The Empirical Study On Tiered Maternal Health Care Service In Jiangsu Province

Objective:On the basis of clarifying the definition and classification of maternal health care services,this study analyzes the implementation status of the tiered maternal health care services,finds the factors that promote the implementation of the policy and the key issues that hinder the implementation of the policy,and puts forward suggestions to improve the tiered maternal health care services in Jiangsu province,at the same time provides reference for other regions.Contents:Clarifying the definition and classification of maternal health care services,Analyzing the background,the policy content,implementation status and effect of the tiered maternal health care services to give some suggestions for perfecting the tiered maternal health care services in Jiangsu Province.Methods:Through literature research,this study clarifies the definition and classification of the maternal health care services and the division of responsibilities between various types of medical and health institutions at different levels.By field investigation,we summarize the policy context and content,using Meter-Horn model to analyze the implementation,and using the descriptive statistics to analyze the effect of the tiered maternal health care services.Results:1.Jiangsu province clarifies the division of responsibilities,service capabilities between various types of medical and health institutions at different levels.Primary health care institutions need to provide these services including building cards,maternity health care services,high-risk pregnancy factors screening,postpartum visit and postpartum 42 days check.The secondary-level medical and health institutions need to provide maternity health care services and the high-risk maternal management.The third-level medical and health institutions need to set up the maternal critical intensive care center,provide smooth first aid green channel to accept other institutions referral,and are responsible for promoting technological development and service standards,strengthen the emergency guidance and training.2.The implementation of the tiered maternal health care services policy owns better system environment,clear policy goal,and the certain policy resources,but the grassroots talent is still lacking.Hospital information system has been quite sound,and information platform construction can also be connected in the region while the provincial and municipal levels can't be.There's always be referred or collaborated by medical union,prenatal diagnosis/screening network,maternal critical intensive care network and two-way referral,the referral channel is relatively smooth,and by the end of 2016,Jiangsu Province has established 19 regional maternal and child health services consortium,but the depth of the collaboration still need to strengthen.3.By the first-treatment relevant indicators,we know Changzhou grass-roots build rate increased from 72.1%in the first quarter of 2014 to 95.1%in the third quarter of 2016,the grass-roots prenatal inspection rate increased from 71.9%to 94.9%.From 2014 to 2016,primary health care institutions' average growth rate of providing early pregnancy card,early and mid-term pregnancy examination and prenatal screening services are the highest in different levels of medical institutions,especially,the prenatal screening services'average growth rate achieves to 104%.By the two-way referral and maternal health care related indicators,all indicators from 2014 to 2016 are relatively stable with no obvious change.Conclusion:It has initially launched the tiered maternal health care services on the basis of clarification of the division of responsibilities and service capabilities between various types of medical and health institutions at different levels,health care workers and pregnant women can provide or accept tiered services to a large extent in Jiangsu province.In medical union,vertical collaboration has technical guidance and training learning while the collaboration depth is not enough,the referral channel is much smooth while the informational transformation is still incomplete and only up-referral no down-referral,the health information system is inter-regional interconnection,but provincial and municipal level can't be interconnected,and the community medical institutions' service capacity is still lacking and limited.There's an initial effect after the implementation of the tiered maternal health care services policy,the grass-roots build rate and the grass-roots prenatal inspection rate both exceeded 90%,however,because the policy implementation time is short,the effect has not appeared yet.Recommendations:To strengthen the tiered maternal health care services,this study proposed the following recommendations:According to the norms,documents and other regulations,medical and health institutions implement their division of responsibilities,improving the use of funds allocated to finance.To improve service capacity in community medical institution,it's necessary to strengthen the construction of the human resource and the infrastructure.At the same time,Refining referral Standards,establishment referral cooperation and supervision mechanisms should be built,in order to regulate the two-way referral behavior.Improving the distribution of benefits mechanism,changing the management and incentive mechanism should be carried out,so as to promote the long-term collaboration.And focused on improving the regional maternal and child health information platform to break the information barriers between medical institutions and establish regional inspection,pathology diagnosis,medical imaging center and remote consultation information system.