Understanding the Role of Clinical and Functional Needs in Home-Visit Nursing Effectiveness: Evidence From South Korea

Objectives This study aims to examine the differential impact of home-visit nursing services on health outcomes, healthcare utilization, and healthcare costs among long-term care beneficiaries in South Korea. By categorizing beneficiaries based on clinical and functional needs, we explore which subgroups benefit the most from these services. Methods Using data from the National Health Insurance Service, we analyzed older adults newly eligible for long-term care services between 2016 and 2018 (n = 140 968). Participants were classified into 4 subgroups based on clinical and functional needs: low clinical/low functional, low clinical/high functional, high clinical/low functional, and high clinical/high functional needs. Propensity score matching was used to balance treatment (home-visit nursing) and control groups. Outcomes were assessed across health, healthcare utilization, and costs. Results Our analysis showed that home-visit nursing services significantly reduced healthcare costs for individuals with high clinical and high functional needs. This result can be partly attributed to the decline in the number of outpatient visits and inpatient days among the treated individuals. In contrast, no significant effect on health outcomes, such as institutionalization or unplanned hospitalizations, was found across any subgroup. Conclusions The study highlights the importance of targeting high-need, high-cost populations to optimize the efficiency of home-visit nursing services. Policy makers should consider mechanisms such as need-based service coordination and workforce expansion to focus these services on populations that would benefit the most, maximizing both economic and patient-centered outcomes.