• 보건행정학회지
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• 제23권2호
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• pp.132-144
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• 2013

Background: The purpose of this study was to analyze the medical expense change and influencing factors after introducing longterm care insurance system. The study period was 2 years before and after introduction of the system. Methods: We analyzed data collected from two divided group lived in Incheon. Four hundred and eighty-five elderly who received long-term care wage for one year were selected for experimental group. For control group, 1,940 elderly were selected by gender and age stratified random sampling. Difference-In-difference analyses was used for evaluating policy effectiveness. Also multiple regression analyses were conducted to identify the factors associated with total medical expenditures. The control variables were demographic variables, economic status, diseases, and medical examination variables. Results: Difference-in-difference analyses showed that total average medical expenses among long-term patients has decreased by 61.85%. Of these, the hospitalization expenses have decreased by 91.63% and the drug expenses have increased by 31.85%. Multiple regression analyses results showed that total average medical expenses among long-term patients have significantly decreased by 46.5% after introducing the long-term care insurance. The hospitalization expenses have significantly decreased by 148.5%, whereas the drug expenses have increased by 53.6%. And outpatient expenses have increased by 10.4%, but the differences were not statistically significant. Conclusion: The results showed that total medical expenses and hospitalization expenses have decreased after introducing the long-term care insurance. These results could support the opinion that the health insurance spending among long-term patients will be reduced gradually by long-term care insurance through changing medical demand.

• 가정∙방문간호학회지
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• 제26권3호
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• pp.253-264
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• 2019

The aim of this review is to present a German system of an outpatient care center under the German Health Insurance Act and home care (integration of medical care, basic care, bathing) under the Long-Term Care Insurance Act. This idea of a German integrated home care system should contribute to the development of a Korean home care model. Prior the introduction of long-term care insurance (1995), and with the of the health insurance law (1989), German outpatient care centers already provided medical and basic care services for patients with acute and chronic symptoms. Since 1995, patients with acute symptoms and rehabilitation periods under the Health Insurance Act have been eligible for home care. The Long-Term Care Insurance Act is intended for all citizens who are unable to carry out their daily activities for more than six months. In 2017, 13,657 (97%) of 14,050 outpatient care centers provided home care services after long-term care and health insurance. In other words, patients in Germany can use home care in both the acute and chronic phase at the same home care center, or 'integrated home-care center'.

• 한국사회복지학
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• 제66권2호
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• pp.5-29
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• 2014

본 연구는 사회학적 신제도주의 관점에서 노인장기요양서비스를 제공하는 조직들이 평가제도를 어떻게 채택하고 집행하는지를 동형화와 분리현상으로 해석하였다. 이를 위해 장기요양서비스를 제공하고 있는 7개 기관을 대상으로 심층인터뷰를 한 자료를 질적 내용분석 하였다. 분석결과, 평가제도가 장기 요양기관의 공식적인 구조에 있어서는 동형화를 이끄는 것으로 나타났다. 그러나 장기요양기관 평가제도가 의도한 공급기관 간 경쟁을 통한 효율성을 촉진하는 방식으로 채택되기보다, 정부자원에 의존하기 위해 강압적으로 평가제도를 채택하는 것으로 나타났다. 이러한 결과는 평가제도가 정부규제에 의해 장기요양서비스를 표준화하는 양상으로 집행되고 있음을 확인시켜주었다. 또한, 동형화에 수반되는 조직의 공식구조와 실제 활동의 분리현상도 부분적으로 관찰되었다. 무엇보다 분리현상은 정부역할로서 조직의 이중구조에서 발생할 수 있는 비효율성의 문제를 개선할 수 있는 평가체계의 운용이 요구되며, 특히 돌봄 서비스의 고유성을 반영한 평가지표에 대한 개선이 시급함을 보여준다.

• 한국노년학
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• 제38권3호
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• pp.453-466
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• 2018

본 연구의 목적은 정책 비교를 통한 한국의 장기요양보험 제도가 중국 청도의 장기요양보험 시스템 구축에 미치는 영향과 시사점을 검토하는데 있다. 중국과 한국의 문화배경, 생활습관 및 인구구조 등 다양한 측면에서 매우 유사하여 한국 장기요양보험의 성공적인 경험은 중국 청도의 장기요양보험 제도를 구축하는 데 큰 도움이 될 것으로 판단된다. 이에 본 연구는 문헌연구를 통해 Gilbert & Terrell의 사회복지정책분석 프레임워크에서 청도와 한국의 장기요양보험 정책을 비교해 보았다. 정책비교를 통해 청도의 현재 시범 정책 문제점들로 입법 지원 부족, 재정 독립 그리고 심사 기준 등이 명확하지 않고 인적자원 부족을 논의하였다. 이에 다양한 차원에서의 정책비교를 통해 법제 지원, 평가기준 상세화, 혜택범주 확대화, 서비스네트워크 강화, 재원 최적화를 위해 청도의 장기요양보험 개선 제안들을 결론으로 제시해 보았다.

• 보건행정학회지
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• 제32권3호
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• pp.258-271
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• 2022

The rapidly aging trend of Korea is a major factor that threatens the sustainability of the long-term care insurance system. Therefore, looking at how Japan and Germany mitigated the financial burden when they managed similar long-term care insurance systems will provide important implications for improving the Korean system in the future. The study was conducted using the literature review method, and the "country" was set as a unit for the case analysis. The three countries selected are Korea, Japan, and Germany. Recently in Korea, the insurance premium rates of all subjects have been rapidly rising, which can exacerbate the issue of intergenerational equity. On the other hand, Japan has responded to the aggravating finances for long-term care insurance due to aging by raising coinsurance for selected groups like the wealthy elderly. Germany is selectively raising the insurance premium rates by additionally increasing the premium rate for childless recipients. A more preventive and quality-oriented care service plan can be promoted by referring to the recent changes in Japan and Germany. In addition, a more effective and selective increase in payment burden in Japan and Germany could be considered in response to a recent equity issue in Korea.

• 가정∙방문간호학회지
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• 제27권3호
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• pp.241-249
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• 2020

Purpose: This study aimed to investigate possible ways to expand the services of home-visit nursing through a review of the progress, achievements, and obstacles of home-visit nursing; a pilot project of an integrated home-service; the application of the Omaha System; as well as a case analysis of providing home-visit nursing services. Method: An integrated review was conducted using various source materials, including laws, previous studies, and a case analysis. Results: In case analysis of providing visiting nursing service, rehabilitation nursing, end-of-life nursing, and dementia care showed high nursing needs. It was necessary that the various home visit nursing services in the intervention area of the Omaha System, administrative services, case management, and center operation activities were all included in the payment systems of long-term care insurance. Conclusion: In the future, home visit nursing services of long-term care insurance should be reborn in the form of a center for integrated case management in the community, which would set long-term goals until the time of a client's death and encompass the realm of human rights for health, quality of daily life, and a dignity of life.

• 대한간호학회지
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• 제34권2호
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• pp.278-289
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• 2004

Purpose: The purpose of this study was to classify the elderly in long-term care facilities using the Resource Utilization Group(RUG-III) and to examine the feasibility of a payment method based on the RUG-III classification system in Korea. Method: This study measured resident characteristics using a Resident Assessment Instrument-Minimum Data Set(RAI-MDS) and staff time. Data was collected from 530 elderly residents over sixty, residing in long-term care facilities. Resource use for individual patients was measured by a wage-weighted sum of staff time and the total time spent with the patient by nurses, aides, and physiotherapists. Result: The subjects were classified into 4 groups out of 7 major groups. The group of Clinically Complex was the largest (46.3%), and then Reduced Physical Function(27.2%), Behavior Problems (17.0%), and Impaired Cognition (9.4%) followed. Homogeneity of the RUG-III groups was examined by total coefficient of variation of resource use. The results showed homogeneity of resource use within RUG-III groups. Also, the difference in resource use among RUG major groups was statistically significant (p<0.001), and it also showed a hierarchy pattern as resource use increases in the same RUG group with an increase of severity levels(ADL). Conclusion: The results of this study showed that the RUG-Ill classification system differentiates resources provided to elderly in long-term care facilities in Korea.

• Communications for Statistical Applications and Methods
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• 제28권4호
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• pp.393-410
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• 2021

The Korean Long-Term Care Insurance (K-LTCI) provides financial support for long-term care service to people who need various types of assistance with daily activities. As the number of elderly people in Korea is expected to increase in the future, the demand for long-term care insurance would also increase over time. Projection of future expenditure on K-LTCI depends on the number of beneficiaries within the grading system of K-LTCI based on the test scores of applicants. This study investigated the suitability of mixture distributions to the model K-LTCI score distribution using recent empirical data on K-LTCI, provided by the National Health Insurance Service (NHIS). Based on the developed mixture models, the number of beneficiaries in each grade and its variability under the current grading system were estimated by simulation. It was observed that a mixture model is suitable for K-LTCI score distribution and may prove useful in devising a funding plan for K-LTCI benefit payment and investigating the effects of any possible revision in the K-LTCI grading system.

• 가정∙방문간호학회지
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• 제14권2호
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• pp.98-105
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• 2007

Home health care system in Korea has been classified into three types of home care programs based on different laws and regulations; for example, home health care nursing(HHCN) is based on medical laws, visiting health care nursing (VHCN) is based on long-term health care insurance, and visiting health care(VHC) is based on the regional health care act. HHCN in Korea has taken on an important role under the mandate of the national health care system since 2000. VHCN will commence its role under the long term health care insurance system in 2008. The strengthening of VHC commanded health promotion and prevention for vulnerable families in the community in 2007. This is an important turning point for increasing quality management for home health care program; it suggests certain possibilities for building a foundation for further changes in the service delivery structure. Accordingly, the home health care policy makers in Korea have a major function and role that consists of developing an agenda and alternatives for policy making in a systematic manner and clearly presenting implementation strategies for elderly health care system.

• 대한간호학회지
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• 제40권3호
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• pp.349-358
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• 2010

Purpose: The purpose of this study was to estimate nursing costs and to establish appropriate nursing fees for long-term care services for community elders. Methods: Seven nurses participated in data collection related to visiting time by nurses for 1,100 elders. Data on material costs and management costs were collected from 5 visiting nursing agencies. The nursing costs were classified into 3 groups based on the nurse's visit time under the current reimbursement system of long-term care insurance. Results: The average nursing cost per minute was 246 won. The material costs were 3,214 won, management costs, 10,707 won, transportation costs, 7,605 won, and capital costs, 5,635 won per visit. As a result, the average cost of nursing services per visit by classification of nursing time were 41,036 won (care time <30 min), 46,005 won (care time 30-59 min), and 57,321 won (care time over 60 min). Conclusion: The results of the study indicate that the fees for nurse visits currently being charged for long-term care insurance should be increased. Also these results will contribute to baseline data for establishing appropriate nursing fees for long-term care services to maintain quality nursing and management in visiting nursing agencies.