Is an expanded nurse role economically viable?
BACKGROUND
Community health practitioners (CHPs) in Korea are Registered Nurses with a 6-month special training who have responsibility for delivering primary health care to remote or isolated communities. Research has indicated that these practitioners' contribution to improving the health of rural and remote populations has been effective. Despite this, CHP programmes have been fundamentally re-examined by the Korean government, as a consequence of the national economic crisis of 1998 and restructuring of the health care delivery system.


OBJECTIVE
The aim of this paper is to analyse CHP services in primary health care, and evaluate some of the economic impacts of these services through a cost-minimization analysis.


METHODS
A retrospective, descriptive-correlational design was used. A self-administered questionnaire was sent to 600 CHPs who were randomly selected from the target population, and 272 returned the questionnaire after one reminder letter, a response rate of 45.3%.


RESULTS
There was a significant difference in average cost of care between a model based on CHP services and one including no CHP services, in which equivalent care was provided by physicians (t = -6.833, P < 0.001). The average costs ratio was 2.16 (sd = 1.24), with a range of 0.09-9.63, indicating that CHP services were almost half the price of the 'no CHP services' model.


CONCLUSIONS
The results provide evidence of the economic validity of the CHP's role in the public sector, where there is no net income to serve as a policy guideline. The conclusion can be drawn that CHP services are more effective than physician services (or 'no CHP services').
Lee
Taewha
T
College of Nursing, Nursing Policy Research Institute, Yonsei University, Seoul, South Korea. twlee5@yumc.yonsei.ac.kr
Ko
Il-Sun
IS
Jeong
Seok Hee
SH
D003152:Community Health Nursing / Q000191:economics*; D003365:Costs and Cost Analysis / Q000379:methods; D006801:Humans; D007723:Korea; D024802:Nurse's Role; D011320:Primary Health Care / Q000191:economics / Q000592:standards; D011365:Professional Practice Location / Q000191:economics; D012189:Retrospective Studies; D019035:Rural Health Services / Q000191:economics; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D019037:Urban Health Services / Q000191:economics