• Health Policy and Management
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• v.20 no.2
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• pp.104-127
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• 2010

To vitalize the link program of Korean long-term care insurance system to community-based services for non-eligible people, we analysed the claim data from the Korean National Health Insurance Corporation (NHIC), and conducted a questionnaire survey to charging employees of elderly service department at local governments. The subjects were all 81,377 people, 57,454 of them were arranged to community-based services. The link program was more necessary among the missed subjects rather than the arranged people due to the need for physical or psychological assistance. By the result of the survey to the local government employees, 59.5% of subjects responded their proportion of link service was over 10% and under 20%, and 54.3% of them responded their job boundary are not clear. Major type of linking was notification the subject list to local government, 91.4%; proportion of periodical notification on the status of their service link were 57.1%, only 7.1% were followed to manage after the link. Difficult factors at the link process were pointed out the overload by other side work, deficiency of resources, rigidity of priority of link, and so on. Considering these results, to vitalize the community-based services to the non-eligible people, it may be essential the active participation of the subjects, construction of parts working in coordination among the institutions including NHIC, local governments, and service providers; development of various services for maintenance or promotion of the non-eligible peoples' health and functional status; and active participation of institutions from the third sector, and so on.

• Research in Community and Public Health Nursing
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• v.33 no.4
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• pp.357-371
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• 2022

Purpose: This study aims to investigate factors related to long-term length of stay (LOS) of patients with chronic diseases in Korean veterans hospitals. Methods: The subjects were 196 elderly patients with chronic disease staying in the hospital for more than 10 days, Data were collected by the survey of patients with structured questionnaires and medical records review by nurses from July 15 to August 10, 2019. Collected data were analyzed using t-test, ANOVA, Pearson's correlation coefficient and stepwise multiple regression. Results: The present and desired LOS were 37.78±32.66 days and 60.87±45.95 days, respectively. Factors affecting hospital LOS were found to be main disease (genitourinary) (p<.001), assistance in activities of daily living (p<.001), area of hospital (p<.001), payment of medical fees (p=.026), hospital satisfaction (p=.036) and the explanatory power of these variables was 26.4%. The most common health problems that need to be solved after discharge were symptom alleviation and health promotion. These problems can be solved using community-based facility services or visiting medical-welfare services (especially home care nursing). Conclusion: In order to reduce hospital LOS, the following measures are required: personalized self-management education, provision of transportation services for dialysis therapy of inactive patients, linking patients with visiting medical-welfare services including home care nursing and mobile healthcare services, operation of the case management system including the notice of the discharge date at admission, interim check of patient status, and connecting the patient with community resources or transferring the patient to long-term care facilities at discharge.

• Health Policy and Management
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• v.33 no.3
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• pp.295-310
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• 2023

Background: The long-term care (LTC) group has higher rates of chronic disease and disability registration compared to the general older people population. There is a need to provide integrated medical services and care for LTC group. Consequently, this study aimed to identify medical usage patterns based on the ratings of LTC and the characteristics of benefits usage in the LTC group. Methods: This study employed the National Health Insurance Service Database to analyze the effects of demographic and LTC-related characteristics on medical usage from 2015 to 2019 using a repeated measures analysis. A longitudinal logit model was applied to binary data, while a linear mixed model was utilized for continuous data. Results: In the case of LTC ratings, a positive correlation was observed with overall medical usage. In terms of LTC benefit usage characteristics, a higher overall level of medical usage was found in the group using home care benefits. Detailed analysis by medical institution classification revealed a maintained correlation between care ratings and the volume of medical usage. However, medical usage by classification varied based on the characteristics of LTC benefit usage. Conclusion: This study identified a complex interaction between LTC characteristics and medical usage. Predicting the requisite medical services based on the LTC rating presented a challenge. Consequently, it becomes essential for the LTC group to continuously monitor medical and care needs, even after admission into the LTC system. To facilitate this, it is crucial to devise an LTC rating system that accurately reflects medical needs and to broaden the implementation of integrated medical-care policies.

• Health Policy and Management
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• v.26 no.4
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• pp.305-314
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• 2016

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.

• Health Policy and Management
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• v.20 no.1
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• pp.19-36
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• 2010

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.

• Health Policy and Management
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• v.8 no.1
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• pp.203-230
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• 1998

This purposes of this study is to develope policies on the facilities for the elderly care in Korea. Methodology of this study adopts comparative analysis on the facilities for the elderly care in 6 countries which have experienced various problems on the elderly. These 6 countries are Japan, Sweden, America, Australian, England and Germany. Major issues for comparative analysis are the standard of care facilities, residence condition, finance of facilities establishment and expense, operating system, management, and the law and administrative structure about the facilities for the elderly care. The elderly people need various kinds of welfare services such as medical care facilities, nursing home facilities, home care facilities etc.. Thus the public policies for the aging population nations are compose of income maintenance program, health and medical care services and social welfare services. The policies of facilities for elderly care are very important since these policies include the characteristics of income maintenance, me\ulcorner미 care program and welfare program. This study willsupply basic data for the development of facilities for the elderly care in Korea, especially conceming the system and institutional device of the facilities.

• Perspectives in Nursing Science
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• v.6 no.1
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• pp.55-65
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• 2009

The Korean government introduced Home Care Services System to cut medical cost and make efficient use of limited medical resources because of increasing chronic diseases and the growing population of the elderly. The Korean government established measures to control the use of insurance services by restricting the number of nurse's visits to patient's home and by asking the patients to shoulder the transportation fee of nurses during the visit. Factors such as oversupply of hospital facilities, low price of home care services, high insurance coverage for hospital services and increased nuclear family set up resulted in the limited use of home care nursing services. The introduction of long-term care insurance in 2007 brought the decrease in the number of home care agencies and these agencies are facing a crisis today. The increase in chronic diseases and growing population of the elderly recently resulted in the need to control the high medical cost. Home care services for early discharge patients and chronic-severe disease patients will contribute in the reduction of medical cost at the same time improves the quality of patient's life. To catch up with the demands of the nation, accessibility to home care services should be improved and policies such as the expansion of home care services insurance coverage and promotion of establishing home care agencies should be considered.

• The Korean Journal of Applied Statistics
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• v.35 no.4
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• pp.457-468
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• 2022

In aged society, it is important to prevent older people from being disability needing long-term care. The purpose of this study is to develop a prediction model to discover high-risk groups who are likely to be beneficiaries of Long-Term Care Insurance. This study is a retrospective study using database of National Health Insurance Service (NHIS) collected in the past of the study subjects. The study subjects are 7,724,101, the population over 65 years of age registered for medical insurance. To develop the prediction model, we used logistic regression, decision tree, random forest, and multi-layer perceptron neural network. Finally, random forest was selected as the prediction model based on the performances of models obtained through internal and external validation. Random forest could predict about 90% of the older people in need of long-term care using DB without any information from the assessment of eligibility for long-term care. The findings might be useful in evidencebased health management for prevention services and can contribute to preemptively discovering those who need preventive services in older people.

• The Journal of the Korea Contents Association
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• v.19 no.8
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• pp.525-534
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• 2019

Korea is facing one of the fastest aging population problems in the world due to the extension of life expectancy and low birth rates due to economic development and the development of health care. It has become difficult to take care of elderly people in need of long-term care at home, and social problems such as dementia and the increase in stroke cases are serious problems. The government is enacting and implementing the Long-Term Care Insurance Act for the purpose of improving the quality of life for senior citizens subject to long-term care and alleviating the burden of family support in order to solve such social structure and problems for senior citizens. However, as a result of the implementation of the long-term care insurance system for the elderly, the privatization of the facilities and the disorder are causing widespread requests for public accountability of the services and the enhancement of the quality of the facilities. In addition, various arrangements are needed for the production of low-wage medical care workers, tasks for quality improvement, problems regarding financing methods, and so on. In order to maintain and develop the long-term care insurance system for the elderly, the government will consider seeking ways to improve the legal and institutional aspects according to changes in the social environment of the age, as well as seeking mental and psychological measures for the stabilization of old life as well as physical health.

• Korea Journal of Hospital Management
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• v.25 no.2
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• pp.14-24
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• 2020

Purposes: The purpose of this study is to analyze the factor of affecting on job satisfaction by mediating attitude of care service. Methodology: (1)Identify socio-demographic characteristics, work characteristics, the elderly support period, the presence of education related to the elderly, the presence of service associated with the elderly, and significant factors of the research subjects. (2)Identify changes in the number of education and services before and after obtaining a caregiver qualification. (3)Identify the attitude of providing care services and job satisfaction according to the characteristics of the research subjects. (4)Identify the direct and indirect factors influencing job satisfaction by mediating the service attitudes of the research subjects. Findings: First, age factors have positive effects and the volunteering experience have negative effects on job satisfaction by mediating attitude of care service. Although the number of education class has increased after qualification, educational factors had no significant effect. Second, the longer elderly support period had a positive effect on job satisfaction. Practical Implications: This study is meaningful in that it identifies the direct and indirect impacts on job satisfaction through care attitudes. In the future, it will be necessary to pay attention to improving the quality of long-term care services by analyzing the influence factors more.