中指數(shù)由2005年的0.0593迅速下降至2009年的0.0177,表明公平性持續(xù)且明顯改善,這離不開”降消”項目在這一地區(qū)所取得的成功,也表明了有力的政府規(guī)制對改善公平性的作用。 3.上海市孕產(chǎn)婦健康不公平,主要體現(xiàn)在流動和戶籍孕產(chǎn)婦死亡的健康公平性上,10年間,非戶籍孕產(chǎn)婦是全市孕產(chǎn)婦死亡的主流,加強危重孕產(chǎn)婦轉(zhuǎn)診、會診搶救,是降低MMR尤其是非戶籍孕產(chǎn)婦MMR的主要途徑之一。圍繞緊急產(chǎn)科保健上海市制定了一系列規(guī)制,并以2008年頒布的規(guī)制發(fā)揮了最為核心的作用,定性研究表明,該規(guī)制的出臺和執(zhí)行,有效提高了危重孕產(chǎn)婦搶救成功率并推動了全人群尤其是非戶籍孕產(chǎn)婦MMR下降,達(dá)到了預(yù)期效果,孕產(chǎn)婦的健康不公平縮小,而規(guī)制的執(zhí)行過程也很好的體現(xiàn)了服務(wù)提供的公平性。 4.規(guī)制產(chǎn)生效果的促成因素包括：規(guī)制的目標(biāo)與內(nèi)容契合國內(nèi)外所倡導(dǎo)的母親安全的政策環(huán)境；制定過程中以信息為基礎(chǔ)的設(shè)計、自上而下行政和技術(shù)管理的密切結(jié)合、規(guī)制執(zhí)行前必要恰當(dāng)?shù)慕庾x；孕產(chǎn)婦死亡評審、問責(zé)制、考核、懲罰、激勵等機制的綜合運用,尤其是問責(zé)制對相關(guān)的參與者所形成的有效監(jiān)督與約束；各級服務(wù)管理者和提供者作為規(guī)制主要參與者,其權(quán)利和能力保證了規(guī)制的有力執(zhí)行和良好效果。研究同時也表明,規(guī)制效果及持續(xù)性的阻礙因素包括：財政部門這一關(guān)鍵參與者的缺位,緊急產(chǎn)科保健服務(wù)可持續(xù)受限；激勵機制未能發(fā)揮更好的作用影響了執(zhí)行層面參與者的積極性。 5.對緊急產(chǎn)科保健服務(wù)規(guī)制的研究所得的另一重要結(jié)果是,減少危重孕產(chǎn)婦的發(fā)生、進一步縮小健康不公平,僅對緊急產(chǎn)科保健服務(wù)進行規(guī)制還不夠,必須關(guān)口前一,重點規(guī)制基本孕產(chǎn)保健尤其是產(chǎn)前保健。而目前上海市對基本孕產(chǎn)保健服務(wù)所進行的規(guī)制主要是2010年出臺的圍繞孕產(chǎn)婦全覆蓋管理的規(guī)制,這一規(guī)制旨在發(fā)動社區(qū)支持組織的力量完善社區(qū)孕情監(jiān)測網(wǎng)絡(luò),加強全人群尤其是非戶籍孕產(chǎn)婦對孕早期建冊和系統(tǒng)管理服務(wù)利用。 6.以率差和集中指數(shù)評價2004-2011年上海市某區(qū)戶籍和非戶籍對6類基本孕產(chǎn)保健服務(wù)利用的公平性,早孕建冊、規(guī)范產(chǎn)檢和系統(tǒng)管理三類服務(wù)利用不公平最為明顯且2004-2009年有擴大趨勢,但2010年該區(qū)全面推行全覆蓋孕產(chǎn)保健服務(wù)管理后,早孕建冊和系統(tǒng)管理服務(wù)利用公平性顯著改善：早孕建冊的集中指數(shù)由2004年的0.1308上升至2009年的0.1746后,于2010年下降0.1034,2011年繼續(xù)降至0.0594；而系統(tǒng)管理的集中指數(shù)由2004年的0.1434逐步升至2009年的0.1804,于2010年開始迅速下降至0.1054,并于2011年繼續(xù)下降至0.0652,這種明顯改善部分反映了全覆蓋規(guī)制的效果。 7.現(xiàn)場調(diào)查共納入436名研究對象,其中戶籍孕產(chǎn)婦238名,非戶籍孕產(chǎn)婦168名。分析表明,該區(qū)戶籍和非戶籍孕產(chǎn)婦的學(xué)歷、職業(yè)、家庭人均月收入、醫(yī)療保險和生育保險覆蓋率具有顯著性差異(P0.05),且兩類人群對早孕檢查、規(guī)范產(chǎn)檢、產(chǎn)后訪視三類基本孕產(chǎn)保健服務(wù)利用存在明顯差異；以率差衡量,最不公平的是早孕建冊服務(wù)利用,戶籍和非戶籍孕產(chǎn)婦早孕建冊服務(wù)利用的率差為29.4%,率比為1.44,集中指數(shù)為0.0816；對8次以上產(chǎn)檢服務(wù)利用的率差為26.3%,率比為1.41,集中指數(shù)為0.1104；產(chǎn)后訪視服務(wù)利用不公平性最小,率差為22.6%,率比為1.34,集中指數(shù)為0.0798。戶籍和非戶籍孕產(chǎn)婦對其他保健服務(wù)如產(chǎn)前篩查、孕婦學(xué)校和導(dǎo)樂分娩服務(wù)利用也存在明顯不公平,并以孕婦學(xué)校最為明顯,率比為1.6。影響戶籍和非戶籍孕產(chǎn)婦保健服務(wù)利用的主要因素是孕產(chǎn)婦的戶籍、學(xué)歷和生育保險。上海戶籍、有生育保險的婦女,更有可能在孕早期建小卡并完成規(guī)范(整個孕期≥8次)的產(chǎn)前檢查。除戶籍因素外,學(xué)歷水平越高的孕產(chǎn)婦,更有可能尋求和利用產(chǎn)后訪視服務(wù)。 8.定性研究進一步提示,全覆蓋規(guī)制對改善該區(qū)戶籍和非戶籍孕產(chǎn)婦在早孕建冊和管理服務(wù)利用公平性發(fā)揮了明顯作用,但關(guān)鍵參與者的缺位(財政部門、社區(qū)支持組織等)影響了規(guī)制的效果及可持續(xù)性。 五、基于良好治理和有效規(guī)制理論進一步改善上海市孕產(chǎn)保健公平性的政策建議 1、進一步改善我國及上海市孕產(chǎn)保健服務(wù)的公平性,應(yīng)重點關(guān)注產(chǎn)前保健服務(wù)利用的公平性,以項目推動服務(wù)的改善并通過政府規(guī)制落實為常態(tài),是可行的途徑之一。 2、環(huán)境因素影響規(guī)制的效果。新醫(yī)改推行的基本公共衛(wèi)生均等化服務(wù),是改善孕產(chǎn)保健服務(wù)公平性的契機,改善孕產(chǎn)保健服務(wù)公平性的規(guī)制,需要抓住這一良好的環(huán)境促成因素,以強化規(guī)制效果。 3、改善公平性的孕產(chǎn)保健服務(wù)規(guī)制,需要在良好治理的框架下,納入更多參與者并實現(xiàn)以政府為主導(dǎo)的多元共治,推動規(guī)制持續(xù)發(fā)揮作用,對于全覆蓋規(guī)制,財政和公民社會是兩個重要的參與者,應(yīng)當(dāng)發(fā)揮更大作用。 (1)、財政部門是保障規(guī)制順利執(zhí)行和持續(xù)發(fā)揮效果的重要參與者,孕產(chǎn)保健服務(wù)的規(guī)制不論是設(shè)計、管理還是執(zhí)行,都理應(yīng)納入該參與者。 (2)、發(fā)揮公民社會的重要力量,為孕產(chǎn)保健服務(wù)規(guī)制的可持續(xù)性提供支持和保障。 4、完善全覆蓋孕產(chǎn)保健服務(wù)規(guī)制的內(nèi)容,增加對孕婦學(xué)校、規(guī)范產(chǎn)檢服務(wù)的規(guī)制內(nèi)容,從多個環(huán)節(jié)推動上海市孕產(chǎn)保健服務(wù)利用的公平性。 5、改善全覆蓋孕產(chǎn)保健服務(wù)規(guī)制的可持續(xù)性,需要加強規(guī)制制定過程的程序性和規(guī)范化,并通過對規(guī)制的解讀增強規(guī)制的可行性和可操作性,以改善執(zhí)行的效果。 6、發(fā)揮全覆蓋規(guī)制改善基本孕產(chǎn)保健服務(wù)公平性的作用,需要綜合運用激勵、懲罰、考核等多種機制,保證相關(guān)參與者充分履行職責(zé),在財政部門納入規(guī)制過程的前提下,應(yīng)更多的采用經(jīng)濟性激勵機制以確保規(guī)制執(zhí)行者更加主動積極的參與規(guī)制的過程,實現(xiàn)規(guī)制的目標(biāo)。
[Abstract]:First, research background
Health equity is an opportunity for all members of society to achieve the highest possible level of health. In order to achieve this goal, a good health service system is needed to ensure the right to health as a basic human right, without the influence of the economic level, the external environment and so on. In.2000, the health service fairness is listed as the health department in the WHO. The important index of the performance evaluation has been carried out in all countries. The research from the field of maternal and child health service shows that the economic development level leads to the unfair utilization of maternal and health services, which is the original difference between the low income, the middle income and the high income countries. One of the reasons is that the research on the fairness of maternal health and service utilization is limited, but the results indicate that the health service utilization of pregnant and maternity and the health of pregnant and lying in women between the urban and rural areas in China are not fair, and the urban floating population and the household registration population are shown in the use of pregnant and maternal health services and maternal death. The obvious gap has become a challenge for the urban maternity and health care service system.
Economic factors and health service systems are the two main factors that affect the fairness of health services in China. The social and economic development causes the gap between the rich and the poor, and the determinants of health have become more unfair; the market-oriented tendency of health service reform, and the government's correction of the market failure, and the improvement of health services, especially public health. The lack of function on the fairness of service makes the fairness of health service decline further. One of the origins of the regulation is to achieve fairness and realize the social goals of power. The WHO clearly suggests that regulation is the responsibility of the government and the health system and is an important tool to promote the fairness of health services, and the government has formulated various rules through the government. It is necessary to regulate the health service market moderately, to regulate the behavior of the participants to ensure the performance of their duties, to strengthen the fairness of health services and to ensure the basic human rights of everyone. Therefore, the ways to improve the fairness of the health service in China will inevitably involve the health service system in our country and the health service system in our country. The health service regulation system has taken a series of measures to reduce the fairness of the utilization of maternity care services. In the past ten years, a significant improvement in the fairness of hospital delivery service in the country has been improved, which reveals the important role of effective government regulation to the expected goal of improving the policy of improving equity.
At present, in the study of health service fairness in China, the research on the fairness of maternal health service is relatively small, and the empirical study on the effect of maternal health care regulation on fairness has not yet been seen from the point of view of government regulation. This study is devoted to filling this gap in order to promote the regulation of maternal health service. Great role in promoting the continuous improvement of maternal health equity.
Two, the purpose of the study
On the basis of describing and analyzing the current status of the fairness of health care service in China, this paper uses the regulation theory and the framework of regulation effect evaluation, taking emergency obstetric care service in a district of Shanghai as an empirical case, and analyzes how effective government regulation affects health equity, and discusses the influence of regulatory factors on the effect of regulation. On the basis of understanding the equity and related regulations of the use of basic maternity care services in the area, the policy suggestions for further improvement of the health equity of pregnant women are put forward with the theoretical framework of good governance and effective government regulation.
Three, research content and research methods
1, based on the two data sources of China's Health Statistics Yearbook, the fairness of the health of pregnant women in 2000-2009 countries and the fairness of the utilization of 2005-2009 national maternity care services and the allocation of resources were analyzed by the equity evaluation theory and analysis method, so as to make a more comprehensive description of the fairness of the health service in China. The effect of effective government regulation on the implementation of fair policy and improving the fairness of maternal health care services are preliminarily discussed by analyzing the reasons for the significant improvement in the use of equity in hospital delivery services in China.
2, using the qualitative research method, taking a central city in Shanghai as the research site, 22 people of 4 types of participants related to emergency obstetric care service in Shanghai were selected to conduct the semi structural interview with the key lovers, and the emergency obstetric care service regulation was evaluated to improve the household registration and non domicile maternal health in Shanghai. It also analyzes the impact of regulatory environment, process, participants and mechanisms on the effectiveness of emergency obstetric health regulation.
3, using the 2004-2011 year maternal and child health report of the area as the two data source, this paper analyzes the fairness of the household registration and non domicile pregnant and parturient women's utilization of basic maternity care service, and through the field survey method, a questionnaire survey was conducted in 13 community health service centers in the whole region for the women within 6 months after 436 labor, and further analyzed the area in 2011. The fairness and influence factors of household registration and non domicile pregnant and parturient on the utilization of health care services, through the qualitative research on the semi structural interview with the key lovers, understand the direction and key links to further improve the fairness of the health service of pregnant women, and take good governance and effective regulation as the theoretical framework to further improve the fairness. Policy recommendations.
Four, the main research results
In the 10 years of 1.2000-2009, the national MMR continued to decline and the most significant decline in the western region. In the 2003-2009 years, the MMR in the eastern and central regions decreased by 44% and 52% respectively, while MMR in the western region declined by 62%. to measure the health equity of pregnant and lying in women in the eastern and central regions by the extreme difference method for 2000-2009 years in the whole country and in different regions. The difference in the gap between women's death is not significant. The difference between the MMR rate in 10 years is about 10-20/10 million, although the maternal mortality gap between the eastern and western regions is the largest, but the narrowing trend is most obvious, from 65.43/10 million in 2003 to 27.80/10 million in 2009. In the interval, the concentration index of 2000-2009 years was all negative, indicating that maternal mortality was concentrated in the provinces or regions with lower GDP per capita. In 10 years, the inter provincial and inter regional concentration index fluctuated between -0.2 and -0.3, compared with 2000, the absolute value of the concentration index changed little in 2009, suggesting that the health fairness of the pregnant and lying in women in the 10 years did not have to be obtained. To the obvious improvement.
2.2005-2009 national prenatal examination, hospitalization delivery, postpartum visit and system management were all more than zero, indicating that the service utilization was not fair, according to the per capita GDP, the lower the economic level, the worse the pregnant and parturient women were using the health service. The concentration index of the system management in the four kinds of maternity care services was the absolute index. The value of the maximum value is the lowest. The absolute value of the concentration index of the antenatal examination is the smallest, the fairness is best.2005-2009 years. In addition to the delivery service in the hospital, the concentration index of the other three kinds of services is very small, and the fairness is not obviously improved, but the index of the use of the hospital delivery service declined from 0.0593 in 2005 to 0.017 in 2009. 7, the persistence and obvious improvement of fairness, which is inseparable from the success of the "reduction" project in the region, also shows the effect of strong government regulation on improving fairness.
3. the health impartiality of pregnant and lying in women in Shanghai is not fair, mainly reflected in the health equity of migrant and maternal death. In the 10 years, non domicile pregnant and lying in women are the main stream of maternal death in the city. It is one of the main ways to reduce the MMR especially the non domicile pregnant women MMR. The city has formulated a series of regulations and played the most important role in the regulation issued in 2008. Qualitative research shows that the introduction and implementation of the regulation have effectively improved the success rate of critical pregnant and lying in pregnant women and promoted the decrease of MMR in the whole population, especially the non domicile pregnant and lying in women, which had achieved the expected effect, and the health of pregnant and lying in women was unfairly reduced. The execution of the system also reflects the fairness of service delivery.
4. the factors contributing to the effect of regulation include: the objectives and contents of the regulation are compatible with the policy environment of mother's safety advocated at home and abroad; the information based design, the close combination of top-down administrative and technical management in the process of formulation, the necessary and appropriate interpretation before the implementation of the regulation, the review of maternal mortality, accountability, assessment, and punishment. The comprehensive use of mechanisms such as punishment and incentive, especially the effective supervision and restraint formed by the accountability system for the related participants; service managers and providers at all levels as the main participants, their rights and abilities guarantee the powerful enforcement and good effects of regulation. The absence of this key participant in the financial sector, the sustainability of emergency obstetric care services, and the failure to play a better role in the incentive mechanism have affected the enthusiasm of the participants at the executive level.
5. another important result of the study on the regulation of emergency obstetric care service is to reduce the occurrence of critical pregnant women and to reduce the health inequity further. It is not enough to regulate the emergency obstetric care service only. It is necessary to close the mouth of the first place, especially the basic maternity care, especially the antenatal health care. At present, the basic maternity health care is in Shanghai. The main regulation of the service is to regulate the full coverage management of pregnant and parturient women in 2010. This regulation aims to mobilize the strength of community support organizations to improve the community pregnancy monitoring network, and to strengthen the full population, especially the non domicile pregnant and lying in pregnant women in the early pregnancy and system management service.
6. to evaluate the fairness of the household registration and non domicile of 2004-2011 years for the utilization of 6 kinds of basic maternity care services in a district of Shanghai for 2004-2011 years, the establishment of early pregnancy, the standard production inspection and the system management of the three types of service utilization is the most obvious and 2004-2009 year expansion trend, but in 2010, the full coverage of the full coverage of maternal health service management in the district After that, the use of equity in early pregnancy and system management services improved significantly: the concentration index of the early pregnancy volume rose from 0.1308 in 2004 to 0.1746 in 2009, and continued to fall to 0.0594 in 2010, and the centralized index of system management rose from 0.1434 in 2004 to 0.1804 in 2009, and it began to decline rapidly in 2010. To 0.1054, and continued to decline to 0.0652 in 2011, this marked improvement partly reflects the effect of full coverage regulation.
7. the field survey included 436 subjects, including 238 pregnant and lying in women and 168 non domicile pregnant and lying in women. The analysis showed that there were significant differences in the educational background, occupation, family per capita income, medical insurance and birth insurance coverage (P0.05) for the household registration and non domicile pregnant and lying in women in the district (P0.05), and the two groups were examined for early pregnancy, standardized production and postpartum visits. There were obvious differences in the utilization of the three kinds of basic maternity care services; the most unfair was the utilization of early pregnancy volume, with the rate difference of 29.4%, the rate ratio of 1.44, the concentration index of 0.0816, the rate difference of 26.3% and 1.41, the ratio of 1.41, and the ratio of 1.41 to the rate of 1.41. The number was 0.1104; the postpartum visit service was the least fair, the rate difference was 22.6%, the rate was 1.34. The concentration index was 0.0798. and non domicile pregnant and parturient for other health care services such as prenatal screening, pregnant women's schools and the use of guidance delivery service. The main factors for the use of maternal health care service are the domicile household registration, educational background and birth insurance. The Shanghai domicile and childbearing insurance women are more likely to build a small card in the early pregnancy and complete the prenatal examination (the whole pregnancy more than 8 times). Besides the household registration factors, the higher and higher education women are more likely to seek and use postpartum. Visit service.
8. qualitative research into one
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2012
【分類號】：R172

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