• 지역사회간호학회지
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• 제29권4호
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• pp.530-538
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• 2018

Purpose: This study tried to identify changes in family burden after the introduction of the long-term care insurance and to examine the factors influencing subjective and objective caring burden and depression of family caregivers of elders receiving home-based long-term care. Methods: Data were collected from 203 family caregivers of elders from August 1 to 31, 2015 using questionnaires. They were analyzed in descriptive statistics, t test, ANOVA test, and multiple regression analysis. Results: The mean score of depression was 7.24, which suggested mild depression level. The subjective family burden was 2.71 and the objective burden 3.04. The factors affecting depression included subjective burden (t=5.08, p<.001), objective burden (t=2.80, p=.006), time of elderly care per day (t=-3.61, p< .001), caregiving duration (t=3.33, p=.001), age (t=3.13, p=.002), family relationship (t=2.48, p=.014), and economic status (t=1.99, p=.047). Conclusion: The family burden was most important influencing factor on caregiver's depression. Therefore, services and supports to alleviate caregivers' burden in the home-based care should be added to long-term care.

• The Journal of Korean Physical Therapy
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• 제34권2호
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• pp.80-89
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• 2022

Purpose: In Japan, the long-term care insurance and health insurance acts have stipulated the visiting rehabilitation system to provide support at the national level. The prior case of Japan would provide guidelines for seeking a suitable policy direction in South Korea. This study aims to examine the historical transition process of the visiting rehabilitation system in Japan, and the issues that emerged in the process of the institutionalization of this system. Methods: To examine the historical transition process of the system, the regulations announced by the government and their reports were reviewed. The relevant issues were qualitatively analyzed based on the opinions of scholars, therapists, and interested organizations that were reported in published papers on the topic. Result: The visiting rehabilitation system has been implemented in the following chronological order: The Health and Medical Service Act for the aged (1982-2006), the Health Insurance Act (1988-), and the Long-term Care Insurance Act (2000-). Currently, visiting rehabilitation is provided through hospitals, clinics, visiting nursing stations, etc. The following issues came to the fore in the process of the institutionalization of the system: (1) the complexity of the system, (2) the necessity of changing perceptions into a life model approach, (3) insufficient service provision by therapists, (4) the lack of human resources and an education system, (5) the lack of awareness of care managers and doctors about visiting rehabilitation, and (6) the necessity of quality enhancement through a team approach. Conclusion: It is deemed worthwhile to refer to the visiting rehabilitation system in Japan and the issues that emerged in the process of institutionalizing the system while seeking a policy direction for a similar system in South Korea.

• 한국치위생학회지
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• 제10권5호
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• pp.905-915
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• 2010

Objectives : This research identified the attitude towards senior citizens targeting the workers of the facility for senior citizens to establish Long-Term Care Insurance System early on, and to identify the degree of perception on the importance of senior citizens' oral health and on the need for dental sanitation specialists. Methods : This research targeted 233 workers of the facility for the senior citizens located in some parts of the Gyeongnam area. Survey was conducted from December 1, 2009 to January 31, 2010 to identify the facility workers' attitude towards senior citizens and on the perception towards Long-Term Care Insurance System. Results : 1. As for the awareness towards senior citizens, 50.2% said that they are comfortable around senior citizens while degree of kindness towards senior citizens was 48.5%. 21.0% had experienced training for senior citizens' oral health management. As for the question on who should serve as the trainer, dental sanitation specialists were citied the most with 47.6%. 29.2% was very interested in the senior citizens' oral health while 83.7% said that oral cavity managers are needed in the facility for the senior citizens. As for the question on who should be in charge, if necessary, dental sanitation specialist was cited the most with 57.9%. 2. Awareness on the Long-Term Care Insurance System, treatment for the oral cavity sanitation by visiting homes and information on the activity of long-term care specialists was high following the experience of training for the senior citizens' oral health management in case of the workers at the senior citizens' facility. This manifested statistically significant difference(p<0.05)(p<0.01). Moreover, treatment for oral cavity sanitation manifested statistically significant difference was manifested in the treatment for oral cavity sanitation following the need for oral health managers and who should be in charge, if necessary(p<0.01). Conclusions : These results advocate the need to develop diverse senior citizens' oral health management methods and to continue to carry out actions for senior citizens' oral health improvement that can be carried out by the long-term caretakers for the management of senior citizens' oral cavity health.

• 한국보건간호학회지
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• 제29권3호
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• pp.403-411
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• 2015

Due to lack of an information system regarding the status of using home-visit nursing (HVN), it has barriers of providing improvement of the HVN for management of elderly health care in Korea. The twofold aims of the current review are to expose the existing agendas for HVN and to suggest the political implications for HVN of Korea based on the transition process and revised HVN system of Japan. This review suggests that an information evaluation system has to precede for HVN services in detail. And, the service provided per manpower should be assessed by separating the code of manpower (registered nurse, nurse aide, dental hygienist) as well as securing detailed and precise information on the HVN services. The other suggestion, development of a community-based home health care nursing model in order to provide necessary services for long-term health insurance beneficiaries. In addition, a master plan for health care for elderly should be established at the national level in order to establish an effective home health nursing delivery system.

• 한국사회복지학
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• 제64권4호
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• pp.31-56
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• 2012

본 연구의 목적은 일본 개호정책 전개과정에서의 '가족개호(가족에 의한 개호제공)'에 대한 금전적 평가에 초점을 맞추어, 특히 개호보험제도의 도입이 '가족개호의 비용화'에 미친 영향을 살펴봄으로써 '가족개호'의 제도화 현상을 포착하는 것이다. 이를 위해 본 연구에서는 '개호의 사회화' 이념을 '가족개호의 비용화'라는 분석개념으로 조작적으로 정의하고, 이 '가족개호의 비용화' 상황과 그에 대한 국가의 개입방식을 개호서비스 제공에서의 가족의 역할과 가족개호에 대한 사회적 평가의 수준, 그리고 가족개호자(여성)의 가정 내 환경 및 노동시장에서의 지위 등과의 관련 속에서 분석한다. 이러한 분석을 통하여, 본 연구에서는 일본 개호정책의 전개과정에 나타난 '가족개호의 비용화구조'를 밝힘으로써 개호보험제도 실시와 더불어 현금급여가 극히 잔여적으로 도입될 수밖에 없었던 정책적 맥락을 이해하고자 한다.

• 보건행정학회지
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• 제20권2호
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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.

• 보건행정학회지
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• 제31권2호
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• pp.173-179
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• 2021

Background: In Korea, the length of stay and medical expenses incurred by medical aid patients are increasing at a rate faster than the national health insurance. Therefore, there is a need to create a management strategy for each type of hospitalization to manage the length of stay of medical aid patients. Methods: The study used data from the 2019 National Health Insurance Claims. We analyzed the factors that affect the length of stay for 186,576 medical aid patients who were hospitalized for more than 31 days, with a focus on the type of hospitalization in long-term care hospitals. Results: The study found a significant correlation between gender, age, medical aid type, chronic disease ratio, long-term care hospital patient classification, and hospitalization type variables as factors that affect the length of hospital stay. The analysis of the differences in the length of stay for each type of hospitalization showed that the average length of stay is 291.4 days for type 1, 192.9 days for type 2, and 157.0 days for type 3, and that the difference is significant (p<0.0001). When type 3 was 0, type 1 significantly increased by 99.4 days, and type 2 by 36.6 days (p<0.0001). Conclusion: A model that can comprehensively view factors, such as provider factors and institutional factors, needs to be designed. In addition, to reduce long stays for medical aid patients, a mechanism to establish an early discharge plan should be prepared and concerns about underutilization should be simultaneously addressed.

• 응용통계연구
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• 제27권5호
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• pp.667-679
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• 2014

우리나라 노인장기요양보험에서는 수급자가 월 한도액 범위 내에서 필요한 서비스를 비용-효율적으로 이용할 수 있도록 지원하고자 표준장기요양이용계획서를 작성하여 제공하고 있다. 본 연구는 표준장기요양이용계획서의 객관성 확보와 업무 효율성 제고를 위하여 의사결정나무기법을 이용해 수급자의 건강 및 기능 상태에 맞는 최적의 급여계획을 도출하는 표준급여모형을 개발하였다. 타당도 높은 모형 개발을 위하여 국민건강보험공단의 전국 220개 장기요양운영센터로부터 장기요양인정조사와 표준장기요양이용계획서 작성 경험이 풍부한 직원(본 연구에서는 '훈련된 조사자'라고 함)을 추천받아 자료수집의 내용과 방법에 대해 교육을 실시하였고, 이들이 수급자의 건강 및 기능 상태를 평가하고 작성한 수급자 개인별 맞춤형 급여계획을 자료 분석에 활용하였다. 표준급여모형은 1단계로 시설 또는 재가 급여 권고 여부를 결정하는 모형을, 2단계로 재가급여를 권고했을 경우의 재가급여 세부 종류별 권고 여부를 결정하는 모형을 개발하였다. 본 연구에서 개발된 표준급여모형은 전산프로그램화 되어 국민건강보험공단 직원이 수급자에게 제공할 표준장기요양이용계획을 수립하는 과정에 실제로 활용되고 있어 표준장기요양이용계획서의 객관성 확보와 업무 효율화가 기대된다.

• 보건행정학회지
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• 제33권3호
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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.

• 한국병원경영학회지
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• 제29권2호
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• pp.37-47
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• 2024

Purpose: This study aimed to determine the effect of adjusted out-of-pocket maximum rules in the 'differential co-payment ceiling', which means having a higher burden of co-payment, that expanded to the entire ceiling level in long-stay admission patients in long-term care hospitals(LTCH). Methodology: We used health insurance claim data between January 1, 2022, and December 31, 2022 received from the National Health Insurance Service. The study populations were inpatients in long-term care hospitals more than 1 days during the study period. We performed the difference in characteristics of the LTCH patient of the differential and general ceiling by the chi-square test. We estimated the change of the population, cost, and co-payments per person under the assumption of restructuring. Finding: Based on adjusted out-of-pocket maximum rules in 2023, it was expected that the number of benefits decreases at the high-income level while increasing at the low-income level. The burden of health expenditure after reimbursement of co-payment ceiling, is expected to increase by 65.1% in the highest medical necessity, whereas the low medical necessity would decreases compared to 2022. Practical Implications: The results demonstrate that the current out-of-pocket maximum rules do not reflect the needs of medical necessity. This study suggested the need to reflect the medical necessity in LTCH on the out-of-pocket maximum rules in the future.