The Impact of Professionals' Specialty in a Home Visiting Program on Health Outcomes and Medical Expenses

Background/Purpose

In 2016, the Korean government launched the home visiting social service program, which provides door-to-door services to communities. Home visiting program is increasingly recognized as an important method of the welfare service delivery system. In particular, it has been developed to aim at improving the health of the elderly and the poor. However, prior studies focus on the effect of the program on limited health outcomes (e.g., mortality rate, HIV prevention), not general health-related outcomes of the program.

Therefore, to fill this gap in the literature, this study investigates how and to what extent a home visiting program and professionals’ specialty in the program influence health-related outcomes (i.e., health outcomes, hospital visits, and medical expenses). We believe this is a timely research subject as the outbreak of the current pandemic expanded the hard-to-reach area of public health, which increased the necessity of evaluating doorstep social service deliveries.

Methods

1)Data and Sample

This study examines the home visiting program's effects on individual health outcomes using the Korean Community Health Survey from 2018 to 2020 years. Each year’s sample consists of 226,000. After then, we also investigate how the program affects hospital visits and out-of-pocket medical expenses at the municipality level, analyzing monthly credit card transaction data from BC card, the biggest company in South Korea. The total number of municipalities in South Korea is 3,613, equivalent to U.S. counties. We used a difference-in-difference (DID) model with an event study approach to show a time-evolving trend.

2)Measures

This study analyzes the impact of the home visiting program as well as professionals’ specialty (i.e., social workers and health professionals) on health-related outcomes. The outcomes include individual health outcomes (i.e., physical and mental health measures) and the total medical expenses and hospital visits at the municipality level. Other covariates consist of monthly regional COVID infection rates and community characteristics (i.e., social service infrastructures, population composition).

Results

We find that the home visiting program is likely to enhance health outcomes (i.e., subjective well-being and dental health) by 3 to 6 percent. The effects differ by specialty of professionals in the program; the introduction of healthcare professionals is associated with positive mental health outcomes. Second, only the introduction of healthcare professionals is associated with a 6.3 percent reduction in hospital visits, regardless of the COVID pandemic. For the elderly, this introduction exhibits large effects on reductions in both hospital visits (9.1%) and medical expenses (6.9%).

Conclusion and Implications

This study found that the home visiting program (especially with healthcare professionals) is associated with health improvement and hospital visits and medical expenses reductions. The home visiting program can mitigate the negative impact of COVID on such health-related outcomes. Our finding supports continued efforts to expand in-person social services for vulnerable populations (i.e., the elderly), especially during the `non-contact’ era, such as the COVID pandemic.