Progress And Effect Study On The Implementation Of Hospital Maternal Delivery Guarantee In Rural Areas

Objective:Thoroughly understand and analyze the development status of rural maternity hospital delivery guarantee after policy adjustment through empirical research,and evaluate its implementation effect.Explore the problems and shortcomings in the implementation process of rural maternal hospital delivery guarantee policy.Propose further policy recommendations for improving rural maternity hospital delivery guarantee work.Contents:Understand the implementation status of the rural maternal hospital delivery guarantee policy.Evaluate the effect of rural maternal hospital delivery guarantee in typical areas,and put forward suggestions for improving the rural maternity hospital delivery guarantee work.Methods:Through literature research,collect relevant literature,reports,policy documents,books and other materials,sort out,summarize and clarify the relevant methods and dimensions of rural maternal hospital delivery guarantee implementation and policy effect evaluation;in the program design,index selection and policy recommendation process In order to ensure the rationality of the content through the consultation of experts,etc.;through field research,Jiangdu District,Yangzhou City,Jiangsu Province,Daye City,Huangshi City,Hubei Province,and Yongchuan District,Chongqing City were used as research areas to collect information on rural maternity hospital delivery guarantee policies.The collection methods include quantitative data collection and qualitative interviews;quantitative data are analyzed by descriptive statistics,and qualitative data are processed by subject framework method and SWOT analysis method.Results:1.Policy implementation:On the basis of national policy guidance,various localities have successively issued work plans and supporting policies to promote rural maternity hospital delivery guarantees,and implementation is slightly different.Jiangsu Province and Hubei Province have relatively sufficient policy resources.The executive agencies of Yangzhou City and Huangshi City can communicate and coordinate in time.The implementers have the correct value orientation and positive attitude.Huangshi City has a slight lack of policy adjustment,but Under the joint effect of a better system environment,the rural maternity hospitalization guarantee policy in Jiangdu District and Daye City can be smoothly implemented.Due to the lack of effective and timely communication between the executive agencies in Chongqing,the implementation of the policy in Yongchuan District is slightly poor.2.Policy effect analysis:After the policy adjustment,the hospital delivery rate in the survey area was maintained above 99.9%;the maternal system management rate in Daye City and Jiangdu District increased;the overall level of cesarean section rate remained high;The total cost of cesarean section and the cost of self-sufficiency have increased to varying degrees.The cost of cesarean section in Jiangdu District and Yongchuan District has decreased;the proportion of reimbursement for cesarean section expenses and the reimbursement rate of pharmacy in Jiangdu District have increased.The proportion of self-pay for local labor is above 75%;the proportion of cesarean section reimbursement in Jiangdu District and Yongchuan District is higher than that of delivery;maternal awareness of policies related to rural maternity hospital delivery has improved;some women in Daye City and Yongchuan District The family members believe that the economic burden of hospital delivery costs has increased;maternity families generally believe that the process of obtaining security is more convenient.3.SWOT analysis of hospital delivery guarantee method:Different security methods in the survey area have their own advantages,disadvantages and threats,as well as common opportunities.Yangzhou City implemented a fixed-rate reimbursement method of "one system and two files",which improved the rural maternity hospitalization guarantee and fund use efficiency;Huangshi City increased the fixed reimbursement level of hospital delivery expenses,but compared with the policy adjustment,the level of protection is slightly There is a reduction;Yongchuan District adopts the original reimbursement method and level,and the maternity guarantee level is reduced;all localities have simplified the reimbursement process,strengthened government supervision,and improved the fairness of maternity benefits,but there is also a high level of reimbursement for caesarean section.The actual threat is relatively reduced in rural maternity;the common threats include a rapid increase in hospital delivery costs and a gap between urban and rural maternity benefits,and the central and western regions are also facing insufficient financial subsidies during the policy transition period;common opportunities include household registration system reform.Breaking the urban-rural dual division pattern and increasing the control fees for medical institutions.Conclusion:The overall transition of rural maternity hospital delivery guarantee policy is relatively stable;the higher self-paying proportion of hospital delivery is urgently needed to adjust the cost management and compensation ratio;the medical insurance system needs to reasonably formulate the proportion and mode of payment for different types of delivery,and promote natural childbirth.The integration of urban residents’ medical insurance and the new rural cooperative medical system has created favorable conditions for the work of hospitalization and childbirth protection;the gap between urban and rural maternity protection is still one of the main challenges.Recommendations:This study proposes the following recommendations:The different characteristics of the implementation object should be fully considered to achieve a flexible transition of policy.Improve the hospitalization delivery subsidy system and reasonably set the payment level for childbirth expenses.Strictly control the increase in hospital delivery costs and appropriately increase the proportion of medical insurance compensation.Promote the fairness of maternal and childbearing benefits in urban and rural areas and establish a rural maternity insurance system.We will improve laws and regulations related to maternity protection and systematize the legal system for maternity protection.