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http://dx.doi.org/10.4332/KJHPA.2016.26.4.305

Long-Term Care Utilization among End-of-Life Older Adults in Korea: Characteristics and Associated Factors  

Yoon, Nan-He (Office of Policy Development for Healthy Society, Seoul National University College of Medicine)
Kim, Hongsoo (Department of Health Science, Seoul National University Graduate School of Public Health)
Kwon, Soonman (Department of Health Science, Seoul National University Graduate School of Public Health)
Publication Information
Health Policy and Management / v.26, no.4, 2016 , pp. 305-314 More about this Journal
Abstract
Background: The purpose of this study is to examine the characteristics of and factors associated with long-term care (LTC) utilization under public long-term care insurance (LTCI) among end-of-life older adults in Korea. Methods: Using a 5% sample of older people aged 65 or older and their health and LTC insurance data, two-part model analyses were conducted. We compared LTC uses and their determinants during the last year of life among decedents in the year 2010 with those of survivors. We also compared the medical uses of the same sample with their LTC uses. Results: The end-of-life elderly were more likely to use LTC, and their expenditure on LTC was higher than their counterparts. Whether or not older people used LTC during their last year of life was significantly affected by age, sex, health insurance, household income, and living alone; however, LTC costs of the decedents were only affected by functional status, which may have been due to the reimbursement scheme of the current LTCI, which is mainly based on functional dependency level. For the survivors, having chronic diseases significantly increased the likelihood of LTC use, which was not the case for the decedents. End-of-life elderly with relatively low social economic status were more likely to use the LTC other than medical services, while the health conditions affected their medical uses most significantly. Conclusion: The study findings provide key information for predicting demand related to the increasing LTC needs of Korean older people at the end of life.
Keywords
End-of-life care; Decedents; Long-term care; Long-term care insurance; Older adults;
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1 Lee SM, Lee HY, Kim JY, Kang SW. Analysis of medical expenditures for rational management of medical uses in the end-of-life. Wonju: National Health Insurance Service, Health Insurance Policy Institute; 2011.
2 Fuchs VR. "Though much is taken": reflections on aging, health, and medical care. Cambridge (MA): National Bureau of Economic Research; 1984.
3 Jeong HS, Song YM, Lee KS. Aging and health care expenditure. Korean J Health Econ Policy 2007;13(1):95-116.
4 Raitano M. The impact of death-related cost on health care expenditure: a survey. Brussels: Centre for European Policy Studies; 2006.
5 Shin H, Choi M, Tchoe B. The cost of end-of-life care in South Korea. Korean J Health Policy Adm 2012;22(1):29-48. DOI: https://doi.org/10.4332/KJHPA.2012.22.1.029.   DOI
6 Ministry of Health and Welfare. Establishment of a legal basis for hospice, palliative care and cessation of medical care for life prolongation. Sejong: Ministry of Health and Welfare; 2016.
7 Ko SJ, Jung YH. Social values in end-of-life care. Sejong: Korea Institute for Health and Social Affairs (KIHASA); 2014.
8 National Health Insurance Service. 2015 National health insurance statistical yearbook. Wonju: National Health Insurance Service; 2016.
9 The Committee of Vision for Health Care. 2020 vision and policy of medical expenditures in Korea. Sejong: Ministry of Health and Welfare; 2011.
10 Fassbender K, Fainsinger RL, Carson M, Finegan BA. Cost trajectories at the end of life: the Canadian experience. J Pain Symptom Manage 2009;38(1): 75-80. DOI: https://doi.org/10.1016/j.jpainsymman.2009.04.007.   DOI
11 Polder JJ, Barendregt JJ, van Oers H. Health care costs in the last year of life: the Dutch experience. Soc Sci Med 2006;63(7):1720-1731. DOI: https://doi.org/10.1016/j.socscimed.2006.04.018.   DOI
12 Neuberg GW. The cost of end-of-life care: a new efficiency measure falls short of AHA/ACC standards. Circ Cardiovasc Qual Outcomes 2009;2(2):127-133. DOI: https://doi.org/10.1161/CIRCOUTCOMES.108.829960.   DOI
13 Hakkinen U, Martikainen P, Noro A, Nihtila E, Peltola M. Aging, health expenditure, proximity to death, and income in Finland. Health Econ Policy Law 2008;3(Pt 2):165-195. DOI: https://doi.org/10.1017/S174413310800443X.   DOI
14 Hashimoto H, Horiguchi H, Matsuda S. Micro data analysis of medical and long-term care utilization among the elderly in Japan. Int J Environ Res Public Health 2010;7(8):3022-3037. DOI: https://doi.org/10.3390/ijerph7083022.   DOI
15 Payne G, Laporte A, Deber R, Coyte PC. Counting backward to health care's future: using time-to-death modeling to identify changes in end-of-life morbidity and the impact of aging on health care expenditures. Milbank Q 2007;85(2):213-257. DOI: https://doi.org/10.1111/j.1468-0009.2007.00485.x.   DOI
16 Kwon SM, Kim HS, Yoon NH, Jeon BY. Jung YI. Financial projections for sustainable long-term care insurance. Seoul: Seoul National University, Graduate School of Public Health, National Health Insurance Service; 2011.
17 Weaver F, Stearns SC, Norton EC, Spector W. Proximity to death and participation in the long-term care market. Health Econ 2009;18(8):867-883. DOI: https://doi.org/10.1002/hec.1409.   DOI
18 Pot AM, Portrait F, Visser G, Puts M, van Groenou MI, Deeg DJ. Utilization of acute and long-term care in the last year of life: comparison with survivors in a population-based study. BMC Health Serv Res 2009;9:139. DOI: https://doi.org/10.1186/1472-6963-9-139.   DOI
19 Jakobsson E, Bergh I, Ohlen J, Oden A, Gaston-Johansson F. Utilization of health-care services at the end-of-life. Health Policy 2007;82(3):276-287. DOI: https://doi.org/10.1016/j.healthpol.2006.10.003.   DOI
20 Forma L, Rissanen P, Aaltonen M, Raitanen J, Jylha M. Age and closeness of death as determinants of health and social care utilization: a case-control study. Eur J Public Health 2009;19(3):313-318. https://doi.org/10.1093/eurpub/ckp028.   DOI
21 Kim H, Jung YI, Kwon S. Delivery of institutional long-term care under two social insurances: lessons from the Korean experience. Health Policy 2015; 119(10):1330-1337. DOI: https://doi.org/10.1016/j.healthpol.2015.07.009.   DOI
22 Seow H, Pataky R, Lawson B, O'Leary EM, Sutradhar R, Fassbender K, et al. Temporal association between home nursing and hospital costs at end of life in three provinces. Curr Oncol 2016;23(Suppl 1):S42-S51. https://doi.org/10.3747/co.23.2971.   DOI
23 Spillman BC, Lubitz J. The effect of longevity on spending for acute and long-term care. N Engl J Med 2000;342(19):1409-1415. DOI: https://doi.org/10.1056/nejm200005113421906.   DOI
24 Lee YK, Yang CM, Seo DM. Equity in long-term care insurance in Korea. Sejong: Korea Institute for Health and Social Affairs (KIHASA); 2011.
25 Yoo JE. The supply of long-term care services and a registration ratio of nursing homes. Health Soc Welf Rev 2015;35(1):330-362. https://doi.org/10.15709/hswr.2015.35.1.330.   DOI
26 Shin EH, Lim JY. The association between population aging and health care expenditure considering 'death-related costs'. Korean J Health Econ Policy 2014;20(4):51-80.