Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China.
Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China.
Chin Med J (Engl). 2020 Apr 5;133(7):792-799. doi: 10.1097/CM9.0000000000000741.
Regulatory policy (RP) is known as a major factor to improve health care system performance. A significant difference in maternal mortality rates (MMRs) was observed between New York city (NYC) and Shanghai (SH), both first-class international metropolises. This study aims to adopt a quantitative evaluation model to analyze whether RP differences contribute to the different MMRs of the two cities.
Based on collection of all publicly released policy documents regarding maternal health in the two cities, we assessed and compared the status of their maternal health care RPs from 2006 to 2017 through a series of quantitative indicators as regulatory elements coverage rate (RECR), departmental responsibility clarity rate (DRCR), and accountability mechanism clarity rate (AMCR), based on two characteristics of comprehensiveness and effectiveness of RPs. Pearson correlation analysis, principal component analysis, and linear regression analysis were used to test the relationships between the indicators and MMR in SH and NYC.
By 2017, disparities of maternal health care RP are found between SH and NYC, from the indicators of RECR (100% vs. 77.0%), DRCR (38.9% vs. 45.1%), and AMCR (29.2% vs. 22.5%). From 2006 to 2017, RECR, DRCR, and AMCR in SH have shown a higher growth of 8.7%, 53.2%, and 45.2%, compared with growth of 25.0%, 12.5%, and 2.9% in NYC. The three indicators were found all negatively correlated with MMR in SH (Coefficients = -0.831, -0.833, and -0.909, and P < 0.01), while only RECR and DRCR had negative correlation with MMR in NYC (Coefficients = -0.736 and -0.683, and P < 0.05). Linear regression showed that the principal components of the three indicators were found with significant impact on MMRs both in SH (R = 0.914, R = 0.836, P < 0.001) and NYC (R = 0.854, R = 0.357, P = 0.04).
Compared with NYC, the more comprehensive and effective maternal health care RPs in SH had a stronger impact on MMR control, which contributed to the differences between the two cities' MMRs to some extent. The methods and indicators we adopted for assessment are reasonable and comparable.
监管政策（RP）被认为是改善医疗体系绩效的主要因素。纽约市（NYC）和上海（SH）这两个国际大都市的孕产妇死亡率（MMR）存在显著差异。本研究旨在采用定量评估模型分析监管政策差异是否导致这两个城市 MMR 的不同。
本研究基于收集的两个城市关于孕产妇健康的所有公开政策文件，通过一系列定量指标，包括监管要素覆盖率（RECR）、部门责任清晰度率（DRCR）和问责机制清晰度率（AMCR），评估和比较了 2006 年至 2017 年期间两个城市的孕产妇保健 RP 状况，这些指标基于 RP 的全面性和有效性两个特征。采用 Pearson 相关分析、主成分分析和线性回归分析来检验 SH 和 NYC 中 MMR 与指标之间的关系。
到 2017 年，发现 SH 和 NYC 之间的孕产妇保健 RP 存在差异，表现在 RECR（100%比 77.0%）、DRCR（38.9%比 45.1%）和 AMCR（29.2%比 22.5%）指标上。2006 年至 2017 年，SH 的 RECR、DRCR 和 AMCR 增长率分别为 8.7%、53.2%和 45.2%，而 NYC 则分别为 25.0%、12.5%和 2.9%。在 SH 中，这三个指标均与 MMR 呈负相关（系数=-0.831、-0.833 和-0.909，P<0.01），而在 NYC 中仅 RECR 和 DRCR 与 MMR 呈负相关（系数=-0.736 和-0.683，P<0.05）。线性回归显示，这三个指标的主成分在 SH（R=0.914，R=0.836，P<0.001）和 NYC（R=0.854，R=0.357，P=0.04）的 MMR 中均具有显著影响。
与 NYC 相比，SH 更全面、更有效的孕产妇保健 RP 对 MMR 控制的影响更强，这在一定程度上导致了两个城市 MMR 的差异。我们采用的评估方法和指标是合理且具有可比性的。
