• 보건행정학회지
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• 제27권2호
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• pp.103-113
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• 2017

There have been many achievements for 40 years since the introduction of compulsory health insurance. Despite many achievements, it has many challenges in health insurance. Aging, non-communicable disease, and low growth economy are threatening the sustainability of health insurance, and it is time to reform the health insurance. A long-term reform plan will be an absolute necessity for reform of health insurance and health care system. Health insurance and health care reform should be an extremely revolutionary content that completely changes the framework. This reform should deal with the philosophy of health, approach of medical education and doctor training, changing supply of medical service, the innovation of primary medical care, reform of public health system, the management of medical utilization, the integration of medical cure and care services, enhancing the benefit coverage, prohibition of covered and non-covered services, etc. Therefore, it is urgent to form a consensus on the necessity of reform, to establish the health insurance plan on this consensus, and to make efforts to make health insurance sustainable.

• 한국컴퓨터정보학회:학술대회논문집
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• 한국컴퓨터정보학회 2013년도 제48차 하계학술발표논문집 21권2호
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• pp.163-164
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• 2013

노인장기요양보험 체계의 캐어매니지먼트 발달 배경과 제도적 문제점을 파악하여 이에 근거한 활성화 방안을 모색하였다. 기존의 케어매니지먼트는 선진국의 대인 서비스 기관에서 널리 보급되고 있는 사회복지실천의 분야이다. 특히 캐어매니지먼트 활성화를 위해 기존의 케어 대상자들이 양질의 서비스를 받을 수 있도록 케어매니저의 종합적인 지원체계와 교육훈련 및 업무에 관한 제도적 조항이 설정되어야 한다.

• 보건교육건강증진학회지
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• 제32권3호
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• pp.97-107
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• 2015

Objectives: The current study aims to examine whether the influence of National Long-term Care Insurance(NLCI) on the quality of life(QoL) trajectory of older adults with disabilities is more positive than its influence on those without disabilities. Methods: Sample consisted of 5,362 elderly aged 65 and over who participated in the Korean Welfare Panel Study from Wave1 to Wave7. Data were analyzed using latent growth curve modeling. Results: Major findings are as follows. (1) Before the NLCI, the trajectories of QoL between older adults with disabilities and those without were same. (2) After the NLCI, elders with disabilities showed lower levels of QoL at the beginning, but the gaps gradually decreased with time. These results indicate that the implementation of NLCI more positively affected elders with disabilities than those without disabilities. Conclusions: These results suggest that the NLCI functions properly as one of social security nets to cope with the needs of older adults with disabilities. In conclusion, it is critical to develop a sustainable NLCI system to enhance the QoL of older adults with disabilities.

• 한국보건간호학회지
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• 제5권1호
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• pp.70-95
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• 1991

The ageing problem of the population has been emerging in Korea since 1970's so that it is expecting the elderly 65 years and over among the total population from $4.5\%$ in 1988 to be $6.3\%$ in year 2000. This study was conducted to provide secure policy development in coming years for the aged on medical and health care aspects based on the examining current status of the aged problems and health care policies and systems. The study divided into four parts; The first part examined the medical insurance program and public assistance program of the health services in relation to the aged. The second part emphasized on reduction of medical care cost for the aged. The third part studied the regular health check-up program and health education for the aged. The fourth part examined the chronic disease management programs for the aged and strategies of the health care service quality improvement and specialized programs. The following recommendations made as the results of the study. 1. At present, the medical insurance program and public assistance program for the medically indigent is not appropriate to the elderly because it is a part of general medical insurance program so that Health Security Law for the Aged is proposed. 2. Medical cost will be increased due to the high occupancy rate of hospital beds and long stay of the elderly so that it is recommended to develop an early discharge program, home health care program, Health hospice and an althernative programs. 3. At present, a regular health check-ups for the elderly is not included in medical insurance program so that it is recommended to be included in the insurance program and at the same time health education program thoroughly developed for the aged. 4. To make proper medical and nursing services on chronic diseases for the elderly, it is recommended manpower development, specialized clinics or hospitals, nursing homes and an equivalent long term care facilitices should be established on the community based and a research institutions also to be related to supper the care programs.

• 한국노년학
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• 제32권2호
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• pp.467-485
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• 2012

노인장기요양보험 재가서비스의 질 향상을 목적으로 2010년도에 처음 도입된 재가장기요양기관평가제도는 재가서비스 질의 수준을 한 단계 끌어올렸다는 평가를 받고 있지만, 한편으로는 지속적인 제도개선의 필요성이 제기되었다. 재가장기요양기관평가제도의 발전을 위해서는 평가대상자인 재가장기요양기관들의 의견을 수렴하여 제도 개선에 반영함으로써 평가에 대한 피평가기관의 수용성을 높이는 것이 중요하다. 이에 본 연구는 '2010년 재가장기요양기관 평가'에 참여한 피평가기관 중 재가서비스 이용자의 86.7%를 차지하고 있는 방문요양기관의 평가책임자들을 대상으로 평가단계와 평가체계 전반에 대한 인식과 태도를 조사하였다. 조사는 국민건강보험공단 대용량 웹팩스 서버와 전자메일을 이용하여 진행되었으며, 3,487개 방문요양기관 중 473개소가 최종 설문을 완료하였다. 연구결과에 의하면, 평가등급에 따라 장기요양기관평가에 대한 인식과 태도에 차이가 있는 것으로 나타났다. 즉, 평가등급이 높은 기관일수록 평가준비기간이 길었고, 평가에 대한 이해도가 높았으며, 평가항목들이 장기요양서비스의 질을 적절히 평가한다고 생각하고 있었고, 평가결과 통보서의 내용이 기관의 질 개선 활동에 유용하다고 생각하고 있었다. 이러한 연구결과는 피평가기관의 재가장기요양기관평가 제도에 대한 인식과 의견을 제시함으로써 향후 재가장기요양기관평가제도에 대한 개선안을 마련하는데 유용하게 활용될 것으로 기대한다.

• 보건행정학회지
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• 제32권4호
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• pp.347-355
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• 2022

Background: Since November 2019, long-term care hospitals have been able to provide patients with discharging programs to support the elderly in the community. This study aimed to identify both patient- and hospital-level factors that affect successful community discharge from long-term care hospitals. Methods: A multilevel logistic regression model was performed using hospitals as a clustering unit. The dependent variable was whether a patient stayed in the community for at least 30 days after discharge from a long-term care hospital. As for the patient-level independent variables, an agreement between a patient and the family about discharge, length of hospital stay, patient category, and residence at discharge were included. The number of beds and the ratio of long-stay patients were selected for the hospital-level factors. The sample size was 1,428 patients enrolled in the discharging program from November 2019 to December 2020. Results: The number of patients who were discharged to the community and stayed at least for 30 days was 532 (37.3%). The intraclass correlation coefficient was 22.9%, indicating that hospital-level factors had a significant impact on successful community discharge. The odds ratio (OR) of successful community discharge increased by 1.842 times when the patients and their families agreed on discharge. The ORs also increased by 3.020 or 2.681 times, respectively when the patients planned to discharge to their own house or their child's house compared to those who didn't have a plan for residence at discharge. The ORs increased by 1.922 or 2.250 times when the hospitals were owned by corporate or private property compared to publicly owned hospitals. The ORs decreased by 0.602 or 0.520 times when the hospital was sized over 400 beds or located in small and medium-sized cities compared to less than 200 bedded hospitals or located in metropolitan cities. Conclusion: The results of the study showed that the patients' and their family's willingness for discharge had a great impact on successful community discharge and the hospital-level factors played a significant role in it. Therefore, it is important to acknowledge and support long-term care hospitals to involve active in the patient discharge planning process.

• 한국보건간호학회지
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• 제24권2호
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• pp.285-301
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• 2010

Purpose: The study was aimed at qualitatively enhancing and promoting a home visiting nursing program established in Korea on July 1, 2008, as part of the Long-Term Care Insurance for the Elderly program. Methods: Structural, procedural and consequential aspects of home visiting nursing care wereclassified on the horizontal axis by applying the standard notions for the evaluation of medical care (Donabedian, 1998). At the same time, the home visiting nursing care service support system and the service provision system weredivided on the vertical axis with reference to the accreditation standards for home visiting nursing care organizations suggested by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO, 2008). The data were collected from June 4, 2008 to October 27, 2008, and were analyzed using SPSS ver. 15.0. Results: Twenty-two (proposed) standards, centered on the standard elements under the conceptual framework of the study, were developed, and comprised structural aspects (n=10), procedural aspects (n=6) and consequential aspects (n=6). Those criteria and indicators underwent two content validity surveys among groups of home visiting nursing care research and training experts. The research produced 22 proposed standards, 50 proposed criteria and 166 proposed indicators. Conclusion: The home visiting nursing care standards developed pursuant to the Long-Term Care Insurance for the Elderly Act and the applicability of these standards need to be verified by home visiting nurses. These proposed standards should prove useful in developing an assessment tool to encourage the qualitative enhancement of visiting nursing care in Korea.

• 한국임상보건과학회지
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• 제4권3호
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• pp.603-614
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• 2016

Purpose. The purpose of this study was to provide basic data regarding the intention to use community care service based on special grading for dementia in the South Korean Society. Methods. A survey was conducted using a questionnaire adapted on the basis of literature review regarding the first to fourth grade under the long-term care insurance system for the aged from May 1 to 30, 2015 and a total of 272 questionnaires were statistically processed using SPSS 21.0. Frequency analysis, descriptive statistics, and cross-tabulation analysis were performed. The non-parametric type of test, ${\chi}^2$ test, was used for statistical testing. Results. This study obtained the following results: First, caregivers had greater intention to ask recipients to use daytime and nighttime care service. Second, there were statistically significant differences in caregivers' education, occupation, monthly average income, co-residence status, intimacy, and care-giving burden (emotional, financial, and social) and recipients' activities of daily living, instrumental activities of daily living, mental health status, dementia status, and intention to use community care service based on special grading for dementia. Conclusions. There are very few statistical data and academic materials regarding special grading for dementia, which has recently been established. The results of this study are therefore expected to help make a systematic analysis of the intention to use community care service by caregivers based on special grading for dementia.

• Journal of Korean Academy of Oral Health
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• 제42권4호
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• pp.204-209
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• 2018

Objectives: This study was conducted to identify the demand and willingness to pay for oral hygiene services among elderly people with long-term care insurance. Methods: Our study was a cross-sectional analysis. Subjects comprised 126 elderly individuals from long-term home-care centers. A total of 28 centers were selected through convenience sampling from among 78 centers in ${\bigcirc}{\bigcirc}$. For analysis, semi-structured questionnaires that required about 20-30 minutes to complete were used. Analysis was performed using SPSS 23.0 software. Results: The overall demand for oral hygiene services was 44.4%, and willingness to pay was 31.0%. Thirty-three people (58.9%) of elderly those who have demand for an oral hygiene service were willing to pay for the service, and 64 people (91.4%) who did not have a demand were not willing to pay for it. Among those with partial dependence on brushing, 65.6% had demand for oral hygiene services and 50.0% were willing to pay costs. Among basic livelihood beneficiaries, 69.6% were willing to pay for oral hygiene services; general subjects and relievers were less willing to pay. Conclusions: The overall demand for oral hygiene services among elderly people was 44.4%, and the willingness to pay was as low as 31.0%.

• 한국사회복지학
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• 제62권2호
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• pp.279-306
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• 2010

본 연구는 정책네트워크이론을 적용하여 한국과 일본의 노인장기요양(개호)보험제도의 정책결정과정을 상호 비교, 분석하고 우리나라에의 정책적 이론적 시사점을 도출하고자 하였다. 연구결과로는, 한국과 일본 모두 노인요양(개호)문제에 대한 정책의제형성은 정부 주도로 이루어지고 정책과정단계별 특성에 따라 정책참여자의 범위가 확대되었으나, 두 나라간 노인요양문제에 대한 정책의제형성 배경에는 차이가 있음을 알 수 있다. 그리고 두 나라 모두 정책의제형성 초기단계부터 정책참여자간의 상호 작용은 비교적 협력적이었으나, 제도골격이 국민들에게 공표되면서 급격히 갈등관계 내지 비판적으로 변화해 갔으며, 정책과정단계별 특성에 따라 주도적 참여자들의 역할이 두드러졌고, 연계형태도 비슷한 모습을 보여주고 있다. 또한 정책과정별로 정책참여자의 범위와 정책산출에의 정책참여자들의 의견 반영 정도가 다르지만, 한국, 일본 모두 정부주도로 노인요양문제에 대한 정책 추진결과로 정책의제형성기부터 국회심의결정기까지 매우 유사한 정책네트워크모형을 보여주고 있다. 정책참여자의 범위 뿐만 아니라 개방적인 상호작용시스템 구축의 중요성, 개호보험제도 정책결정과정의 많은 한계점, 과도한 정부주도 정책네트워크로 인한 정책산출에 정부의지가 너무 많이 반영되는 단점 등이 본 연구의 시사점으로 볼 수 있다.