J Korean Acad Community Health Nurs JKACHN Journal of Korean Academy of Community Health Nursing 1225-9594 2288-4203 Korean Academy of Community Health Nursing 10.12799/jkachn.2015.26.2.89 Original Article The Effects of Visiting Nursing Services in Long-term Care Insurance: A Difference-in-Difference Analysis Kim Jieun Lee Insook College of Nursing, Seoul National University, Seoul, Korea. Corresponding author: Lee, Insook. College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Korea. Tel: +82-2-740-8828, Fax: +82-2-765-4103, lisook@snu.ac.kr 06 2015 30 06 2015 26 2 89 99 06 02 2015 04 05 2015 05 06 2015 © 2015 Korean Academy of Community Health Nursing 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose

The purpose of this study was to demonstrate the effects of visiting nursing services in long-term care (LTC) insurance on changes in health status and physical functions among the elderly.

 Methods

We analyzed survey data on the living status and welfare needs of the elderly from 2008 and 2011 using the difference-in-difference method with propensity score matching.

 Results

The subjects were 76 elders including 38 visiting nursing service users(intervention group) and 38 home-based LTC service users (control group). Results from DID analysis confirmed that the subjective health status level of the intervention group was 2.2 points higher (p=.044) and the depression level was 0.3 point lower (p=.039) than the control group. In addition, the intervention group's ADL score was 1.9 (p=.027) and IADL 3.9 (p=.030), showing that their health was deteriorated less.

 Conclusion

Visiting nursing service in LTC insurance was associated with delayed deterioration of subjective health status, depression, ADL and IADL. These findings suggest the need of rebuilding visiting nursing service programs focusing on prevention services, which will be more contributive to elderly health care and the reduction of social costs.

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Development Report Seoul National Health Insurance Corporation 2010 10 Report No.: 2010-18 Research frameworks based on Andersen's behavioral model of service use. General Characteristics Before Propensity Score Matching (<italic>N</italic>=151)
Variables Characteristics Categories Min~Max Total (n=151) CG (n=109) IG (n=42) Distance† x2 or t (w) p‡
n (%) or M±SD n (%) or M±SD n (%) or M±SD
Predisposing characteristics Gender Male 47 (31.1) 34 (31.2) 13 (31.0) <0.01 <0.01 .571
Female 104 (68.9) 75 (68.8) 29 (69.0)
Age 60~90 75.3±6.71 75.3±6.81 75.1±6.42 -0.19 0.15 .878
Living arrangement Alone 42 (27.8) 32 (29.4) 10 (23.8) 4.58 .206
Spouse 52 (34.4) 32 (29.4) 20 (47.6) 0.18
Adult children 48 (31.8) 38 (34.9) 10 (23.8) -0.11
Etc 9 (6.0) 7 (6.4) 2 (4.8) -0.02
Enabling resources Education 0~16 4.2±4.19 4.0±3.98 4.7±4.69 0.71 2,142.50 .519
Religion Yes 102 (67.5) 70 (64.2) 32 (76.2) 0.12 1.98 .179
No 49 (32.5) 39 (35.8) 10 (23.8)
Household's monthly income 2.87~696 117.3±127.39 124.8±138.80 97.9±89.92 -26.95
Subjective life status 1~3 1.4±0.57 1.4±0.59 1.4±0.50 0.02 0.04 .849
Need Number of chronic disease 0~9 2.3±1.56 2.0±1.58 2.9±1.49 0.42 1,910.50 .109
Disabled Yes 43 (28.5) 30 (27.5) 13 (31.0) 0.03 0.18 .409
No 108 (71.5) 79 (72.5) 29 (69.0)
Cognitive function 0~30 20.8±5.22 21.3±4.49 19.6±6.50 -1.73 2,601.50 .194
Difficulty of daily living DV (Yes) 35 (23.2) 26 (23.9) 9 (21.4) -0.02 0.10 .467
DH (Yes) 28 (18.5) 18 (16.5) 10 (23.8) 0.07 1.07 .210
DM (Yes) 38 (25.2) 28 (25.7) 10 (23.8) -0.02 0.06 .495

CG=comparison group; IG=intervention group; DV=due to vision; DH=due to hearing; DM=due to mastication; †Distance of mean different between matched comparison group and matched intervention group (PSM analysis); ‡Comparison between the intervention group and the comparison group (χ2 tests for categorical variables, t tests or Wilcoxon rank sum tests for continuous variables, Cochrane-Amitage Trend test for ordinary variables).

 General Characteristics After Propensity Score Matching (<italic>N</italic>=76)
Variables Characteristics Categories Min~Max MCG (n=38) MIG (n=38) Distance† x2 or t (w) p‡
n(%) or M±SD n(%) or M±SD
Predisposing characteristics Gender Male 7 (18.4) 11 (29.0) 1.17 .421
Female 31 (81.6) 27 (71.1) 0.11
Age 63~90 75.0±6.17 75.0±5.86 0.08 0.06 .951
Living arrangement Alone 5 (13.2) 10 (26.3) 3.39 .342
Spouse 16 (42.1) 16 (42.1) <0.01
Adult children 16 (42.1) 10 (26.3) -0.16
Etc 1 (2.6) 2 (5.3) 0.03
Enabling resources Education 0~16 4.2±4.01 4.7±4.86 0.50 2,142.50 .521
Religion Yes 29 (76.3) 28 (73.7) -0.03 0.07 .996
No 9 (23.7) 10 (26.3)
Household's monthly income 2.87~586.2 122.6±131.77 96.7±93.93 -25.86 2,370.50 .740
Subjective life status 1~3 1.3±0.55 1.4±0.49 0.11 0.04 .856
Need Number of chronic disease 0~9 2.9±1.75 3.0±1.54 0.05 1,910.50 .117
Disabled Yes 12 (31.6) 13 (34.2) 0.03 0.06 .997
No 26 (68.4) 25 (65.8)
Cognitive function 0~30 20.3±4.81 20.8±5.18 0.50 2,601.50 .196
Difficulty of daily living DV (Yes) 9 (23.7) 8 (21.1) -0.03 0.08 .999
DH (Yes) 7 (18.4) 7 (18.4) <0.01 <0.01 .999
DM (Yes) 7 (18.4) 9 (23.7) 0.05 0.32 .786

MCG=matched comparison group; MIG=matched intervention group; DV=due to vision; DH=due to hearing; DM=due to mastication; †Distance of mean different between matched comparison group and matched intervention group (PSM analysis); ‡Comparison between the intervention group and the comparison group (χ2 tests for categorical variables, t tests or Wilcoxon rank sum tests for continuous variables, Cochrane-Amitage Trend test for ordinary variables).

 Difference in Difference Analysis after Propensity Score Matching (<italic>N</italic>=76)
Indicator Groups Pre-service (2008) Post-service (2011) Post-Pre p Min Max
M±SD M±SD M
Health status Subjective health status Intervention 8.4±1.55 4.3±1.23 -4.1 2 10
Comparison 8.5±1.31 2.2±1.36 -6.3
Difference 2.2 .044
Depression Intervention 8.8±4.75 10.3±4.19 1.6 0 15
Comparison 8.8±4.88 10.7±4.41 1.9
Difference -0.3 .039
Physical function Vision Intervention 2.4±0.68 2.5±0.65 0.1 1 4
Comparison 2.4±0.60 2.4±0.63 0.0
Difference 0.1 .437
Hearing Intervention 2.7±0.57 2.6±0.64 -0.1 1 4
Comparison 2.6±0.50) 2.6±0.49 0.0
Difference -0.1 .481
Mastication Intervention 2.3±0.57 2.1±0.67 -0.2 1 4
Comparison 2.1±0.53 2.0±0.57 -0.2
Difference 0.0 .880
ADL Intervention 19.4±1.48 18.7±2.21 -0.8 7 21
Comparison 19.7±2.02 17.0±3.72 -2.7
Difference 1.9 .027
IADL Intervention 28.7±5.56 27.8±5.57 -0.9 10 33
Comparison 29.3±5.50 24.5±5.15 -4.8
Difference 3.9 .030

ADL=activities of daily living; IADL=instrumental activity of daily living.