Cost-benefit Analysis of Home Visiting Care for Vulnerable Populations with Hypertension

Article information

Res Community Public Health Nurs. 2011;22(4):438-450

Publication date (electronic) : 2014 April 04

doi : https://doi.org/10.12799/jkachn.2011.22.4.438

¹Full-time Lecturer, College of Nursing, Eulji University, Korea.

²Professor, College of Nursing, Seoul National University, Korea.

Address reprint requests to: Ko, Young, Department of Nursing, College of Nursing, 77, 771 Beon-gil, Gyeyoung-ro, Jung-gu, Deajeon 301-746, Korea. Tel: 82-42-259-1719, Fax: 82-42-259-1709, camassia@naver.com

Received 2011 September 24; Revised 2011 December 15; Accepted 2011 December 15.

Abstract

Purpose

This study was to investigate the effect of home visiting care service and to evaluate the effect from the cost-benefit perspective.

Methods

Target participants were enrolled in 2007~2008 for home visiting care and provided with a home visiting nursing service for more than 18 months in J Ward of S City. Of 391 participants, 244 who satisfied the inclusion criteria were used in the final analysis. Cost-benefit analysis was done using the net benefit and benefit/cost ratio.

Results

After providing the home care nursing service, the blood pressure control rate increased from 50.8% to 75.4%. Of the subjects, 39.8% maintained their blood pressure level within the target range. As a whole, the net benefit of home visiting care per person ranged from 434,964.86 to 447,112.43 won and the benefit/cost ratio ranged from 2.82 to 2.84.

Conclusion

Home visiting care for vulnerable populations with hypertension was effective in both maintaining blood pressure and reducing blood pressure to the target range. Therefore these results are especially useful for establishing the value of home visiting services for policy makers as well as for prioritizing vulnerable populations.

Keywords: Cost-benefit analysis; Visiting nurse; Home care service; Vulnerable population; Hypertension

Notes

This article is revision of the first author's doctoral thesis from Seoul National University.

References

1. Ahn YO, Kim DH, Bae JM, Lee MS, Shin MH, Lee SI. A study on effective implementation of health examination Seoul: National Health Insurance Corporation; 1995.

2. Alcocer L, Cueto L. Review: Hypertension, a health economics perspective. Ther Adv Cardiovasc Dis 2008;2:147–155. doi: 10.1177/1753944708090572.

3. Bae SI, Kim JS, Park IS. The cost-benefit analysis for high blood pressure in health examination. Korean J Health Econ Policy 2005;11:39–61.

4. Bae S, Kim J, Min K, Kwon S, Han D. Patient compliance and associated factors in the community-based hypertension control program. Korean J Prev Med 1999;32:215–227.

5. Cantor JC, Morisky DE, Green LW, Levine DM, Salkever DS. Cost-effectiveness of educational interventions to improve patient outcomes in blood pressure control. Prev Med 1985;14:782–800. doi: 10.1016/0091-7435(85)90071-4.

6. Collins R, Peto R, MacMahon S, Hebert P, Fiebach NH, Eberlein KA, et al. Blood pressure, stroke, and coronary heart disease. part 2, short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet 1990;335:827–838. doi: 10.1016/0140-6736(90)90944-Z.

7. Earp JA, Ory MG, Strogatz DS. The effects of family involvement and practitioner home visits on the control of hypertension. Am J Public Health 1982;72:1146–1154.

8. Grover SA, Coupal L, Kaouache M, Lowensteyn I. Preventing cardiovascular disease among canadians: What are the potential benefits of treating hypertension or dyslipidemia? Can J Cardiol 2007;23:467–473. doi: 10.1016/S0828-282X(07)70786-9.

9. Jung YH, Ko SJ. Estimating socioeconomic costs of five major disease. Public Finance Rev 2004;18:77–104.

10. Kang YS, Lee SJ, Yang BM, Hur J. Cost-benefit analysis of nursing intervention program for the aged. J Korea Gerontol Soc 1988;8:120–144.

11. Kaplan GA, Keil JE. Socioeconomic factors and cardiovascular disease: A review of the literature. Circulation 1993;88:1973–1998.

12. Kim JH, Lee HY, Jung HJ. 2007 National health insurance statistical yearbook Seoul: Health Insurance Review & Assessment Service, National Health Insurance Corporation; 2008.

13. Ko IS, Kim GS, Lim MH, Lee KJ, Lee TW, Park HS, et al. Effects of health education on the knowledge and self-care of hypertension for visiting nursing clients. J Korean Acad Public Health Nurs 2007;21:134–145.

14. Korea Center for Disease Control and Prevention. 2007 National health statistics: the first year (2007) of the 4th the national health and nutrition examination survey 2008. 12. Retrieved October 5, 2009. from http://knhanes.cdc.go.kr.

15. Lee JY, Kim HL, Kim YH. Difference of self-care behavior implementation in clients with hypertension by visiting nursing service. Chungnam J Nurs Acad 2006;9:53–62.

16. Lee TW, Ko IS. Cost-benefit analysis on community health practitioner. J Korean Acad Nurs 2002;32:435–446.

17. Liljas B. How to calculate indirect costs in economic evaluations. Pharmacoeconomics 1998;13(1 Pt 1):1–7.

18. Management Center For Health Promotion. Estimation of optimal workload for the visiting nurse of customizing health care through the job analysis Seoul: Ajou University, Management Center For Health Promotion; 2009-a. 03.

19. Management Center For Health Promotion. 2007 Customized home visiting care project yearbook Seoul: Management Center For Health Promotion, Ministry of Health, Welfare and Family Affairs; 2009-b. 12.

20. Ministry of Health and Welfare. Result report of customized home visiting care project in 2007 Seoul: Ministry of Health and Welfare; 2007. 11.

21. Ministry of Labor. Survey report on wage structure Seoul: Ministry of Labor; 2008. 05.

22. Ministry of Public Administration and Security. Civil service pay. guidance 2008. 06. Retrieved December 15, 2009. from www.mopas.go.kr.

23. Park JG, Choi MJ. Automobile insurance Incheon: SunHak Press; 2004.

24. Park KO. Nurse! Why do they leave small and medium hospitals? Korean Nurses Association Policy Forum, Seoul, Korea 2008. 11. Retrieved November 20, 2009. from http://www.khna.or.kr/resource/frame_data.php.

25. Shin HS, Lee TJ, Yang BM. The economic analysis on visiting nurse program. J Ins Health Environ Sci 1993;3:9–17.

26. Statistics Korea. Economic activity participation rate and consumer price index 2009. Retrieved October 24, 2009. from http://www.kostat.go.kr/.

27. The Korean Society of Hypertension. 2004 Korean hypertension treatment guidelines Seoul: Committee on Guidelines of Hypertension Treatment, The Korean Society of Hypertension; 2004. 12.

28. World Health Organization. The world health report 2002-reducing risks, promoting healthy life Geneva: World Health Organization; 2002. 10.

29. Yang BM, Kim JH, Lee SY. The economic analysis of industrial health promotion program: A cost-benefit analysis of preventing occupational disease program in Korea Seoul: Ministry of Labor; 1992.

30. Yonsei University Health Promotion Project Support Group. Cost-effectiveness analysis of national prevention programs for cardiovascular disease Seoul: Management Center for Health Promotion, The Korea Institute for Health and Social Affairs; 2007.

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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.

Figure 1

Conceptual framework of the study.

Table 1

General Characteristics of Participants (N=244)

Elem.=elementary.

^†Control=SBP<140 mmHg and DBP<90 mmHg.

Table 2

Cost per Person and Total Cost for Home Visiting Care (N=244)

^†Five among 244 subjects didn't take other service (inpatient and outpatient visit) for hypertension treatment.

Table 3

Total Benefit per Person (Reduction of Admission Rate) (N=244)