需求侧卫生政策与妇幼健康——基于农村住院分娩补助政策的经验研究

Demand-side Health Policy and Maternal and Infant Health: Empirical Evidence from the Hospitalized Delivery Subsidy Policy in Rural China

《财经研究》2023年49卷第5期 页码：64 - 78 online：2023年5月3日

作者

中：王晓霞 , 赵丽惠

英：Wang Xiaoxia, Zhao Lihui

作者单位：首都经济贸易大学 劳动经济学院, 北京100070

摘要及关键词

摘要：妇幼健康关系到长期人力资本形成，是“健康中国2030”战略规划的重要领域。农村的妇幼健康水平相对薄弱，而针对需求侧的卫生政策是重要的政策实施方向。文章关注了农村孕产妇住院分娩补助政策，使用双重差分策略考察其成效。研究表明，农村孕产妇住院分娩补助政策的实施显著提高了农村孕产妇的住院分娩率，并且效果逐年累积。分地区来看，政策效果符合向中西部弱势地区倾斜的定位。在低收入、经产妇人群中，政策效果相对有限。政策效果随医疗卫生机构的密度上升而提升，体现了医疗供给侧联动改革的重要性。对妇幼健康的进一步分析表明，农村孕产妇住院分娩补助政策能够通过提升分娩技术来改善孕产妇健康，但没有提升养育行为的科学性，因此对婴幼儿健康可能没有产生积极影响，而医疗卫生机构的密度能够增进政策的妇幼健康效果。文章的研究有助于未来在重点人群、供给侧政策配合等方面完善妇幼健康政策，也为实施需求侧卫生补助政策提供一定参考。

关键词：需求侧卫生政策；农村孕产妇；住院分娩补贴；双重差分；妇幼健康

Summary: Maternal and infant health is closely related to human resource accumulation, and is an important task in the Healthy China 2030 blueprint. Rural areas suffer from weak maternal and infant health, and the demand-side health policy is considered as a principal instrument to address this problem. This paper focuses on the hospitalized delivery subsidy policy in rural areas, which was implemented on a large scale in 2008. Using the information on policy implementation and birth cohort, this paper constructs a DID identification strategy, and investigates the effect of the policy on the hospitalized delivery rate and further on maternal and infant health. To our knowledge, this paper is the first to conduct an evaluation of this policy within a causal investigation framework. It sheds light on the future improvement in the maternal and infant health policy and the demand-side health policy in a broader sense. The study finds that the hospitalized delivery subsidy policy has significantly improved the hospitalized delivery rate in rural areas, and the effect has been cumulated over time. By region, the effect is in alignment with the policy’s intention to help the disadvantaged central and western areas; the effect is quite limited among low-income and multiparous women, indicating insufficiency in terms of helping the weak; the effect on hospitalized delivery rate increases with the density of health institutions, reflecting the importance of simultaneous supply-side health reform. The analysis on maternal and infant health shows that the policy has been effective in improving maternal health, through enhancing delivery technique. However, the policy has not exerted a positive effect on the scientific parenting behavior, and thus is found unable to improve infant health. The density of health institutions could enhance the effect of the policy on maternal and infant health. The policy implications are as follows: This paper calls for special policy attention to low-income and multiparous women and make these groups the real beneficiaries of hospitalized delivery; to enhance the effect of the demand-side health policy, it is necessary to increase the density of health institutions and improve health service quality; the demand-side health policy should work on effective health education, so as to cultivate scientific parenting and improve maternal and infant health in the long run.

Key words: demand-side health policy; rural pregnant women; hospitalized delivery subsidy; DID; maternal and infant health

其他信息

DOI：10.16538/j.cnki.jfe.20230221.403

收稿日期：2022-08-19

基金项目：国家自然科学基金项目（71603173）；北京市教委科研计划项目（SM201710038009）

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