Research On The Effect Of Different Government Purchasing Methods On Maternal Health Management

Objective:Through different perspectives of government departments,maternity health service providers,medical personnel,and pregnant women,Investigating the status and satisfaction of purchasing maternal health management services in typical regions where different government purchasing methods are used,and to discuss the problems of different purchase methods,to provide a basis for improving the policy of purchasing health services during pregnancy and childbirth.Methods:A field survey is conducted to investigate the status of maternal health management purchase services in Xuanhua District of Zhangjiakou City and Hechuan District of Chongqing City.The use of literature research methods,group interviews,and questionnaires are used to collect data;quantitative data were mainly descriptive statistical analysis,and qualitative data were classified,summarized,and summarized.Results:1.The main practices in the survey regions:The main responsibility for the implementation of maternal health management services in the two surveyed regions is the local health administrative agency;the main form of the purchase services is Hechuan District contract purchase,Xuanhua District free service voucher purchase;The subjects are household registration and permanent pregnant women(Xuanhua District is for more than 6 months,Hechuan District is for more than 3 months).There are differences in the choice of purchasing service providers.Hechuan District provides service providers with medical facilities with capacity for inspection,including some private hospitals;Xuanhua District provides service providers only for local public medical institutions;Xuanhua District purchases service fund subsidies for "Post payment system,according to the number of services paid," Hechuan District,"prepayment system and performance evaluation combined payment."2.Conditions of maternal health management funds:Since the implementation of the services,the situation of maternal health management in the surveyed areas such as early pregnancy establishment rate,5 or more prenatal check-up rates has improved.Among them,Hechuan District has the largest change,increasing by about 10%and 3%respectively.Maternal subsidies for Hechuan District increased from 320 yuan/person before the implementation of the purchase to 511 yuan/person per year,and 264 yuan for each pregnant woman after adjustment in Xuanhua District.3.Satisfaction of medical staff and maternity:Compared with the time before the implementation of the purchase of services,the medical staff in both places think that their workload has increased,but the enthusiasm for the work has been higher than before;at the same time,the medical staff in both places think that the imple mentation of government purchases Services are more conducive to the management of maternal health care.Maternal and childbearing women in the two regions surveyed had high levels of awareness and satisfaction with purchasing service policies.However,24%of pregnant women in Hechuan District believed that contract purchases could not meet their own health needs,and 8%of pregnant women in Xuanhua District considered free service vouchers.Can not meet their own health needs.Discussion:Although the two places have adopted.different service purchasing methods,they have achieved better results:improved maternal health management status and enhanced accessibility of clients,such as maternal health management rates in the two places have increased significantly At the same time,it maintained at a relatively high level;it changed the way of investing maternity health management funds;it created an incentive mechanism for medical institutions and medical personnel,and to a certain extent raised the efficiency of maternal and child health workers;strengthened the health administration Assessment and supervision of medical institutions.However,there are also problems such as relatively few service items,insufficient service personnel,unreasonable design of free service vouchers,and difficulty in supervision and administration of contract systems.It is worth noting that the use of government purchases is not the only factor that causes changes in local maternal health status.The improvement of maternal health care during the pregnancy in both places is the result of a combination of various factors.The integration between various health agencies and the government Increased emphasis on basic public health,improved awareness of maternal self-care,and so on,are all responsible for the improvement of maternal health management.Suggestions:Expand the scope of free service projects and give grass-roots personnel policy support;Expand the scope of providing medical services to purchase services,property introduce competition mechanisms;Reasonable pricing and compensation;Select service providers and purchase methods according to local conditions...