생의 말기 재가 환자의 통합지원에 대한 비용편익 분석
Cost-Benefit Analysis of Integrated Support for the End of Life
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: This study conducted a cost-benefit analysis of an integrated support operation model for end-of-life care services for chronically ill patients at home to provide a basis for local governments to provide integrated care support. Methods: The study population included patients registered in the family medicine department of a large hospital in Seoul and receiving home care services. The costs and benefits were estimated for households using the community integrated support ser vice and those using existing home care services. The service period was three months, and the number and costs of outpatient and pharmacy visits were examined before and after the service period to estimate the additional costs and benefits of using the Community Integrated Support Service. Results: When the integrated support center was used by one doctor, one nurse, and one case manager to care for 32 homebound patients, the total cost was KRW 9,357,972 more than the home care center under the same conditions; the net benefit was KRW 16,764,767, which was 2.79 times higher than the cost. In the sensitivity analysis, even if the discount rate of the benefit was reduced to 21% and the cost was increased by 140%, the net benefit was a benefit-cost ratio of 1.58. Conclusion: The results suggest that an integrated community medical, health, and social care service model should be developed and implemented in end-of-life home care. Especially in the case of medical care, it is necessary to consider its costs.
Abstract
Purpose: This study conducted a cost-benefit analysis of an integrated support operation model for end-of-life care services for chronically ill patients at home to provide a basis for local governments to provide integrated care support. Methods: The study population included patients registered in the family medicine department of a large hospital in Seoul and receiving home care services. The costs and benefits were estimated for households using the community integrated support ser vice and those using existing home care services. The service period was three months, and the number and costs of outpatient and pharmacy visits were examined before and after the service period to estimate the additional costs and benefits of using the Community Integrated Support Service. Results: When the integrated support center was used by one doctor, one nurse, and one case manager to care for 32 homebound patients, the total cost was KRW 9,357,972 more than the home care center under the same conditions; the net benefit was KRW 16,764,767, which was 2.79 times higher than the cost. In the sensitivity analysis, even if the discount rate of the benefit was reduced to 21% and the cost was increased by 140%, the net benefit was a benefit-cost ratio of 1.58. Conclusion: The results suggest that an integrated community medical, health, and social care service model should be developed and implemented in end-of-life home care. Especially in the case of medical care, it is necessary to consider its costs.
참고문헌 (36)
- Worldwide Palliative Care Alliance, "Global atlas of palliative care" (2020), Worldwide Palliative Care Alliance
- "Palliative care" (2020)[URL]
- "Causes of death statistics for 2022" (2020)[URL]
- "Service type" (2023)[URL]
- "Distribution of new hospice patients" (2022)[URL]
- 2023Chronic disease status and issues, "Korea Disease Control and Prevention Agency", Korea Disease Control and Prevention Agency, ~ (2023)
- "Act on hospice and palliative care and decisions on life-sustaining treatment for patients at the end of life" (2023)[URL]
- There is a dire lack of hospice facilities that help with peaceful death, "The Seoul Shinmun Daily", 2019
- Stiel S, "Symptoms and problem clusters in cancer and non-cancer patients in specialized palliative care-is there a difference?", Journal of Pain and Symptom Management, 48(1), pp.26~35 (2014)[DOI]
- Bužgová R, "The unmet needs of family members of patients with progressive neurological disease in the Czech Republic", PLoS One, 14(3), pp.e0214395~ (2019)[DOI]
- Tsai PC, "Needs of family caregivers of stroke patients : a longitudinal study of caregivers' perspectives", Patient Preference and Adherence, 9, pp.449~457 (2015)[DOI]
- Murali KP, "Complex care needs at the end of life for seriously ill adults with multiple chronic conditions", Journal of Hospice and Palliative Nursing, 25(3), pp.146~155 (2023)[DOI]
- Woo J, "Quality of end-oflife care for non-cancer patients in a non-acute hospital", Journal of clinical nursing, 20(13-14), pp.1834~1841 (2011)[DOI]
- Ikezaki S, "Predictors of dying at home for patients receiving nursing services in Japan : a retrospective study comparing cancer and non-cancer deaths", BMC Palliative Care, 10, pp.3~ (2011)[DOI]
- Eo Y, "Preferred place of death and its determinants among Korean older adults", Journal of Korea Academia-Industrial cooperation Society, 23(8), pp.590~597 (2022)[DOI]
- Lee YJ, "Factors influencing quality of life among family caregivers of non-cancer patients at the end-of-life stage", Journal of Korean Academic Society of Home Health Care Nursing, 30(3), pp.243~251 (2023)[DOI]
- Ahn E, "Effectiveness of home hospice care : a nationwide prospective observational study", Support Care Cancer, 28(6), pp.2713~2719 (2020)[DOI]
- Development and effect of Home-based end of life care service model amnong chronic disease patients R&D report, "Lee JE", Korea Health Industry Development Institute, Osong: The Catholic University of Korea, Industry- Academic Cooperation Foundation, ~, pp.HI15CO828 (2018)
- Lee SM, "Consensus guidelines for the definition of the end stage of disease and last days of life and criteria for medical judgment", Journal of the Korean Medical Association, 61(8), pp.509~521 (2018)[DOI]
- Kim YH, "NECA's Methodological Guide for Economic Evaluation of Medical Intervention", National Evidence-based Healthcare Collaborating Agency, ~ (2021)
- Kim DG, "Cost-benefit analysis" (2004), Parkyoungsa
- Research on the development of guidelines for cost, "benefit analysis for environmental policies", Kim IC, 2003
- Lamfre LS, "Economic impact of informal care of cancer patients at the end of life", Annals of Palliative Medicine, 13(1), pp.73~85 (2024)[DOI]
- "Socioeconomic burden of disease trends and regional variation" (2023)[URL]
- Daaleman TP, "The impact of a community-based serious illness care program on healthcare utilization and patient care experience", Journal of the American Geriatrics Society, 67(4), pp.825~830 (2019)[DOI]
- Dainty KN, "Home visit-based community paramedicine and its potential role in improving patient-centered primary care : a grounded theory study and framework", Health Services Research, 53(5), pp.3455~3470 (2018)[DOI]
- Yu BN, "Integrating model of patient-organization in chronic disease", Journal of Industrial Economics and Business, 32(2), pp.539~552 (2019)[DOI]
- Suk JE, "Community care : social service paradigm transformation and challenges", The Korean Social Security Association-papers published in a periodical presentation, 2019(2), pp.83~109 (2019)
- Bolgeo T, "The importance of dedicated supportive research infrastructure in the hospital setting to support clinical nursing research and evidence-based practice", Journal of Advanced Nursing, 79(12), pp.4425~4427 (2023)[DOI]
- Höglander J, "Registered nurse-patient communication research : an integrative review for future directions in nursing research", Journal of advanced nursing, 79(2), pp.539~562 (2023)[DOI]
- Liberati EG, "Invisible walls within multidisciplinary teams : disciplinary boundaries and their effects on integrated care", Social Science & Medicine, 150, pp.31~39 (2016)[DOI]
- Ke Y, "Implementing an inclusive, multidisciplinary supportive care model to provide integrated care to breast and gynaecological cancer survivors : a case study at an asian ambulatory cancer centre", International Journal of Integrated Care, 23(1), pp.14~ (2023)[DOI]
- Norman GJ, "Home and community-based services coordination for homebound older adults in home-based primary care", BMC Geriatrics, 18(1), pp.241~ (2018)[DOI]
- Lykkegaard J, "General practitioners' home visit tendency and readmission-free survival after COPD hospitalisation : a Danish nationwide cohort study", NPJ Primary Care Respiratory Medicine, 24, pp.14100~ (2014)[DOI]
- Kim JW, "Recommendations for the government's integrated chronic disease management initiative", Research Institute for Healthcare Policy Korean Medical Association, 16(3), pp.20~24 (2018)
- "Average salary for doctors to hit 300 million won by 2022" (2024)[URL]