Differences of maternal mortality rate between Shanghai and New York city from the perspective of regulatory policy

Abstract

Background 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. Methods 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. Results 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 2 = 0.836, P < 0.001) and NYC (R = 0.854, R 2 = 0.357, P = 0.04). Conclusion 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.

Are Essential Women’s Healthcare Services Fully Covered? A Comparative Analysis of Policy Documents in Shanghai and New York City from 1978–2017

“…The latter was chosen as an indicator in the government performance evaluation system. In addition, SH always paid attention to the supervision of the process and effectiveness of WHSs [ 40 ]. For example, the obstetric emergency care grading system and responsibility chain was implemented for the management of critically ill pregnant women.…”

“…Liu et al found disparity between natives and migrants in SH, and analyzed the barriers in maternal health service utilization in 2009 [ 39 ]. Li et al analyzed and compared the perspective of regulatory policies on MMRs control in SH and NYC, concluding that the more comprehensive and effective regulatory policies had a more substantial impact on MMR control from 2006 to 2017 [ 40 ]. We have seen few studies on the impact of WHSs delivery on MMRs in the two cities.…”

The Impacts of Regional Regulatory Policies on the Prevention and Control of Chronic Diseases in China: A Mediation Analysis

“…For example, previous research has shown that the soundness of RPs can effectively improve unhealthy lifestyles among patients with hypertension [7]. Similarly, the soundness of RPs has also been found to promote maternal and child health [25]. In this context, regions with better RPs have more effective PCCDs, particularly when RPs are more comprehensive and cover a range of aspects, such as diet management and the living environment.…”

“…to reflect the importance of RPs. Furthermore, the mechanism requires supervision by external restraint mechanisms for the implementation of the policies [25]. Therefore, four quantitative indicators were adopted.…”

“…This study's researchers were previously trained and thus understood the standardised methods for collecting necessary documents. The coding information mainly included two components, the first of which consisted of basic information related to the documents, including their official names, types, year of publication, and department or institution of publication, while the second consisted of contents related to RPs aimed at chronic disease, including content forms (e.g., long-term goals and short-term goals) [25], responsibilities, work contents, tasks, assessment indicators, assessment requirements, and accountabil-ity. We analysed the credibility of the data collection process via the test-retest reliability method with intraclass correlation coefficient (ICC).…”