Adaptation and the limitations of evaluation method from the view point of micro economics in nursing

通过对45家医院291名产妇的调查，从微观经济学的角度对护理工作进行评价。调查对象分为产妇、助产士及护理管理人员三组。调查内容包括既往疾病史、孕期、分娩期、产后期、分娩费用、住院费用、医院资产、助产士自主权等。分析的目的是找出决定分娩费用和医院收费价格的因素。我们使用了多元回归分析。从上述变量中选取15个变量作为自变量，并以价格作为因变量，结果如下。（l）价格下降的因素是产科医生的干预、监测设备的使用、分娩中未出生婴儿的风险和体重增加。（2）价格上涨因素为孕期住院和助产士健康教育。（3）医院助产士的自主性水平较低。(1)产科医生在遇到问题时倾向于要求助产士进行健康教育。(2)增加产科医生干预时间、准备好监护设备、控制体重是控制医疗费用的重要措施。(3)在低风险病例中，应增加产科医生干预的时间，以提高助产士的自主性。

We investigated 45 hospitals and got 291 samples of women in childbirth to evaluate nursing care from the viewpoint of micro economics. The subjects of our investigation was divided three of the women in childbirth, midwives and nursing administrator. The questionnaire was constructed with the factors related to past illness, a pregnancy period, delivery period, postpartum period, the cost (childbirth expenses and the hospital charges), hospital property and midwives autonomy. The goal of the analysis was to find out the factors to fix the price of childbirth expenses and the hospital charges. We used multi regression analysis. The dependent variable was the price and independent variables were 15 variables selected from above group.The results is follows.(l)Price decreasing factors were intervention of an obstetrician, use of monitoring devices, risk of an unborn child in delivery and weight increasing.(2)Price increasing factors were admission to hospital in pregnancy period and health education by midwife.(3)The level of midwives autonomy was low in hospitals.Followings are suggested.(1) Obstetricians tend to request health education to midwife in the cases of having problems.(2) Increasing of obstetrician intervention time, preparation of monitoring device and weight control are important for medical expenses control.(3) It is required for increasing the time of obstetrician intervention to set high level of midwives autonomy in a low risk case.