Aim To examine whether long-term care insurance (LTCI) reduces medical utilization and the burden of medical costs of beneficiaries. Methods The elderly cohort database of the National Health Insurance Service during 2005-2013 was used. The participants were 3029 beneficiaries who received consecutive LTCI services. We carried out a 1:3 case-control match on the propensity score to select a comparison group, and the final participants were 12 116 people, including 9087 who formed the control group. The dependent variables were semi-annually measured medical utilizations (inpatient, outpatient and drug prescription) and the burden of medical costs at the individual level. This study applied the method of generalized estimating equations to the data. Results The present study showed that the number of hospitalizations of beneficiaries significantly decreased compared with non-beneficiaries (ratio 0.95, 95% CI 0.95-0.96). Similarly, the length of stay of beneficiaries also showed a significant reduction compared with non-beneficiaries (ratio 0.76, 95% CI 0.73-0.79). The number of outpatient visits and receipt of drug prescriptions of beneficiaries and non-beneficiaries increased marginally. The burden of medical costs of beneficiaries reduced considerably compared with non-beneficiaries (ratio 0.80, 95% CI 0.77-0.83). Conclusions The study results show that the burden of medical costs for LTCI beneficiaries were significantly reduced compared with non-beneficiaries, despite the rise in medical costs among older adults. The positive effect of LTCI supports continuous implementation and expansion of the LTCI service for non-beneficiaries who require care assistance. Geriatr Gerontol Int 2018; 18: 1641-1646.

Does long-term care insurance reduce the burden of medical costs? A retrospective elderly cohort study.

Notes that chronically ill people who are uninsured have higher out-of-pocket medical spending and are five times less likely to see a physician than their insured counterparts.

OutofPocket Medical Spending for Care of Chronic Conditions

The purpose of this study is to investigate the factors affecting family caregiver financial burden of out-of pocket expenses for the nursing home service under Long-term Care Insurance System. We conducted a national cross-sectional descriptive survey from July to September 2010 to collect data based on the long-term care benefits cost specification. Total 1,016 family caregivers completed questionnaires. 185 subjects of total were excluded from the data analysis due to being answered by user(18 cases), or caregivers not to pay for services expenditures(122 cases), having a missing data on family caregivers characteristics(45 cases). Finally, 831 subjects were included in the study. The average financial burden was 3.18(). We divided subjects into two groups by level of burden, high-burden group and low-burden group. In the result of the multiple logistic regression analysis, family caregiver financial burden was significantly higher in family caregivers with ages 40 to 49 compared to less than 40, lower educational level, unsatisfaction for long-term care service, high percentage(more than 50%) of cost-sharing and high total out-of pocket expenses(more than 300,000 won) for long-term care services. Also, Family caregivers who are spouse felt higher financial burden compared to son. This study is meaningful as the first attempt to measure family caregiver financial burden for long-term care service and to identify factors affecting the financial burden. Family caregivers felt financial burden of out-of pocket expenses for the nursing home service. The policy makers, the insurer, and the providers need to pay attention to ease family caregiver financial burden.

Factors Related to Family Caregiver Financial Burden of Out-Of Pocket Expenses for the Nursing home service under Long-term Care Insurance System

The purpose of this study is to investigate the burden of caring for the care-givers of the elderly in Korea by using an integrated literature review method. A total of 23 studies were analyzed using a search database. When care-givers had higher sense of filial and guilt or more than two diseases, they showed high level of feeling of burden. Also, they had high level of feeling of physical burden by their oldness, service period (especially at the period of 1-3 years). In the feeling of economic burden, they had high level of feeling of burden by their oldness, or elderly’s disease periods. The feeling of burden by psychological condition was found in elderly in aged and the beginning of admission of nursing home. The feeling of burden by environment situation was found when the functional status of the elderly was bad. Therefore, we need to concern care-givers’s feeling of burden with elderly people in the nursing home. In the future, I believe that the findings of this study will be helpful for development of the intervention program for alleviate burden for the care-giver.

An Integrated Review on Main Caregiver’s Burden of Elderly in Korean Nursing Home

Factors to influence the family caregivers’ burden with the community-dwelling elderly under long-term care insurance system: comparison among sub-dimensions

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’ bur-den 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 (±6.12). In multiple regression analysis, there were statistically significant fac-tors affecting on the family caregivers’ burden, that are related to background and context (region, living status, education level, relation-ship 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.Keywords: Family caregivers; Burden; Elderly; Long-term care insurance

/pdf/factors-related-to-family-caregivers-burden-with-the-6qyu0eep35.pdf

Factors Related to Family Caregivers' Burden with the Community-Dwelling Disabled Elderly under the Long-Term Care Insurance System

Doctors and Nurses' Perceptions of Tele-consultation in Long Term Care Institutions in South Korea Kwon, Jinhee · Lee, Jungsuk · Jang, Hyemin · Hwang, Rahil Senior Research Fellow, Health Insurance Research Institute, National Health Insurance Service, Wonju Researcher, Health Insurance Research Institute, National Health Insurance Service, Wonju Professor, Department of Nursing, Shinhan University, Uijeongbu, Korea

/pdf/doctors-and-nurses-perceptions-of-tele-consultation-in-long-1abbahjrqd.pdf

Doctors and Nurses' Perceptions of Tele-consultation in Long Term Care Institutions in South Korea

National Health Insurance Service(NHIS) provide care-plans for beneficiaries in the long-term care insurance(LTCI) systems that help them use LTC services appropriately. The care-plan includes recommendations for the most adequate type of care (gold standard) for beneficiaries. This study develops a decision-support system to determine the appropriate type of care plan. To develop a model, we used a data set that welltrained assessors in the NHIS investigated as a gold standard for beneficiaries: nursing home care, home-visit care, home-visit bathing, home-visit nursing, or day and night care. The decision-support system was established through a decision-tree model, because it may be easy to explain the algorithm of a decision-support system to working groups and policy makers. Our results might be useful in evidence-based care planning in an LTCI system and contribute to the efficient use of LTC services.

/pdf/a-decision-support-system-for-care-plan-in-long-term-care-440lj9lffa.pdf

A Decision-support System for Care Plan in Long-term Care Insurance

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.

A study on the present status and improving management of the non-eligible people in Korean long-term care insurance system

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