• Health Policy and Management
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• v.4 no.2
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• pp.27-57
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• 1994

The objective of running a long-term care institution is to provide services helpful for maintaining, supporting, and improving elderlies' optimum level of physical, mental, and psychosocial functioning. For the purpose of analyzing the current situations of institutional long term care facilities in Korea, 27 facilities were selected proportionately from each of the cities and provinces, out of the total 152 facilities. About 20% of those who were institutionalized during 25 August through 2 Qctober 1993, the 391 elderlies were chosen on a systematic random basis. The instrument of this study was developed by modifying the tools of CARE, MAI and PCTC. A multivariate approach of discriminant analysis and clustering technique were employed for this study. The Stiudy reveals that there is no clear differentiation of goals and functions among the longterm care institutions in Korea. Staffing patte군 of long-term care facilities shows a shortage of nurses, physical therapists, and dieticians. The linkage between acute care facilities and long-term care is weak, and administration of long-term care faciltiy is carried out by non-professionals. They are responsible for assessing health status before entering the facility, and evaluating elderlies' care. Therefore, it is not surprising to find that most of the facilities have accommodated agede regardless of their real needs and health status. Based upon findings of the analysis, this study has classified long-term care facilities into four types : Type I is to help elderlies maintain independence in daily living activities. Type II facilities have the objective of maintaining and improving the current level of elderlies' function. Type III is to maintain maximum independence of elderlies in activities of daily living. And Type IV is identified for the group of facilities designed to restore or improve functional abilities of elderlies. In conclusion, the following suggestions are made : the need for long-term care should be assessed by multidimensional measurement. Institutional long-term care facilities should be classified and developed in response to type of type of care and service need. Both acute and long-term care facilities should be linked together in order to support the evaluation of service operation and program development.

• 한국사회정책
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• v.25 no.1
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• pp.125-159
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• 2018

The purpose of this study is to analyze the factors affecting service use intention of long-term care among the disabled. This study conducts a longitudinal study using the modified Andersen model by the disabled age groups of the 50-64 group and the 65 over group. This study examined random effects panel logit analysis for the 50-64 group and the 65 over group by age variations. The results have shown that there are different factors Influencing factors for each specific age group of the disabled(50-64, 65 over). The results were as follows: there are differences of factors between the 50-64 group and the 65 over group. This study found that predisposing factors of the service use intention of long-term care were significantly related to age, residential area, education status, existence of spouses. Enabling factors of the service use intention of long-term care were significantly related to long-term care service recognition, saving, personal salary income level, housing status. Need factors of the service use intention of long-term care were significantly related to chronic diseases, psychological health, IADL. So, there are a need for a policy considerations such as service for the mid-old age disabled by age groups. Finally, implications and future research directions were discussed based on the finding of the study.

• Health Policy and Management
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• v.24 no.1
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• pp.71-84
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• 2014

Background: Informal care is increasingly recognized as placing a significant burden on the lives of family caregivers. The purpose of this study is to investigate factors related to family caregivers' burden with the community-dwelling disabled elderly under the long-term care insurance system, using the Stress Process Model developed by Pearlin (1990). Methods: Total 1,233 family caregivers with the disabled elderly, using the long-term care services in their home from May to June 2009, completed questionnaires finally. The questionnaire of this study consists of a total of 32 questions, including 11 questions related to background and context, 17 questions related to objective stressors, and 4 questions related to coping resourses. Family caregivers' burden is measured by the Korean Revised Caregiving Appraisal Scale (K-RCAS, Cronbach's alpha=0.86). To investigate factors related to family caregivers' burden, multiple regression analysis was conducted. Results: The average score of caregivers' burden was 22.0 (${\pm}6.12$). In multiple regression analysis, there were statistically significant factors affecting on the family caregivers' burden, that are related to background and context (region, living status, education level, relationship with beneficiary), objective stressors (duration of caregiving), coping resourses (caregiver's health status). Conclusion: This study found that family caregivers experience a considerable burden. The findings suggest that policies must be taken to relieve family caregivers of their duties temporarily, and to support them with counselling and education.

• Health Policy and Management
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• v.17 no.2
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• pp.52-67
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• 2007

Korean government is preparing the long-term care financing and delivery system in order to cope with rapid population aging. The system should be designed to provide demented patients with an appropriate services that the patients want to take, and considered to be necessary for them. In this regard, this study aims to analyse empirically a relationship between the types of long-term care services that demented patients wanted to take and they actually received during 2004. The caregivers of 609 dementia patients, who were randomly selected in a manner of proportional allocation from a nationwide claim database of the Korean National Health Insurance Corporation, were interviewed in September, 2005. Independent variables include socio-demographic characteristics, Activities of Daily Living(ADL) and Instrumental Activities of Daily Living(IADL). To explore the correspondence of the types of long-term care services that demented patients wanted to take and that they actually received, and its affecting factors, we conducted chi-square test and logistic regression analysis. Main findings are as follows. First, while only 20% of study subjects wanted home services as a long-term care services, those who wanted to use the long-term care facilities and general hospital were 37%, 43% respectively. Second, the correspondence rate was just 38% on average, and extremely low in the demented patients who wanted to use long-term care facilities. Third, the demented patients who resided in urban areas and received relatively high level of education showed high correspondence rate. Fourth, the high ADL score was closely related to low correspondence rate.

• Korean Journal of Social Welfare Studies
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• v.40 no.3
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• pp.5-40
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• 2009

As of June 2008, the government's expansion policy for the long-term care service infrastructure has achieved an outstanding 96.4% occupancy rate of facilities across the country. Despite such achievement, practical issues including the physical lack of facilities, disproportional regional spread and decline in government accountability have raised concerns about the effectiveness of the policy's implementation. This study was aimed at defining the implementation procedure of expansion policy for long-term care service infrastructure, analyzing variables that affect it, examining the problems revealed in implementation procedure, and suggesting improved plan on that policy. Research methods were to review literatures on infrastructure expansion policy, to conduct case studies on K province, C city and 4(2 corporations and 2 privately owned) facilities in C city for studying practical implementation procedure on a local government level, and to use Alexander(1985)'s framework for analyzing variables of policy implementation. As a result of this study, policy variables including the clarity and adequacy of policy goal, nature of service providers, task and responsibility between government authorities, and implementation variables such as propensity toward budget allocation, financial restraint, swift utilization of budgets and the streamlining of involved procedures and inter-agency relations stood out as the main factors affecting policy implementation. In adddition, this study suggested several improvement measures such as accounting facilities need based on real local demand and supporting to private participation and so on.

• Health Policy and Management
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• v.19 no.4
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• pp.78-97
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• 2009

This study examined the factors related to family caregiver satisfaction with institutional care services for beneficiaries under the Public Long-Term Care Insurance(PLTCI) system. Determining what contributes to family caregiver satisfaction is a critical step toward implementing effective quality improvement strategies. A national cross-sectional descriptive survey was conducted from November to December 2008, using proportionate quota sampling based on the location and level of Long-Term Care of the beneficiaries. Total 1,745 family caregivers wrote informed consents and 733 (response rate 42%) completed questionnaires, which included caregiver characteristics, organizational resources, primary objective and subjective stressors, perceived quality of services, and family caregiver satisfaction. Family caregivers were satisfied overall with institutional care. In multiple regression analysis, there was a statistically significant difference in degree of family caregiver satisfaction according to caregiver characteristics(relationship to beneficiary), primary objective stressors (insurance type of beneficiary), perceived quality of services(respect to family caregivers' idea, ADL support, expertness of staff, careful concern of staff, fulfillment of client's requests, and safety of institution's environment). In public long-term care, satisfaction efforts are in an early stage of development. This study is meaningful as the first attempt to measure family caregiver satisfaction with institutional care for beneficiaries under the PLTCI system, and to identify factors affecting the satisfaction. Among the identified factors, the policy makers, the insurer, and the providers need to pay attention to perceived quality of services, in particular, to improve customer satisfaction. Our findings can provide quality care improvement initiatives in the public long-term care setting.

• 한국사회정책
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• v.24 no.1
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• pp.67-95
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• 2017

This study compared policies of elderly abuse of long-term care facilities on WHO, Main countries for improvement of Korean policy. So, This study reviewed policies of elderly abuse of long-term care facilities on WHO, Main countries. So, This study reviewed risk factors that may increase the potential for abuse of an older person can be identified at individual level, care-woker levels, socio-cultural levels and facilities levels. The results of the study were as follows: First, The openness of long-term care facilities are emphasized on many countries. There are a need for a policy considerations such as policies of Ombudsman, Adult guardianship for visiting facilities, external monitoring. Second, There was a difference of facilities infrastructure and workers of treatment condition long-term care facilities each other countries. So It is important to improve facilities infrastructure and workers of treatment condition. Third, It is necessary to consider traits of elderly in long-term care facilities. Especially, it is required to manage dementia elderly and elderly on night time in long-term care facilities. Finally, implications and future directions of policies of elderly abuse of long-term care facilities were discussed based on the finding of the study.

• 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.

• Health Policy and Management
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• v.22 no.4
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• pp.522-537
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• 2012

The purpose of this study was to analyze the level of the cognitive function and activities of daily living of the beneficiary older adults at home based on Korean Long-term Care Insurance System. A cross-sectional descriptive survey was conducted from November 2010 to May 2011, the final respondents were 1,026 beneficiary older adults taking home visit care covered in Korean long-term care insurance system. The questionnaire included general characteristics of subjects, cognitive function, ADL(Activity of daily living). The data was analyzed using the SPSS 20.0 version. There was significant difference in cognitive function and ADL between 1st Grade, 2nd Grade and 3rd Grade of long-term care classification. The correlated factors of cognitive function were ADL, long-term care grade, disability of arm and leg, limitation of joint, bed sore and tube feeding. The correlated factors of ADL were cognitive function, long-term care grade, disability of arm and leg, bed sore and tube feeding. This study suggests that cognitive functions have to be mainly considered in long-term care grade. It is necessary to make an effort to develop long-term care grade in Korean long-term care insurance system an cognitive function improvement program for the beneficiary older adults. Above all things government will be seriously contemplating of revise contents for long-term care grade to provide quality of care for the older adults.

• 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.