Journal List > J Korean Acad Nurs Adm > v.16(3) > 1051552

Lim, Im, Kim, and Ko: An Evaluation of Effects on Hypertension and Diabetes Mellitus Management of a Community-Based Nursing Care Center Using Cost-Benefit Analysis

Abstract

Purpose

This study was conducted to evaluate the economic efficiency of a community-based nursing care center to help policy makers determine whether or not to invest in similar facilities.

Methods

The subjects were 101 elderly people over 65 years who participated in a health management program from February 1 to July 31, 2007. Direct cost was estimated with center operations cost, medical cost for out-patients and pharmacy cost. Indirect cost was measured by transportation cost. Direct benefit was calculated by saved medical cost for out-patients, saved pharmacy cost, saved transportation cost, and reducing hospital charges. Indirect benefit was estimated with prevention of severe complications. Economic efficiency was evaluated by cost-benefit ratio and net benefit.

Results

Operating a community-based nursing care center was found to be cost-effective. Specifically, the cost of operating the center evaluated here was estimated at 135 million won while the benefit was estimated at 187 million won. Benefit-cost ratio was 1.38.

Conclusion

The Community-based nursing care center that was described here could be a useful health care delivery system for reducing medical expenditures.

Figures and Tables

Table 1
Characteristics of subjects* (N=101)
jkana-16-295-i001

*Missing value excluded; Multiple choice; DM= Diabetes mellitus; §CVA=Cerebro vascular accident

SBP=Systolic blood pressure; DBP=Diastolic blood pressure

Table 2
Cost analysis of community based intensive nursing care center for elderly
jkana-16-295-i002

*OPC=Out patient clinic;

Patient number of OPC visit per month × Average cost of OPC per visit × Average number of OPC visit per month;

Patient number of pharmacy visit per month × Average pharmacy cost of pharmacy per visit × Average number of pharmacy visit per month;

§Public transportation cost per one time

Table 3
Benefit analysis of community based intensive nursing care center for elderly
jkana-16-295-i003

*Number of reduced OPC visit per month; Number of reduced pharmacy visit per month;

Number of managed hypertension patient per month × Hospital admission rate of hypertension × Average hospital charges of hypertension patient per year;

§ Number of managed DM patient per month × Hospital admission rate of DM × Average hospital charges of DM patient per year;

Number of managed hypertension patient per month × Severe complications rate of hypertension × Average hospital charges of severe hypertension complications per year;

Number of managed DM patient per month × Severe complications rate of DM × Average hospital charges of severe DM complications per year;

Table 4
Summary of cost-benefit analysis and sensitivity analysis
jkana-16-295-i004

*PAR=Population attributable risk

References

1. Allred CA, Arford PH, Mauldin PD, Goodwin LK. Cost-effectiveness analysis in the nursing literature, 1992-1996. Image J Nurs Sch. 1998. 30(3):235–242.
2. Drummond MF, O'Brien BJ, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. 1997. 2ed. Oxford: Oxford University Press.
3. Kim CI, Lee HS, Jang YO, Lee YN, Lee HJ. Korea national health and nutrition examination survey. 2005. Seoul: Korea Institute for Health and Social Affaires.
4. Kim DK. Cost-benefit analysis. 1997. Seoul: Parkyoungsa.
5. Kim HJ, Hue JH, Lee MH, Kang HY, Jee SH, Nam JM, et al. Cost-effectiveness analysis of national prevention programs for cardiovascular diseases. 2007. Seoul: Management Center for Health Promotion.
6. Lee DB. The epidemiologic study of chronic complications in non-insulin-dependent diabetes mellitus. 1998. Gwangju: Chonnam National University;Unpublished master's thesis.
7. Lee KS, Kam S, Park KS, Jung BK, Kim SK. Community-based hypertension and diabetes management model development for improving adherence and compliance. 2007. Seoul: Korea Centers for Disease Control and Prevention.
8. Lee TW, Ko IS. Cost-benefit analysis on community health practitioner. J Korean Acad Nurs. 2002. 32(4):435–446.
9. Li C, Engstrom G, Hedblad B, Berglund G, Janzon L. Blood pressure control and risk of stroke: A population-based prospective cohort study. Stroke. 2005. 36(4):725–730.
10. Lim JY. A cost-utility analysis of home care services by using the QALY. J Korean Acad Nurs. 2004. 34(3):449–457.
11. Min SH, Ko S, Lim JY. Economic evaluation of Gemcitabine-cisplatin chemotherapy for non small-cell lung cancer patient in an outpatient setting. J Korean Acad Nurs. 2008. 38(3):363–371.
12. Ministry for Health, Welfare & Family Affairs. The guideline of long term care insurance. 2008a. 04. Seoul: Author.
13. Ministry for Health, Welfare & Family Affairs. The manual of customized visiting health care program. 2008b. 12. Seoul:
14. Park CG. Risk profiles for stroke and treatment modality in hypertensive patients. J Korean Soc Hypertens. 2006. 12(2):16–24.
15. Rice D. Estimating the cost of illness. Am J Public Health Nations Health. 1967. 57(3):424–440.
16. Son HY, Kim CY, Back SH, Kim JY. Diabetes in Korea 2007. 2007. Seoul: Health Insurance Review and Assessment Service.
17. Song MS. Report on management and operations of intensive nursing care center for elderly at home in Gwang-Ju. 2006. Gwang-Ju: Community Health Center.
18. Stone PW. Methods for conducting and reporting cost-effectiveness analysis in nursing. Image J Nurs Sch. 1998. 30(3):229–234.
19. Yang BM. Health care economics. 1999. Seoul: Nanamsinseo.
20. Yim ES. Cost-benefit analysis of the case management for the elderly patients with hypertension. 2008. Seoul: Yonsei University;Unpublished doctoral dissertation.
21. Yusuf S, Hawken S, Ôunpuu S, Dans T, Avezum A, Lanas F, et al. Effects of potentially modifiable risk factors associated with myocardial infartion in 52 countries (the INTERHEART study): Case-control study. Lancet. 2004. 364(9438):937–952.
TOOLS
Similar articles