• Journal of Korean society of Dental Hygiene
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• v.10 no.5
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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.

• The Korean Journal of Applied Statistics
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• v.28 no.6
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• pp.1063-1073
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• 2015

In the long-term care insurance (LTCI) system, National Health Insurance Service (NHIS) provide counseling services for beneficiaries and their family caregivers, which help them use LTC services appropriately. The purpose of this study was to develop a Target Selection Model for the Counseling Services based on needs of beneficiaries and their family caregivers. To develope models, we used data set of total 2,000 beneficiaries and family caregivers who have used the long-term care services in their home in March 2013 and completed questionnaires. The Target Selection Model was established through various data-mining models such as logistic regression, gradient boosting, Lasso, decision-tree model, Ensemble, and Neural network. Lasso model was selected as the final model because of the stability, high performance and availability. Our results might improve the satisfaction and the efficiency for the NHIS counseling services.

• Research in Community and Public Health Nursing
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• v.26 no.2
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• pp.89-99
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• 2015

Purpose: The purpose of this study was to demonstrate the effects of visiting nursing services in long-term care (LTC) insurance on changes in health status and physical functions among the elderly. Methods: We analyzed survey data on the living status and welfare needs of the elderly from 2008 and 2011 using the difference-in-difference method with propensity score matching. Results: The subjects were 76 elders including 38 visiting nursing service users(intervention group) and 38 home-based LTC service users (control group). Results from DID analysis confirmed that the subjective health status level of the intervention group was 2.2 points higher (p=.044) and the depression level was 0.3 point lower (p=.039) than the control group. In addition, the intervention group's ADL score was 1.9 (p=.027) and IADL 3.9 (p=.030), showing that their health was deteriorated less. Conclusion: Visiting nursing service in LTC insurance was associated with delayed deterioration of subjective health status, depression, ADL and IADL. These findings suggest the need of rebuilding visiting nursing service programs focusing on prevention services, which will be more contributive to elderly health care and the reduction of social costs.

• The Korean Journal of Applied Statistics
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• v.26 no.5
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• pp.725-736
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• 2013

Retirement income is an important personal and social issue. Problems associated with financial risk wil1 become more pronounced with the growth in the elderly population. Medical expenses in senescence is closely related to financial risk; in addition, some diseases that require long term care will increase financial risk which result in lower quality of life for the elderly. Therefore, it is necessary to understand expected long-term care costs and to manage financial risk from the perspective of an individual. This study evaluate the length of period in which a person is expected to need long term care and actuarial present values of the total cost which needs to be prepared for the care through the Korean public long term care system based on the experience data obtained from Long Term Care Insurance for the Elderly in Korea and a multi-state model.

• Journal of Korean Academy of Nursing
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• v.42 no.2
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• pp.236-247
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• 2012

Purpose: Purposes of this study were: evaluation of family burden of caring for elders who receive long term care services, and examination of differences in burden before and after the introduction of long term care service in Korea. Methods: Data were collected by questionnaires from 416 caregivers of elders who were registered with the Long Term Care Insurance Corporation in six cities. Data were collected in September, 2010 and analyzed using descriptive statistics, paired t-test, and ANOVA with the Scheffe test, and stepwise multiple regression. Results: Family burden decreased significantly after longterm care service was initiated. Subjective burden decreased from 2.93 to 2.69 (t=11.78, $p$<.001), and objective burden, from 3.40 to 3.10 (t=12.73, $p$<.001). Stepwise multiple regression analysis revealed that factors affecting subjective burden were family relations (F=13.60, $p$=.003), age (F=5.47, $p$=.019), job (F=6.98, $p$=.008), and education (F=4.59, $p$=.032), and that factors affecting objective burden were living together (F=17.66, $p$<.001), job (F=13.34, $p$=.003), monthly income (F=6.61, $p$=.010), and type of service (F=6.62, $p$=.010). Conclusion: The results of this first study to investigate caregiver burden after the Korean Long-term Care Insurance System was begun provide positive information for the development of strategies to decrease family burden in long term care.

• 한국사회정책
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• v.25 no.1
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• pp.99-123
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• 2018

Purpose: This study empirically investigates the utilization and expenditure of health care and long-term care at the last year of life for long-term care beneficiaries in Korea. Methods: This study used National Health Insurance and Long-term Care Insurance claims data of 271,474 LTCI beneficiaries, who died from July 2008 to December 2012. Their cause of death, place of death, health care costs, and the provision of aggressive care were analyzed. Results: Cardio-vascular disease(29.8%) and cancer(15.3%) were reported as their major cause of death, and hospital(64.4%), home(22.0%), social care facility(9.2%) were analyzed as the place of death. 99.3% of subjects used both health care and long-term care during the last 1 year of life. The average survival period were 516.2 days after they were LTCI beneficiaries. The health care expenditure gradually increased near the death, and the last month were three times more rather than the first month. Furthermore, 31.8% experienced some aggressive cares(CPR, blood transfusion, hemo-dialysis, etc.) at the last month of life. Conclusion: The results of this study suggest that it is important to develop the end of life care policies(for example, hospice, advanced care directives) for the LTCI beneficiaries. They might contribute to the improvement of quality of life and the reduction of health care expenditure of the elderly at the end-of-life.

• 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.30 no.1
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• pp.72-81
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• 2020

Background: The out-of-pocket maximum is one of the distinctive healthcare systems which sets a ceiling on co-payment in order to reduce the burden of households from the unpredictable medical expenditure. However, this leads to an increase in the demand for healthcare services especially in long-term care hospitals (LTCHs) in Korea. Methods: This study analyzed the influence factor of medical service overuse of 165,592 inpatients in LTCHs which out-of-pocket maximum is applied, by utilizing data from the National Health Insurance Service (2016). Based on Anderson Model, the medical service overuse, as a dependent variable, was defined as long-stay admission more than 180 days at the LTCHs. Independent variable was comprised of predisposing factors (gender, age), enabling factors (income level, types of out-of-pocket maximum) and need factors (illness level, patient use of tertiary hospital). Results: The most powerful factor of medical service overuse in LTCHs was availability of pre-payment for the out-of-maximum (odds ratio [OR], 191.66; p<0.001). This tendency was found in high income level status (p<0.001). Furthermore, mild inpatients (OR, 1.50; p<0.001) which had no experience with the tertiary hospitals (OR, 2.06; p<0.001) were more relevant to the medical service overuse in LTCHs, compared to the severe inpatients. Conclusion: It is suggested that a separate standard of out-of pocket maximum with regards to LTCHs is required to secure the beneficial functions of long-term hospitals and prevent unnecessary financial leakage to achieve sustainable and financially sound National Health Insurance.

• 한국노년학
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• v.30 no.3
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• pp.855-869
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• 2010

The purpose of this study is to identify how to efficiently integrate long-term care facilities into geriatric hospitals. We conducted a survey on the current operations of facilities and medical services of 2009 of 192 long-term facilities and 168 geriatric hospitals in Korea between October and November. Technical statistics and chi-square test were conducted on the collected data using the SPSS 13.0/Win program. There was a difference between the two facility types in terms of the co-payment levels of the food services. Both types selected the budget deficit as their major management problem. Ease of access and the surrounding environment were critical factors used to select the location of both types of facilities. Facility users benefited from the discounted co-payments of both facility types. However, facility users wanted more frequent visits and support from their family members during their stay at the facilities. It was discovered that users in the long-term care facilities stayed longer, that is until they died, compared to their counterparts in geriatric hospitals. The two types of facilities provided their services totally separately to users. Users of the two types of facilities are poorly supported and cared for by their families. This study suggests that setting reasonable service fees, paying caretakers, introducing an integrated facility, strengthening facility assessment standards, introducing the family doctor system, and introducing the handling of long-term care insurance by geriatric hospitals would allow the integration between long- term care facilities and geriatric hospitals to be beneficial.

• 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.