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HOME > J Korean Acad Community Health Nurs > Volume 27(3); 2016 > Article
Original Article
Effects of Visiting Nursing Services in Long-term Care Insurance on Utilization of Health Care
Sangjin Lee, Chanyeong Kwak
Journal of Korean Academy of Community Health Nursing 2016;27(3):272-283.
DOI: https://doi.org/10.12799/jkachn.2016.27.3.272
Published online: September 30, 2016

1Ministry of Health and Welfare, Sejong, Korea.

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

• Received: June 22, 2016   • Revised: September 12, 2016   • Accepted: September 12, 2016

© 2016 Korean Academy of Community Health Nursing

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.

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  • 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.
  • Key Words: Long term care insurance; Nursing service; Medical care cost; Inpatient; Outpatient
Figure 1

Flow chart for selection of study participants.

jkachn-27-272-g001.jpg
Table 1

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

Characteristics Categories Non-service Service x2 or t (p)
n (%) or M±SD n (%) or M±SD
Gender Male 1,724 (39.4) 190 (28.5) 29.04 (<.001)
Female 2,651 (60.6) 476 (71.5)
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)
Yes 928 (21.2) 172 (25.8)
Stroke No 2,723 (62.2) 383 (57.5) 4.50 (.019)
Yes 1,652 (37.8) 283 (42.5)
Hypertension No 1,973 (45.1) 271 (40.7) 3.37 (.036)
Yes 2,402 (54.9) 395 (59.3)
Diabetes mellitus No 2,980 (68.1) 487 (73.1) 7.82 (.003)
Yes 1,395 (31.9) 179 (26.9)
Arthritis No 3,026 (69.2) 395 (59.3) 23.89 (<.001)
Yes 1,349 (30.8) 271 (40.7)
Cancer No 3,868 (88.4) 643 (96.5) 41.69 (<.001)
Yes 507 (11.6) 23 (3.5)
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)
n (%) or M±SD n (%) or M±SD
Care need Tracheostomy No 4,260 (97.4) 658 (98.8) 4.95 (.013)
Yes 115 (2.6) 8 (1.2)
Suction No 4,227 (96.6) 646 (97.0) 0.26 (.356)
Yes 148 (3.4) 20 (3.0)
O2 therapy No 4,203 (96.1) 635 (95.3) 0.78 (.215)
Yes 172 (3.9) 13 (2.0)
Wound care No 2,274 (52.0) 384 (57.7) 7.48 (.003)
Yes 2,101 (48.0) 282 (42.3)
Tube feeding No 4,113 (94.0) 610 (91.6) 5.73 (.013)
Yes 262 (6.0) 56 (8.4)
Pain (cancer) No 4,034 (92.2) 618 (92.8) 0.28 (.597)
Yes 341 (7.8) 48 (7.2)
Foley care No 3,456 (79.0) 468 (70.3) 25.50 (<.001)
Yes 919 (21.0) 198 (29.7)
Colostomy care No 4,142 (94.7) 639 (95.9) 1.91 (.167)
Yes 233 (5.3) 27 (4.1)
Hemodialysis care No 3,732 (85.3) 583 (87.5) 2.34 (.126)
Yes 643 (14.7) 83 (12.5)
Diabetic foot care No 4,174 (95.4) 648 (97.3) 4.98 (.026)
Yes 201 (4.6) 18 (2.7)
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)
Mean SD Mean SD
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
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
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.

This work was supported by the Health Fellowship Foundation fund.

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