孕产期保健服务利用影响因素研究

发布时间：2018-02-27 03:04

本文关键词： 孕产期保健服务社会生态系统理论影响因素新型农村合作医疗计划生育政策流动人口城乡比较　出处：《浙江大学》2014年博士论文　论文类型：学位论文

【摘要】：研究背景良好的孕产期保健可以改善母婴健康状况,显著降低孕产妇死亡率和婴儿死亡率。尽管我国孕产期保健服务已取得了较大发展,但还是存在各种各样的问题,制约着孕产期保健服务的利用,育龄妇女对孕产期保健服务的利用存在着较大的差异。社会生态系统理论是用以考察人类行为与社会环境交互关系的理论,强调生态环境(人的生存系统)对于分析和理解人的行为的重要性。该理论认为人的生存环境的微观、中观和宏观系统总是处于相互影响和相互作用的情境中。从社会生态系统理论的视角,可以提出假设：孕产期妇女个人及其所在的家庭、社会环境构成与其产生交互作用的因素,影响孕产期保健服务的利用。本文将从社会生态系统的视角,于微观、中观和宏观层面对我国孕产期保健利用现状进行分析,探索孕产期保健服务利用的影响因素。研究目的基于社会生态系统理论的视角,从个人、家庭、社会三个层面探索影响孕产期保健服务利用的影响因素。研究方法研究方法包括文献法和调查法,其中文献法主要是通过对国家卫生部门官方发布的社会经济发展和卫生保健事业发展的相关数据进行二次分析,对我国孕产期保健情况、社会因素对孕产期保健服务的影响等方面开展科学评价。调查法是通过定量调查的方式,分别采用2008年、2011年浙江省卫生服务调查的数据,以及通过自行组织的在江苏省开展的孕产期保健服务调查的数据,开展实证研究。结果孕产期保健服务利用受到来自孕产期女性个人、家庭、社会环境的多个层面多种社会因素的影响。值得关注的是社会环境方面的影响,通过分析发现,流动人口、城乡差别、新型农村合作医疗以及计划生育政策等宏观社会因素影响妇幼保健服务的利用。随着新农合等一些卫生筹资制度改革的实施,农村孕产期保健水平得到有效提升,城乡保健服务利用差距不断缩小,但城市中流动孕产妇的保健缺失,给城市孕产期保健工作带来新的压力。社会政策中,我国奉行多年的计划生育政策在控制人口增长、保障人口质量的同时,也导致了一部分计划外分娩人群孕产期保健服务利用的缺失或不足。结论在继续推进新型农村合作医疗的同时,应进一步论证其补偿方案的合理设计,结合孕产期保健的补偿内容,使其能有效减轻农村孕产期保健的经济负担。城市孕产期保健工作中应采取积极措施提高流动人口的孕产期保健服务可及性。在计划生育国策背景下,计划外分娩的人群成为客观上孕产期保健服务利用不足的特殊人群,这一现象成为一些经济发达地区提高孕产期保健服务利用的“瓶颈”,应给予充分关注。
[Abstract]:Research background. Good maternal and parturient health care can improve maternal and child health and significantly reduce maternal mortality and infant mortality. Although health care services during pregnancy and childbirth in China have made great progress, there are still various problems. The utilization of health care services during pregnancy and childbirth is restricted, and there are great differences in the utilization of health care services during pregnancy and childbirth among women of childbearing age. The theory of social ecosystem is used to examine the interaction between human behavior and social environment, emphasizing the importance of ecological environment (human survival system) in analyzing and understanding human behavior. The meso and macro systems are always in the context of interaction and interaction. From the perspective of social ecosystem theory, the hypothesis can be put forward: an individual woman during pregnancy and childbirth and her family, The factors that affect the utilization of health care services during pregnancy and childbirth are affected by the interaction of social environment. This paper will analyze the present situation of health care utilization during pregnancy and childbirth in China from the perspective of social ecosystem, at the micro, meso and macro levels. To explore the factors influencing the utilization of health care services during pregnancy and childbirth. Research purpose. Based on the theory of social ecosystem, the factors influencing the utilization of health services during pregnancy and childbirth were explored from three aspects: individual, family and society. Research method. The research methods include the literature method and the investigation method, in which the literature method is mainly based on the secondary analysis of the relevant data on the social and economic development and the development of the health care enterprise, which are officially released by the state health sector, and the situation of health care during pregnancy and childbirth in China. The impact of social factors on maternal health services and other aspects of scientific evaluation. The method of investigation is to use the data of Zhejiang health service survey on 2008 and 2011, and the data of self-organized survey of pregnant and parturient health services in Jiangsu Province, respectively, to carry out empirical research through the way of quantitative investigation. Results. The utilization of health care services during pregnancy and childbirth is influenced by many social factors, including individual, family, and social environment of women during pregnancy and childbirth. What is worth paying attention to is the impact of social environment. Through analysis, it is found that floating population, urban and rural differences, New rural cooperative medical care and family planning policy and other macro social factors affect the utilization of maternal and child health services. With the implementation of some health financing system reform, such as the New Rural Cooperation (NCMS), the level of health care during pregnancy and childbirth in rural areas has been effectively improved, and the gap in the utilization of health services between urban and rural areas has been narrowing, but the health care of mobile pregnant women in cities is missing. In the social policy, our country pursues the family planning policy for many years while controlling the population growth and ensuring the quality of the population. It also leads to the lack or insufficiency of maternal health services in some unplanned delivery groups. Conclusion. While continuing to promote the new rural cooperative medical system, it is necessary to further demonstrate the reasonable design of its compensation scheme, and to combine the compensation content of the health care during pregnancy and childbirth. We should take active measures to improve the accessibility of maternal health care for the floating population. In the context of the national policy of family planning, we should take active measures to improve the accessibility of health care services in the period of pregnancy and childbirth in rural areas, and in the context of the national policy of family planning, The unplanned delivery group has become a special group with insufficient utilization of health care services during pregnancy and parturition objectively. This phenomenon has become a "bottleneck" in improving the utilization of health care services during pregnancy and childbirth in some economically developed areas, and should be given full attention.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R715.3

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