Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
권호 표지
DOI QR코드

DOI QR Code

Difference in Resource Utilization according to Beneficiary Characteristics of the Long-term Care Facilities

노인장기요양보험 이용자 특성에 따른 자원사용량 차이

  • Published : 2010.03.31
Download PDF
⟨ Previous Next ⟩

Abstract

Fee for long-term care insurance in Korea are determined in proportion to resources utilized according to severity rather than based on categorization of beneficiaries in consideration of the characteristics of resource utilization. This adoption is based on the assumption that as beneficiaries of long-term care insurance, characteristically, demands social services rather than needs medical treatments, the characteristics of beneficiaries and the quality of utilized resources are comparatively homogenous. Therefore, the proposition is that the size of resource consumed by beneficiaries in the same grade is identical. However, even in the same grade, the level of utilized resources is different depending on the characteristic of beneficiaries. In this regard, this study is to examine whether there are differences in the volumes of utilized resources depending on the characteristics of beneficiaries even in the same grade. We analyzed time study data for 2003, 2005, 2006 which conducted by the Korea Institute for Health and Social Affairs. To look at differences in the volumes of utilized resources, we identified characteristics of beneficiaries that influence utilized resource volumes and categorized services provided by facilities into the rehabilitation treatment category, the problematic behavior category, and the physical malfunction category. Then, we examined each service in consideration of service difficulty levels and wage weights. The result of examination showed that differences in utilized resource volumes exist in all three grades depending on the characteristics of beneficiaries. Especially, in the first grade with a high level of seriousness, utilized resource volumes were different for those three service categories and the problematic behaviour category considered dementia was found to consume the largest volume of resources. Moreover, there was the inversion phenomenon of utilized resources volumes between the grades. This result indicates that utilized resource volumes are different even in the same grade depending on the characteristics of beneficiaries and it is required to consider case-mix for reflection of the volumes of utilized resources depending on the characteristics of beneficiaries.

Keywords

References

  1. 공적노인요양보장추진기획단.보건복지부. 공적노인요양보장체계 개발연구(II)-평가판정체계 및 수가급여체계. 공적노인요양보장추진기획단.보건복지부 2004.
  2. 김은경. 요양병원 입원노인의 환자군 분류에 따른 자원이용수준, 대한간호학회지 2003 ; 33 (2) : 275-283. https://doi.org/10.4040/jkan.2003.33.2.275
  3. 김은경, 박하영, 김창엽. 한국의 장기요양서비스에 대한 RUG-III의 적용가능성, 대한간호학회지 2004 ; 34(2) : 278-289. https://doi.org/10.4040/jkan.2004.34.2.278
  4. 김홍수. 환자 및 시설 특성이 장기요양서비스 이용 노인의 자원소모량에 미치는 영향[석사학위 논문]. 서울 : 서울대학교 보건대학원 ; 2003.
  5. 서울대학교병원. 치매 노인 유병률 조사. 보건복지가족부, 2008.
  6. 석재은. 노인장기요양보험 수가 개발의 특성과 평가. 사회복지연구 2008 ; 39 : 253-286.
  7. 선우덕, 김찬우, 최정수, 최혜지, 연병길, 원장원 등. 노인장기요양보험제도 시범사업 평가연구(2차)-장기요양수요조사, 장기요양인정체계 및 장기요양서비스이용지원체계 부문-. 한국보건사회연구원 2007.
  8. 선우덕, 석재은, 김찬우, 이태화, 정형선, 이미진 등. 노인수발보험제도 시범사업 평가연구(1차). 한국보건사회연구원 2006.
  9. 이지전, 김석일, 유승흠, 이상욱. 장기요양시설 노인의 환자구성에 관한 연구. 병원경영학회지 2001 ; 6(3) : 130-147.
  10. 이지전, 유승흠, 오희철, 남정모, 박은철, 이윤환. RUG-III를 이용한 노인환자군분류의 타당 성검증. 병영경영학회지 2001 ; 6(3) : 148-166.
  11. 최병호, 신호성, 허순임, 선우덕, 변용찬, 김상철 등. 노인장기요양보험제도 시범사업 평가연 구(2차)-장기요양수요조사, 장기요양인정체계 및 장기요양서비스이용지원체계 부문-. 한국보건사회연구원 2007.
  12. Bienbaum, H., Bishop, C., Lee, A. J., Jenson, G. Why do nursing home costs vary? the determinants of home costs. Medical care 1981 ; 91(11) : 1095-1107.
  13. Bjorkgren M. A., Hakkinen U., Finne-Soveri U. H., Fries, B. E., Validity and reliability of Resource Utilization Groups(RUG-III) in Finnish long-term care facilities.
  14. Brizioli, E., Bernabei, R., Grechi, F., Masera, F., Landi, F., Bandinelli, S. et al. Nursing home case-mix instruments: Validation of the RUG-III system in Italy. Aging Clinical and Experimental Research 2002 ; 15(3) : 243-253.
  15. Carpenter, G. I., Ikegami, N., Ljunggren, G., Carrillo, E., Fries, B. E. RGU-III and resource allocation: comparing the relationship of direct care time with patient characteristics in five countries. Age and Ageing 1997 ; 26(52) : 61-65.
  16. Desrosierts, J. Bravo, G., Hebert, R., Dubuc, N. Reliability of the revised functional automony measurement system(SMAF) for epidemiological research. Age Ageing 1995 ; 242 : 402-406.
  17. Francesconi, P., Cantini, E., Bavazzano, E., Lauretani, F., Bandinelli, S., Buiatti, E. Classification of residents in nursing homes in Tuscany(Italy) using Resource Utilization Groups Version III(RUG-III). Aging Clinical and Experimental Research. 2005 ; 18(2) : 133-140. https://doi.org/10.1007/BF03327428
  18. Fries, B. E. Comparing case-mix systems for nursing home payment. Health Care Financing Review 1990 ; 11(4) : 103-119.
  19. Fries, B. E., Schroll, M., Hawes, C., Gilgen, R., Jonsson, P. V., Park, P., Approaching cross-national comparisons of nursing home residents. Age and Ageing. 1997 ; 26 : 13-18. https://doi.org/10.1093/ageing/26.suppl_2.13
  20. Grimaldi, P. L. Prospective per diem rates for skilled nursing care. Journal of Health Care Finance 2002 ; 28(3) : 49-62.
  21. Hebert, F., Carrier, R., Bilodeau, A. The functional autonomy measurement system(SMAF) : Description and validation of an instrument for the measurement of handicaps. Age Ageing 1988 ; 17 : 293-302. https://doi.org/10.1093/ageing/17.5.293
  22. Hebert, F., Spiegelhalter, D., Brayne, C. Setting the minimal metrically detectable change on disability rating scales. Arch Phys Med Rehabil 1997 ; 78 : 1305-1308. https://doi.org/10.1016/S0003-9993(97)90301-4
  23. Ikemgami, N., Fries, B. E., Takagi, Y., Ikeda, S., Ibe, T., Applying RUG-III in Japanese Long-Term Care Facilities. The Gerontologist 1994 ; 34(5) : 628- 639. https://doi.org/10.1093/geront/34.5.628
  24. Schlenker, R., Shaughnessy, P., and Yslas. I. The effect of case mix and quality on cost differences between hospital-based and freestanding nursing homes. Inquiry 1983 ; 20 : 361-368.
  25. Schneider, D. P., Fires, B. E., Foley, W. J., Desmond M., Gormley, W. J. Case mis for nursing home payment : Resource utilization groups, version II. Health Care Financing Review 1988 Annual Supplement, 39-52.
  26. Tousignant. M., Hebert. R., Dubuc, N., Simoneau, F., Dieleman, L. Application of a case-mix calssification based on the functional autonomy of the residents for funding long-term care facilities. Age and Ageing 2003 ; 32(1) : 60-66. https://doi.org/10.1093/ageing/32.1.60
  27. Traxler, H.G., Determinants of nursing home costs in Florida: Policy implications and support in National Research Findings. Public health representative 1982 97(6) : 537-544.
  28. Wiener J., Liu, K, Schieber, G. Case-mix differences between hospital-based and freestanding skilled nursing facilities. A review of the evidence. Medical Care 1986 ; 24(12) : 1173-1182. https://doi.org/10.1097/00005650-198612000-00009

Cited by

  1. Development of Peer-Group-Classification Criteria for the Comparison of Cost Efficiency among General Hospitals under the Korean NHI Program vol.47, pp.4, 2012, https://doi.org/10.1111/j.1475-6773.2012.01379.x
  2. Determinants of Amount of Service Use in Community-Based Long-term Care for Elders vol.18, pp.4, 2012, https://doi.org/10.11111/jkana.2012.18.4.402