• Health Policy and Management
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• v.30 no.4
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• pp.522-530
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• 2020

Background: In 2008, Korea implemented a new type of social insurance known as "long-term care insurance". We examined the association between ownership of long-term care facilities and the incidence of pressure ulcers after the implementation of "long-term care insurance". This study is a population-based retrospective cohort study from 2006 to 2013. Methods: We used medical claims data from the Korean National Health Insurance Corporate Elderly Cohort Database from 2006 to 2013. These data comprise a nationally representative sample. To avoid confounders, only patients admitted to one long-term care facility and who stayed for >70% of the follow-up time were included; as a result, 3,107 individuals were enrolled. The main independent variable was the operating entity of the long-term care facility (local government, corporate bodies, and private for-profit owners), and the dependent variable was the 1-year incidence of pressure-ulcers. Survival analysis (Cox proportional hazard model) was used as an analysis method. Results: Compared to patients admitted to local government long-term care facilities, patients admitted to private long-term care facilities had a significantly higher 1-year risk of pressure ulcers (hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.29-2.91); the risk was especially high among patients who were cognitively dependent (HR, 2.34; 95% CI, 1.25-4.37). Conclusion: Patients admitted to private for-profit long-term care facilities were more likely to have pressure ulcers compared to those in local government and corporate body long-term care facilities. Appropriate assessment tools and publicly available information, as well as more restricted legal requirements, are needed to improve the care quality and outcomes of patients in long-term care facilities.

• Health Policy and Management
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• v.22 no.1
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• pp.145-162
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• 2012

The purpose of this study is to understand magnitude and its related factors of user's cost-sharing for non-covered services in long-term care facilities. We corrected data for 1,016 subjects, based on the long-term care benefits cost specification. Eighteen subjects were excluded from the data analysis due to missing data on family care-givers characteristics. Finally, 998 subjects were included in the study. The average cost of non-covered services per month was 209,093 won and distributed from 0 to 1,011,490 won. There was a significant difference by the characteristics of family care-givers and long-term care facilities. The monthly average cost for meal materials per person was 199,181 won(0~558,000), average cost of additional charge caused by using private bed was 232,992 won (50,000~600,000), and costs for haircut and cosmetics were 8,599 won. For the rest, there were various programs costs(93,328 won), diaper and its disposal cost(109,628 won), purchase cost for daily necessaries(24,435 won) and etc. The related factors for the magnitude of non-covered services expenditures were education level of family care-givers, occupancy rate and location of LTC facilities, and the costs of using private bed, haircut and cosmetics, and various programs among non-covered services. These findings suggest that present level range of LTC facilities users' cost-sharing is wide and it is urgent to prepare the standard guideline for cost and level in non-covered services.

• Dementia and Neurocognitive Disorders
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• v.16 no.1
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• pp.1-6
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• 2017

The purpose of this study is to examine interventions and supporting systems by dementia stage, take a look at dementia insurance policies in Korea and the United States, and present Korean private insurance programs for dementia patients. According to the study, our suggestions of a design of private insurance products for Korean dementia patients are as follows. First, the products should support people aged 80 and older. Second, new products should include the mild stage dementia in the insurance coverage. Third, non-pharmacological treatments, such as the cognitive stimulation, the cognitive training, and exercises need to be covered through the new private insurance. Fourth, the private insurance should be contained home health care services in its coverage. These suggestions can reduce the dependence of the public insurance, help people choose appropriate treatments for themselves, and give people a good opportunity to improve the effect of dementia treatment and to increase the satisfaction of patients and their families.

• Survey Research
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• v.11 no.2
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• pp.97-121
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• 2010

Using the 1998-2004 Health and Retirement Study(HRS), this study explored the determinants of private long-term care insurance(LTCI) ownership and the first home care use. To account for the interaction between LTCI purchase and home care use, this study used two-period utility model as theoretical framework. Discrete time model was used as an empirical model to incorporate the time-dependent feature of LTCI ownership. And this study accounted for the endogeneity of LTCI ownership and home care use by employing full information maximum likelihood estimation. This study indicated insignificant effects of private LTCI ownership and Medicaid eligibility on the home care use. Also, the effects of income and assets on home care utilization were negligible. Those who have poor health condition and who do not have potential informal caregivers were more likely to use home care. For private LTCI ownership, income and assets have positive relationship with LTCI purchase, and poor health status and age were negatively related to LTCI purchase. The elderly living with children and those who have more siblings were less likely to have private LTCI, and those who lived with spouses with no children were more likely to buy private LTCI. Based on the findings, this study provides implications to design long-term care(LTC) policies in the U.S. and to develop LTC planning education programs.

• The Korean Journal of Health Service Management
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• v.2 no.1
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• pp.125-136
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• 2008

Government came to enforce long-term care insurance system in preparation for the rapid aging society. Whether this system is successful or not depends on the professionalism of long-term care-givers who are professional population in charge of care service. Currently in the early stage of enforcement, such problems as a race cutting fee resulted from numerical increase of educational facilities, insolvent operation, degradation of education level resulted from unprofessional instructor, are pointed out. As a mean of manpower-training on long-term care insurance system, this study is to research public-private-university network model of the Academy of Continuing Education attached to Ko Sin University which is the case of Yong Do Gu Busan city. Networking between the vision and development strategy of Yong Do Gu on continuing education city, education system on community manpower-training supported by Ko Sin University, and service field of welfare for the elderly can not only contribute to the professionalism of long-term care-givers but also play an ideal role in manpower-utilization and arrangement of community. Through this networking, high quality of education level and circumstance, using the existing infra, manpower-training and utilization for continuing education of Yong Do Gu can be accomplished. Additionally, the connection with facilities related with welfare for the elderly can contribute to professionalism and accountability of manpower-networking.

• Korea Journal of Hospital Management
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• v.13 no.1
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• pp.24-41
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• 2008

This research is aimed at analyzing and understanding the perception and attitudes of inpatients in a general hospital in Seoul towards the activation of private health insurance. Survey was conducted against 231 inpatients, results of which were analyzed in the methods of frequency analysis, chi square test, and logistic regression. The results are summarized as follows; First, better-educated population who finished college education at least, higher-income population, and people who had more knowledge about private health insurance showed more perception about activation of private health insurance. Second, better-educated population who finished college education at least, higher-income population, those who are insured in existing private insurance, oncological patients, and people who had more knowledge about private health insurance showed more positive attitude towards private health insurance paying for actual damages, long-term care insurance, and income security insurance. Third, age and education were the factors affecting perception about activation of private health insurance. The older the age is, perception was 1.035 times positive towards activation of private health insurance, and those who finished college education or above showed 3.148 times positive perception towards the same. Forth, surgical patients showed 1.087 times more positive attitude towards private health insurance paying for actual damages than internal medicine patients, while oncological patients showed 2.314 times more positive attitude than internal medicine patients. Further, understanding on the activation of private health insurance was 6.014 times higher in the higher understanding group than in the lower understanding group. Intention to use long-term care insurance was 2.692 times stronger in the male group than in the female group, and 3.616 times stronger in the oncological patients group than in internal medicine patients group. Further, understanding on the activation of private health insurance was 3.881 times deeper in the higher understanding group than in the lower understanding group. Intention to use income security insurance was 3.185 times stronger in those who have academic background of under the high school than those over the college, and 4.175 times higher in the group those whose monthly average income is over 4 million won than those under 4 million won. Also, intention to use income security insurance was 4.323 times higher in the group those who are insured by existing private insurances than those who are not insured by those insurances and it was 5.234 times higher in the group of oncological patients than in the group of internal medicine patients. Further, intention to use income security insurance was 3.559 times higher in the group those who thought that out-of-pocket money of the National Health Insurance is too much to bear than those it is quite endurable. Understanding on the activation of private health insurance was 4.875 times deeper in the higher understanding group than in the lower understanding group. There were some suggestions could be made based on the results of this research. First, reinforced publicity and education is needed for the low-educated or low-income group, as there are gaps in the understanding on the activation of private health insurance depending on the degree of education and income. Second, government should prepare administrative complementary measures to solve the problem of adverse selection by the consumer which is foreseen when private health insurances are activated. Third, government should suggest the desirable course of development of private health insurance items to ensure efficient use of enormous fund of private insurance market for health security of the people. Further, institutional complementary measures are needed to convert existing cancer insurances or specific disease insurances to private health insurances paying for actual damages guaranteeing against every kind of disease. Forth, it judged that, not only private health insurances paying for actual damages, but also long-term care insurances and income security insurances are prospective as fields to create fresh demand for insurance industry.

• Journal of the Korean Dietetic Association
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• v.28 no.2
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• pp.67-84
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• 2022

This study aimed to explore the status of food service outsourcing behavior of long-term care institutions (LTCIs) through a cross-sectional survey using a questionnaire administered between July 16th and August 7th, 2020. The survey respondents were either dietitians or facility managers, who worked at 731 nursing homes, 477 group homes, and 673 day-care centers. Approximately 25.9% of nursing homes, 11.7% of group homes, and 33.1% of day-care centers used a managed-services company to operate their food service units. The main reason for outsourcing food service by nursing homes was related to the staffing of dietitians and cooks, whereas group homes and day-care centers outsourced food services due to factors relating to meal costs and the cooking process. Almost all the LTCIs entered into private contracts for outsourced food services. Only a few food service contracts included the types of meals, nutrition standards such as protein and calories per meal, and the parameter or ratio of food cost. Of the respondents, 84.5% from nursing homes, 87.5% from group homes, and 87.1% from day-care centers agreed that the quality of outsourced food services of the LTCIs should be regulated. Meals are essential for maintaining the health and functional status of LTCI users. As more LTCIs outsource their food services, we suggest the following: (1) Increasing the minimum dietitian staffing standards for LTCIs as per the Welfare of Senior Citizens Act and requiring at least one dietitian for every nursing home, (2) Making it mandatory to use a standard food service contract template when drafting food service contract, and (3) Developing realistic standards for food service operations considering the size and operation type of the LTCIs.

• The Journal of the Korea Contents Association
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• v.20 no.10
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• pp.308-325
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• 2020

This study examines factual facilites safety of long-term care facilities for eldery, for improvement of Korean policy. So, This study reviewed policies of facilites safety of long-term care facilities on main OECD countries. We analyzed factual survey of facilites safety of long-term care facilities in Seoul metropolitan area. The results of the study were as follows: First, There were differences of law and rule of facilites safety of long-term care facilities in comparison with those of social welfare facilities, child day-care center, hospital. Second, it was the result of location condition analysis. Long-term care facilities in the Seoul metropolitan area were located on more than six floors of buildings. The location conditions of private facilities are weak compared to those of corporations and local governments. Third, there were the result of internal structure of facilities. Overall, the placement status was insufficient. For instance, there are smokeproof masks/fireproof blankets, smoke windows(fire safety windows), smoke smothering. In addition, there were places where legal essential installation structures were insufficient. Private facilities were generally insufficient in facility structures compared to those of local governments and welfare corporations. Fourth, there were the result of safety management. It was confirmed that private facilities were insufficient compared to local government facilities. For instance, there are safety management analysis, response manuals, fire preparedness training, etc. Finally, implications and future directions policies of facilites safety of long-term care facilities were discussed based on the finding of the study.

• The Korean Journal of Health Service Management
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• v.5 no.1
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• pp.147-158
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• 2011

This study compares the degree of satisfaction and the causes of selecting facilities for stroke patients in the senior specialized hospitals and other senior care facilities. The research results are followed. First, The patients who held the level of senior long-term care used senior specialized hospitals, while the patients who had the level of 2 or 3 degree used senior care facilities. The patients helped by cooperative care service used senior care facilities, and the patients helped by private service or family service used senior specialized hospitals. Second, The patients in senior specialized hospitals had affirmative attitude for their service system, while the patients in senior care facilities preferred their various service systems. In the satisfaction of the facilities, the patients in senior care facilities felt more satisfaction to staff, environment, service, and other factors than the patients in hospitals did. Third, in the result of logistic analysis, the patients had an affirmative attitude in case that they had spouse, experience of senior specialized hospitals or senior care facilities, without senior long-term care insurance. They also valued the service standard and the staff quality. As this study points out, the overall preference is higher in the senior care facilities. So, the stroke patients recognized the new role between the hospitals and the facilities after the establishment of long-term senior medicare system. This research had some limitation for the research areas and numbers. So the data analysis for the types of facility and the responses may not be generalized. However, the standard of choosing facility and satisfaction will be a guideline for establishing a new future role between hospitals and facilities. This result will be used as a basic data for the renovation of long-term senior medicare insurance.

• Health Policy and Management
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• v.32 no.4
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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.