改善孕产保健服务公平、可及和质量的政府规制过程——基于上海经验的回顾与评述

孕产保健服务是我国基本公共卫生服务的重要组成，确保孕产妇公平获得优质的孕产保健服务是政府职能之一，而政府规制是政府代表公共利益、履行公共职能的有效手段。近年来上海市围绕设立流动人口平产分娩点、建立和完善紧急产科保健服务网络和制度、推行全覆盖的孕产保健服务三个主要方面进行了一系列有力的政府规制，对改善孕产保健服务的质量和可及性，提高流动和户籍孕产妇服务利用的公平性及健康公平性起了积极作用。通过对这一规制过程的回顾和评述可见：在设计上准确把握问题所在是有效规制的前提，由管理中最高层级监督和推行规制是必要保障，在执行中持续评估规制效果并及时调整和完善是有效规制的关键。在当前强调政府的公共卫生职能、推行公共卫生服务均等化的医改背景下，借鉴这一规制过程的经验具有积极的现实意义。

Review on the process of regulation to improve the equity, accessibility and quality of maternal health care in Shanghai

Maternal health care service is the important part of public health in China, and the government should play a leading role in ensuring the equity, accessibility and quality of maternal health care. Regulation is an effeetive means to perform public function for the government which is on behalf of the public interest. In recent years, a series of regulations in Shanghai was issued from 3 aspects in maternal health care： establishing the Desig- nated Childbirth Service Delivery Points, establishing and improving the Emergency Obstetric Care network, and pur- suing the community-based monitoring on pregnancy. These regulations effectively improved the equity, quality and accessibility of maternal health care in Shanghai. Based on the analysis of this regulation process, we know that a problem-based designing, management from top to down, keeping on evaluating and adjusting in the regulation imple- mentation are the three key aspects for an effective regulation process.