| Objective: From the different aspects of management departments, maternal and child health service providers and pregnant women, we had surveyed the current state and satisfaction of maternal health management purchasing service in basic public health, discussed the appeared problems and provided the basis for maternal and child health purchasing service policy.Methods: We had chosen Nanhai District in Guangdong Province, She County in Anhui Province and Pinghu City in Zhejiang Province with the typical case investigation method as our survey areas, which were three pilot areas of maternal health management purchasing service. We had conducted this survey with the methods of literature research, group interview and questionnaire investigation. We would process the quantitative data by descriptive statistical analysis and use the method of classification, induction, summary and refining on the qualitative data.Results:1. The main measures in survey area: Among the three maternal health management purchasing service survey area, the main responsibility was all the local health administration agencies, the main form of purchasing service was all the ‘service voucher’ mode and the service object was all the household registration and permanent pregnant women(more than 6 months). On the choice of the purchasing service under-staked subject, both Nanhai District and She County had chosen all the qualified medical institutions in its home area, and Pinghu City was only the maternal and child care health clinics and townships. Both Nanhai District and Pinghu City of the performance appraisal way were every six months for an assessment and She County was real-time monitoring with the annual performance appraisal for informatization technology. The service purchase subsidies in Nanhai District and Pinghu City was ‘after the pay system: according to the project payment’, and which was ‘the combination of appropriations and examination of settlement system’ in She County.2. Conditions of maternal health management funds: In the 2014 per ca-pita basic public health services, Nanhai District was 28.5 yuan, She County was 35 yuan and Pinghu City was 38.7 yuan. In the proportion of maternal health management service funds accounted for the basic public health funds, Nanhai District was 5.83%, She County was 10.01% and Pinghu City was 3.4%. In the maternal health management antenatal examination purchasing service subsidy standards, Nanhai District was 347.4 yuan, She County was 285 yuan and Pinghu City was 159.7 yuan(township) / 175.64 yuan(municipal). Since the implementation of the purchasing service, the antenatal examination purchasing service subsidy standard in Nanhai District and Pinghu City had not been changed, and which had been increased in She County from 100 yuan to 285 yuan.3. Conditions of maternal health management: Since the implementation of the purchasing service, both the pregnancy building volume rate and the above 5 times antenatal examination rate had been increased in survey area. The change in She County was the sharpest, the former was increased by 11.98% and the latter was increased by 32.08%. Followed by Pinghu City, the former was increased by 6.09% and the latter was increased by 5.70%. The minimum was Nanhai District, the former was increased by 0.54% and the latter was increased by 5.35%. The average number of every pregnant women antenatal examination in all survey institutions were more than five times, except the Guicheng hospital in Nanhai District.4. Medical staff satisfaction: Since the implementation of the purchasing service, 86.95% of the medical staff on average thought that the workload was increased. 60.87% of the medical staff on average thought that the income didn’t change, of which 21.74% of the medical staff thought that the income being less than ever before. On average, 86.95% of medical personnel supported purchasing service. On average, 52.17% of the medical staff thought that the purchasing service was difficult to meet the needs of pregnant women.5. Pregnant women satisfaction: On average, 37.5% of maternal didn’t know the policy of government providing free five times antenatal examination. On average, 75.0% of pregnant women thought that they had enjoyed the free service, however, 45.55% of pregnant women on average in Nanhai District said that they haven’t enjoyed the free service, of which were all flow pregnant women. On average, 94.44% of pregnant women thought that it was very convenient when receiving free antenatal examination. The pregnant women having received prenatal maternal service thought that they were very satisfied with the medical institutions providing free services, the medical personnel service quality and the service attitude, and the proportion was all 100%.Conclusions: There were many good effects in the implementation of maternal health management purchasing service, such as the efficiency and quality of the maternal health management being improved, having changed the investment way of maternal health management funds, having directly given the funds subsidy to the service objects and enhanced their autonomy and accessibility, having produced incentive on medical institutions, having strengthened the examination and supervision of the public health administrative department on medical institutions. There were also some problems in the implementation process of purchasing service, for example, the funds proportion of maternal health management in purchasing service needed to be adjusted, the time setting up on antenatal examinations was not standard and the service contents purchased were not reasonable, the informatization level was low and the measures of performance evaluation needed to be improved, the understanding of the management institutions and medical staff on purchasing service was not enough, the contents was still not enough to meet pregnant’ demand, the awareness of purchasing service policy among the floating pregnant was a little lower and it was very difficult for them to get the free ‘service voucher’.Suggestions Increase the expenditure proportion of the maternal health management in the basic public health service and distribute the funds reasonably. Standardize the antenatal examination time and formulate the content of purchasing service reasonably. Expand the scope of medical institutions undertaking purchasing service. Realize the informatization of the maternal health management to improve job efficiency. Implement the budget subsidy of the related medical staff and perfect the performance appraisal scheme. Strengthen the propaganda works to improve the maternity awareness and understanding of the purchasing service policy. |
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