Research Institute of Health Development Strategies, Fudan University, Shanghai, China.
Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
J Glob Health. 2022 Mar 19;12:11002. doi: 10.7189/jogh.12.11002. eCollection 2022.
Creating an enabling environment (EE) can help foster the development and health of children. The Chinese government implemented a new health care reform (NHR) in 2009 in a move to promote an EE for health. The purpose of this study was to evaluate the impact of the NHR on EE for children's health.
An interrupted time-series analysis was used to evaluate the changes in the EE before and after 2009 in China. This study analysed the EE through five quantitative indicators, including policy element coverage rate (PECR), service meeting with children's needs rate (SMCNR), multisector participation rate (MPR), and accountability mechanism clarity rate (AMCR), based on the content analysis of available public policy documents (updated as of 2019) from 31 provinces in mainland China, and the number of health care personnel of maternity and child care centres per 10 000 population (HP per 10 000 population), based on the 2002-2019 China Health Statistical Yearbook and China Statistical Yearbook.
The average values of PECR, SMCNR, and MPR increased rapidly to 90.96%, 82.46%, and 81.31%, respectively, in 2019, representing a higher value compared to the AMCR (7.38%). The NHR promoted the EE, in which HP per 10 000 population showed the fastest increase (β = 0.03, < 0.01; β = 0.10, < 0.01), followed by SMCNR (β = 0.94, < 0.01; β = 1.83, < 0.01), AMCR (β = 0.13, < 0.01; β = 0.24, = 0.14), MPR (β = 1.35, < 0.01; β = 2.47, < 0.01) and PECR (β = 1.43, < 0.01; β = 1.47, < 0.01).
The NHR has a positive impact on the EE, especially on the human resources and service provision for children. Efforts should be intensified to improve the clarity of the accountability mechanism of the health-related sectors.
营造有利环境（EE）有助于促进儿童的发展和健康。中国政府于 2009 年实施了新的医疗改革（NHR），以促进健康方面的 EE。本研究旨在评估 NHR 对儿童健康 EE 的影响。
采用中断时间序列分析方法，评估 2009 年前后中国 EE 的变化。本研究通过对中国大陆 31 个省的现有公共政策文件（截至 2019 年更新）进行内容分析，以及基于 2002-2019 年《中国卫生统计年鉴》和《中国统计年鉴》的每 10000 人口的妇幼保健中心卫生保健人员数量（每 10000 人口的 HP），使用五个定量指标来评估 EE，包括政策要素覆盖率（PECR）、满足儿童需求的服务率（SMCNR）、多部门参与率（MPR）和问责机制清晰度率（AMCR）。
2019 年，PECR、SMCNR 和 MPR 的平均值迅速提高到 90.96%、82.46%和 81.31%，分别高于 AMCR（7.38%）。NHR 促进了 EE，其中每 10000 人口的 HP 增长最快（β=0.03，<0.01；β=0.10，<0.01），其次是 SMCNR（β=0.94，<0.01；β=1.83，<0.01）、AMCR（β=0.13，<0.01；β=0.24，<0.01）、MPR（β=1.35，<0.01；β=2.47，<0.01）和 PECR（β=1.43，<0.01；β=1.47，<0.01）。
NHR 对 EE 具有积极影响，特别是对儿童的人力资源和服务提供。应加强努力，提高与健康相关部门的问责机制的清晰度。
