Effects of Visiting Nursing Services in Long-term Care Insurance on Utilization of Health Care

Sangjin Lee; Chanyeong Kwak

doi:10.12799/jkachn.2016.27.3.272

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Lee and Kwak: Effects of Visiting Nursing Services in Long-term Care Insurance on Utilization of Health Care

Original Article

Journal of Korean Academy of Community Health Nursing 2016; 27(3): 272-283.

Published online: 30 September 2016

DOI: https://doi.org/10.12799/jkachn.2016.27.3.272

Effects of Visiting Nursing Services in Long-term Care Insurance on Utilization of Health Care

Sangjin Lee¹, Chanyeong Kwak²

¹Ministry of Health and Welfare, Sejong, Korea.

²Division of Nursing, Hallym University, Chuncheon, Korea.

Corresponding author: Kwak, Chanyeong. Division of Nursing, Hallym University, 1 Hallymdaehak-gil, Chuncheon 24252, Korea. Tel: +82-33-248-2724, Fax: +82-33-248-3734, chanyeong@gmail.com

Received 22 June 2016 Revised 12 September 2016 Accepted 12 September 2016

(open-access):

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.

Abstract

Purpose

This is a comparative study using secondary data from the Korean national long term care (LTC) insurance.

Methods

Visiting nursing (VN) service users (n=666) and non-users (n=4,375) were extracted and compared in terms of medical expenditures, length of hospitalization, and annual number of ambulatory care visits to investigate effects of VN services in LTC.

Results

Total health care expenditures were compared between the two groups and it was found that VN service users spent about $ 1700 than non-users for their medical costs between 2009 and 2011. The average length of in-hospital stay for VN service users was 19.4 days shorter than that of non-users. However, using VN services did not significantly influence the annual number of ambulatory care visits.

Conclusion

The study has found that VN services are effective ways of providing community-based LTC services. We recommend LTC policy makers to further utilize VN services to deliver cost effective health care services.

Keywords: Long term care insurance, Nursing service, Medical care cost, Inpatient, Outpatient

Figures and Tables

Figure 1

Flow chart for selection of study participants.

Table 1

Baseline Characteristics according to Service or Non-service (N=5,041)

Characteristics	Categories	Non-service	Service	x² or t (p)
Characteristics	Categories	n (%) or M±SD	n (%) or M±SD	x² or t (p)
Gender	Male	1,724 (39.4)	190 (28.5)	29.04 (<.001)
Gender	Female	2,651 (60.6)	476 (71.5)	29.04 (<.001)
Age (year)	65~69	1,132 (25.9)	133 (20.0)	13.36 (.010)
	70~74	879 (20.1)	139 (20.9)
	75~79	894 (20.4)	136 (20.4)
	80~84	781 (17.9)	144 (21.6)
	≥85	689 (15.7)	114 (17.1)
		74.31±9.22	75.31±8.93	-2.52 (.145)
Economic sates	Medicaid	2,182 (49.9)	344 (51.7)	10.87 (.368)
	1~2	206 (4.7)	45 (6.8)
	3~4	173 (4.0)	26 (3.9)
	5~6	251 (5.7)	25 (3.8)
	7~8	421 (9.6)	67 (10.1)
	9~10	1,142 (26.1)	159 (23.9)
Care-giver	Alone	429 (9.8)	73 (11.0)	7.29 (.063)
	Couple	1,486 (34.0)	220 (33.0)
	Son or daughter	1,352 (30.9)	231 (34.7)
	Ect	1,108 (25.3)	142 (21.3)
Dementia	No	3,447 (78.8)	494 (74.2)	6.42 (.007)
Dementia	Yes	928 (21.2)	172 (25.8)	6.42 (.007)
Stroke	No	2,723 (62.2)	383 (57.5)	4.50 (.019)
Stroke	Yes	1,652 (37.8)	283 (42.5)	4.50 (.019)
Hypertension	No	1,973 (45.1)	271 (40.7)	3.37 (.036)
Hypertension	Yes	2,402 (54.9)	395 (59.3)	3.37 (.036)
Diabetes mellitus	No	2,980 (68.1)	487 (73.1)	7.82 (.003)
Diabetes mellitus	Yes	1,395 (31.9)	179 (26.9)	7.82 (.003)
Arthritis	No	3,026 (69.2)	395 (59.3)	23.89 (<.001)
Arthritis	Yes	1,349 (30.8)	271 (40.7)	23.89 (<.001)
Cancer	No	3,868 (88.4)	643 (96.5)	41.69 (<.001)
Cancer	Yes	507 (11.6)	23 (3.5)	41.69 (<.001)
Disease number		1.94±1.11	2.02±1.03	-1.81 (.071)

Table 2

Baseline Health Status according to Service or Non-service (N=5,041)

Variables	Categories		Non-service	Service	x² or t (p)
Variables	Categories		n (%) or M±SD	n (%) or M±SD	x² or t (p)
Care need	Tracheostomy	No	4,260 (97.4)	658 (98.8)	4.95 (.013)
	Tracheostomy	Yes	115 (2.6)	8 (1.2)	4.95 (.013)
	Suction	No	4,227 (96.6)	646 (97.0)	0.26 (.356)
	Suction	Yes	148 (3.4)	20 (3.0)	0.26 (.356)
	O2 therapy	No	4,203 (96.1)	635 (95.3)	0.78 (.215)
	O2 therapy	Yes	172 (3.9)	13 (2.0)	0.78 (.215)
	Wound care	No	2,274 (52.0)	384 (57.7)	7.48 (.003)
	Wound care	Yes	2,101 (48.0)	282 (42.3)	7.48 (.003)
	Tube feeding	No	4,113 (94.0)	610 (91.6)	5.73 (.013)
	Tube feeding	Yes	262 (6.0)	56 (8.4)	5.73 (.013)
	Pain (cancer)	No	4,034 (92.2)	618 (92.8)	0.28 (.597)
	Pain (cancer)	Yes	341 (7.8)	48 (7.2)	0.28 (.597)
	Foley care	No	3,456 (79.0)	468 (70.3)	25.50 (<.001)
	Foley care	Yes	919 (21.0)	198 (29.7)	25.50 (<.001)
	Colostomy care	No	4,142 (94.7)	639 (95.9)	1.91 (.167)
	Colostomy care	Yes	233 (5.3)	27 (4.1)	1.91 (.167)
	Hemodialysis care	No	3,732 (85.3)	583 (87.5)	2.34 (.126)
	Hemodialysis care	Yes	643 (14.7)	83 (12.5)	2.34 (.126)
	Diabetic foot care	No	4,174 (95.4)	648 (97.3)	4.98 (.026)
	Diabetic foot care	Yes	201 (4.6)	18 (2.7)	4.98 (.026)
	Number		1.17±0.55	1.16±0.44	-1.81 (.071)
Activities of daily living			26.77±6.30	25.20±6.10	2.75 (.097)
Cognitive function			4.57±2.47	4.84±2.41	2.32 (.128)
Rehabilitation function			15.12±3.88	14.37±3.43	15.03 (<.001)

Table 3

Medical Cost according to Service or Non-service

Variables	Year	Non-service		Service		t (p)
Variables	Year	Mean	SD	Mean	SD	t (p)
Total medical cost (won)	2009	9,737,171	11,842,018	5,766,340	7,843,330	8.38 (<.001)
	2010	10,401,643	12,340,262	5,001,793	6,317,000	11.07 (<.001)
	2011	9,728,544	11,986,919	4,175,214	5,913,082	21.74 (<.001)
	2009~2011	8,628	9,472,588	1,591,126	8,421,830	-4.07 (<.001)
Total inpatient day (day)	2009	35.76	74.82	29.13	67.72	2.16 (.031)
	2010	42.32	94.58	20.38	46.88	5.88 (<.001)
	2011	39.84	94.59	16.74	56.71	6.14 (<.001)
	2009~2011	-4.07	87.40	12.38	82.51	-4.56 (<.001)
Total outpatient day (day)	2009	55.67	58.72	43.76	44.24	5.02 (<.001)
	2010	53.96	60.37	41.27	44.10	5.21 (<.001)
	2011	50.91	60.19	35.32	38.95	6.48 (<.001)
	2009~2011	4.76	42.03	8.45	36.80	-2.14 (<.001)

Table 4

Multiple Regression to Predict Change of Medical Cost by 2009~2011

Variables	Change of total medical cost
Variables	Bu (won)	SE (won)	βs	t
(Constant)	2,896,003	1,544,822		1.88
Service (ref=non-service)	1,970,407	395,621	0.07	4.98^**
Gender (ref=male)	-268,498	291,546	-0.01	-0.92
Age	-22,867	16,815	-0.02	-1.36
Economic state	-43,959	31,154	-0.02	-1.41
Care-giver (ref=no)	-153,260	143,389	-0.02	-1.07
Dementia (ref=no)	-638,187	343,497	-0.03	-1.86
Stroke (ref=no)	540,544	298,193	0.03	1.81
Hypertension (ref=no)	-48,746	281,173	-0.01	-0.17
Diabetes mellitus (ref=no)	-278,024	309,695	-0.01	-0.90
Arthritis (ref=no)	-377,027	303,485	-0.02	-1.24
Cancer (ref=no)	388,977	578,379	0.01	0.67
Tracheostomy (ref=no)	1,572,544	1,096,228	0.03	1.44
Suction (ref=no)	3,000,985	1,009,112	0.06	2.97^*
O2 therapy (ref=no)	238,336	717,925	0.01	0.33
Wound care (ref=no)	-730,503	399,822	-0.04	-1.83
Tube feeding (ref=no)	-2,098,748	645,792	-0.06	-3.25^*
Pain (ref=no)	496,103	675,284	0.01	0.74
Foley care (ref=no)	-1,145,415	411,036	-0.05	-2.79^*
Colostomy care (ref=no)	1,137,829	671,662	0.03	1.70^*
Hemodialysis care (ref=no)	-2,892,582	506,928	-0.11	-5.71^**
Diabetic foot care (ref=no)	1,692,246	673,406	0.04	2.51^*
ADL baseline score	88,064	28,812	0.06	3.06^*
Cognitive function baseline score	-203,983	61,496	-0.06	-3.32^*
Rehabilitation function baseline score	-44,968	43,951	-0.02	-1.02
	R²=.29, Adjusted R²=.29, F=101.87, p<.001

Bu=unstandardized regression coefficients: βs=standardized regression coefficients; ^*p<.05, ^** p<.001.

Table 5

Multiple Regression to Predict Change of Inpatient and Outpatient Day by 2009~2011

Variables	Change of total inpatient day				Change of total outpatient day
Variables	Bu (day)	SE (day)	βs	t	Bu (day)	SE (day)	βs	t
(Constant)	61.93	14.49		4.28^**	0.44	6.82		0.06
Service (ref=non-service)	19.44	3.71	0.08	5.24^**	3.12	1.75	0.03	1.79
Gender (ref=male)	-4.33	2.73	-0.02	-1.58	-0.56	1.29	-0.01	-0.44
Age	-0.47	0.16	-0.05	-2.98^*	0.09	0.07	0.02	1.26
Economic state	-0.32	0.29	-0.02	-1.1	-0.03	0.14	0.00	-0.20
Care-giver (ref=no)	-2.75	1.35	-0.03	-2.04^*	0.38	0.63	0.01	0.6
Dementia (ref=no)	-9.97	3.22	-0.05	-3.10*	0.35	1.52	0.00	0.23
Stroke (ref=no)	4.53	2.80	0.03	1.62	0.39	1.32	0.01	0.30
Hypertension (ref=no)	-0.46	2.64	0.00	-0.18	-0.25	1.24	0.00	-0.20
Diabetes mellitus (ref=no)	0.12	2.90	0.00	0.04	2.61	1.37	0.03	1.91
Arthritis (ref=no)	-0.38	2.85	0.00	-0.13	1.21	1.34	0.01	0.91
Cancer (ref=no)	-5.30	5.42	-0.02	-0.98	-2.76	2.55	-0.02	-1.08
Tracheostomy (ref=no)	-0.55	10.28	0.00	-0.05	-0.89	4.84	0.00	-0.18
Suction (ref=no)	19.32	9.46	0.04	2.04^*	2.65	4.45	0.01	0.60
O2 therapy (ref=no)	2.29	6.73	0.01	0.34	-2.34	3.17	-0.01	-0.74
Wound care (ref=no)	-11.95	3.75	-0.07	-3.19^*	1.17	1.77	0.01	0.66
Tube feeding (ref=no)	-35.00	6.06	-0.10	-5.78^**	-2.01	2.85	-0.01	-0.77
Pain (ref=no)	-0.88	6.33	0.00	-0.14	1.41	2.98	0.01	0.47
Foley care (ref=no)	-17.76	3.85	-0.09	-4.61^**	-1.18	1.81	-0.01	-0.65
Colostomy care (ref=no)	0.49	6.30	0.00	0.08	-4.26	2.96	-0.02	-1.44
Hemodialysis care (ref=no)	-6.21	4.75	-0.03	-1.31	-24.28	2.24	-0.21	-10.85^**
Diabetic foot care (ref=no)	8.63	6.32	0.02	1.37	-1.21	2.97	-0.01	-0.41
ADL baseline score	0.31	0.27	0.02	1.15	0.24	0.13	0.04	1.92
Cognitive function baseline score	-1.50	0.58	-0.04	-2.60^*	-0.17	0.27	-0.01	-0.63
Rehabilitation function baseline score	-0.29	0.41	-0.01	-0.69	-0.37	0.19	-0.03	-1.90
	R²=.39, Adjusted R²=.38, F=122.65, p<.001 R²=.05, Adjusted R²=.04, F=10.08, p<.001

Bu=unstandardized regression coefficients: βs=standardized regression coefficients; ^*p<.05, ^** p<.001.

Notes

This work was supported by the Health Fellowship Foundation fund.

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