Cost-effectiveness Analysis of Home Care Services for Patients with Diabetic Foot / 간호행정학회지

PURPOSE: This study was a retrospective survey to examine economic feasibility of home care services for patients with diabetic foot. METHODS: The participants were 33 patients in the home care services (HC) group and 27 in the non-home care services (non-HC) group, all of whom were discharged early after inpatient treatment. Data were collected from medical records. Direct medical costs were calculated using medical fee payment data. Cost-effectiveness ratio was calculated using direct medical costs paid by the patient and the insurer until complete cure of the diabetic foot. Effectiveness was the time required for a complete cure. Direct medical costs included fees for hospitalization, emergency care, home care, ambulatory fees, and hospitalization or ambulatory fees at other medical institutions. RESULTS: Mean for direct medical costs was 11,118,773 won per person in the HC group, and 16,005,883 won in the non-HC group. The difference between the groups was statistically significant (p=.042). Analysis of the results for cost-effectiveness ratio showed 91,891 won per day in the HC patients, and 109,629 won per day in the non-HC patients. CONCLUSION: Result shows that the cost-effectiveness ratio is lower HC patients than non-HC patients, that indicates home care services are economically feasible.

Analysis of Direct Service Costs about Diabetic Foot Patients / 대한족부족관절학회지

PURPOSE: The objective of this study was to analyze diabetic foot patients' direct service costs until the cure of the disease. MATERIALS AND METHODS: The subjects of this study were randomly sampled 60 patients who had been treated for diabetic foot at one of two tertiary hospitals and cured of the disease during from January 2008 to December 2009, and whose diagnostic code was E11.5 or E14.5. Data were collected from medical records and direct service costs were analyzed using data on the payments of individual service charges. Direct service costs spent at other medical institutions for the same disease were excluded. Collected data were analyzed using descriptive statistics. RESULTS: The subjects' mean hospital stay was 29 days, and mean period until cure was 132 days. The inpatient cost per patient was 10,844,648 won, outpatient cost was 715,751 won, and home care services cost was 641,854 won, so total direct service cost per patient was 11,913,419 won. The total direct service cost in patients who had their foot amputated was 12,769,822 won, 1.3 times higher than without amputation, who had vascular intervention was 16,219,477 won, 1.9 times higher than non-vascular intervention, who had both infection and artery occlusion was 17,522,435 won, 2.0 times higher than either infection or artery occlusion. CONCLUSION: In diabetic foot patients, the direct service cost was highest as 17,522,435 won in patients accompanied with both infection and occlusion of lower extremity artery.

An Analysis of the Elderly Care and Management in Hospital-Based Home Care Agencies

PURPOSE: To analyze the home care services provided to the elderly aged 65 and older by a hospital-based home care agencies and to investigate the effects of long-term care insurance for the elderly. METHOD: The subjects were the home care service recipients aged 65 and older in 172 hospital-based, home care agencies registered in Health Insurance Review & Assessment Service in January, 2007. The data were collected using a questionnaire from March 16 to April 15, 2007. The questionnaire return rate was 43.8%. RESULT: The hospital-based home care agencies were able to visit 66.5% of the national administrative districts. Of the home care service recipients, over 50% were 65 years old and older. About 43% of the agencies reported that over 50% of their patients would be subject to the long-term care insurance. They expressed concern that home care services would be withdrawn once the insurance system is initiated. CONCLUSION: This study suggests that hospital-based home care agencies need to manage home care services with long-term care insurance. It also recommends developing guidelines for the use of services and referrals.