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Original Article
- The Effects of Visiting Nursing Services in Long-term Care Insurance: A Difference-in-Difference Analysis
- Jieun Kim, Insook Lee
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Journal of Korean Academy of Community Health Nursing 2015;26(2):89-99.
DOI: https://doi.org/10.12799/jkachn.2015.26.2.89
Published online: June 30, 2015
College of Nursing, Seoul National University, Seoul, Korea.
• Received: February 6, 2015 • Revised: May 4, 2015 • Accepted: June 5, 2015
© 2015 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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Abstract
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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.
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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.
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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.
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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.
Table 1
General Characteristics Before Propensity Score Matching (N=151)
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).
Table 2
General Characteristics After Propensity Score Matching (N=76)
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).
Table 3
Difference in Difference Analysis after Propensity Score Matching (N=76)
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References
Citations
Citations to this article as recorded by 
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Figure 1
Research frameworks based on Andersen's behavioral model of service use.
Figure 1
The Effects of Visiting Nursing Services in Long-term Care Insurance: A Difference-in-Difference Analysis
| 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 | |||
| 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 | |||
| 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 |
Table 1
General Characteristics Before Propensity Score Matching (N=151)
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).
Table 2
General Characteristics After Propensity Score Matching (N=76)
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).
Table 3
Difference in Difference Analysis after Propensity Score Matching (N=76)
ADL=activities of daily living; IADL=instrumental activity of daily living.
Table 1
Table 2
Table 3
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© Korean Academy of Community Health Nursing.
College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
E-mail: office@rcphn.org
© Korean Academy of Community Health Nursing.