노인장기요양보험 이용현황과 제도확대방향의 모색

Korea is expected to have a steady increase in the number of elderly people who are in need of care and special care such as dementia and stroke, as the number of aging population is increased. Therefore, to stabilize supply and demand of long-term care professionals and to improve the quality of long-term care services, it is imperative that measures are taken to train long-term care professionals and diversify the care personnel system. The purpose of this study is to propose a new qualification system for securing the expertise of long-term care professionals and young long-term care professionals in Korea. This study examines both Korean and German case studies on long-term care professionals, including related literatures, regulations and statistical data. It examines the situation of long-term care professionals and their education system in Korea, and also explores the system of long-term care worker and their training system in Germany. For the training of professional care personnel, it is necessary to classify long-term care worker into care worker manager as professional workforce and care worker. Care worker manager get national certifications when they successfully complete a care curriculum at college or university where professional education is available. For this purpose, long-term care-related curriculum for social worker, health and nurse care is opened. Their main tasks include the provisions of basic long-term care services as well as care service guidance for care worker, case managements and counseling support. The introduction of a professional care worker training system enables the provision of high-quality services through the acquisition of long-term care professionalism. They are required for the increasingly diverse and complex long-term care. Also, the divisions of long-term care tasks can help relieve the burden of long-term care workers and improve their treatment of labor. This specialization of the long-term care services can also contribute solving the current aging problem of the care workers by expanding the participation opportunity of the young people, and improving their negative images and treatments.

Due to the trends of the increase in life expectancies and decrement in fertility rates, the world population is moving towards becoming an ageing nation. With the rise in the number of older people, the demand for long-term care services is expected to increase. Long-term care services are ubiquitous in the developed country, especially in the European region as the countries have become the aged nations. Apart from that, the cost for long-term care services differs for individuals based on the level of needs and the service provider, either public or private nursing home for long-term care. Due to the growing cost of long-term care services, a long-term care insurance policy may be seen as an alternative to covering the cost of long-term care services because the risk is mitigated for individuals. However, most Asian countries are not familiar with the long-term care insurance policy as there is no specific insurance policy for long-term care services offered yet in these countries. The essential factor in constructing a long-term care insurance policy is to identify the risks that are insurable to be included in the policy to be used later for pricing long-term care insurance policy in Malaysia. This study provides an in-depth review and understanding of the insurable risks associated with long term care insurance in European and Asian countries.

Utilization of long-term care services under the public long-term care insurance program in Korea: Implications of a subsidy policy

The importance of having access to care options and being able to finance this has been laid bare through the experience of the COVID-19 health emergency. While most countries have public options for long-term care and health care, these are not always comprehensive and may not support the needs of the community. Having long-term and health care options that are affordable are important public policy considerations, especially when ageing is affecting many OECD countries and morbidity is impacting health outcomes. Private insurance can extend care options, and provide additional services that may not always be available through the public sector. However, insurance is not uniformly offered across countries, especially given the differences in the public system, and the manner in which it is made available will differ as well.This report examines selected countries that have characteristics in their long-term care and/or healthcare system, which may facilitate the use of private insurance to support the provision of public health and long-term care services.

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) andthe 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.

Background. A new public long-term care (LTC) insurance was launched in 2000 in Japan. However, there have been few studies involving factors that increase LTC costs of demented subjects; no follow-up studies involving the Government-Certified Index (GCI) and requisite costs related to the causes of dementia. Method. An epidemiological survey was conducted in a rural area in Japan in 1999, and 271 subjects were diagnosed as dementia patients. Age, sex, mini-mental state examination, clinical dementia rating, activity of daily living, causes of dementia, and coexisting physical disease were confirmed. After the LTC insurance has been launched, we tracked the GCI stages and payment amounts every month for 8 years. Result. 209 subjects were certified to be eligible for LTC insurance; however, 13 did not receive any payment. Only 49 out of 209 were alive after the follow-up period. The most common cause of dementia was Alzheimer's disease (AD), followed by vascular dementia (VaD). There was no significant difference between the mortality rates of the two groups. VaD subjects required higher costs than AD subjects in the total certified period and in GCI stage 5. Conclusion. Our results indicate that causes of dementia can have an impact on the requisite costs for the LTC insurance.

隨著總生產率下降、人口成長率下降與平均餘命的延長，台灣的65歲以上老年人口早於民國82年達到人口老化國家門檻的7%，預計民國107年達高齡社會的14.7%，民國117年達超高齡社會的22.5%。伴隨人口結構的快速高齡化、家庭照顧功能的消失與失能失智人口的增加，以生活照顧而非醫療治病為主的長期照護(長照)保險制度即將成為我國社會福利的另一主幹。 從目前我國長照保險規劃報告，我們可以歸納以下的重點。長照的對象應該是65歲以上日常生活與工具性日常生活失能的老人、失智者與身心障礙者。長照的納保原則上會比照健康保險，以全民為對象。長照的傳遞，將由相關之保險局負責從申請、訪視評估與需求判定，而照顧計劃之擬定以及執行則希望由地方政府完成，以達因地制宜效果。財務規劃上，根據實際調查預估之失能人口、照護分級(需支援、需照護一、二、三級)以及現今十年長照計劃使用率，民國100年，110年及120年之高推估保險總費用將達GDP之0.75%，0.97%及1.25% (低推估為0.36%，0.46%及0.61%)，但是給付卻上限遠低於德國、日本，甚至南韓。 針對這份長照保險草案，個人認為可以從服務策略看到在未來長照服務執行上，確實存在顧客期望差距的知識缺口、自以為是的標準訂定缺口、實務輸送服務的輸送缺口、服務提供與行銷的溝通缺口乃至可能的顧客實際感受差距的服務缺口。其中，尤其是服務提供人員的素質、訓練與理念奠定，將是長照服務能否成功的關鍵。為求補強服務策略分析上的弱點，個人認為可以從照服員與照管專員等第一線人員的專業訓練課程標準化與在職評估制度化，來強化人力資源。財務規劃上，更須依照工作內容與實際付出，提昇給付上限與支付標準，強化長照從業者的工作尊嚴與工作控制感，清晰其社會角色地位，當更有助於我國未來推動全面的長照保險。

Introduction: In Japan, since the Long-Term Care Insurance launched in 2000, elderly care has been supported with both medical and long-term care insurance, based on the community-based integrated care system aiming at living in the community to the end of lives. Medical expenses per person aged 75 and older show a decrease from US $8,192 in 1999 to US $7,197 in 2002, however, they gradually increased to US $9,352 in 2019. The long-term care costs also increased from US $4,248 in 2006 to US $5,182 in 2021. Meanwhile, the proportion of deaths in hospitals decreased from 82.4% in 2005 to 67.4% in 2021, showing a shift towards non-hospital settings. (US $1.00 = 102 Japanese yen) Aims, Objectives, Methods: This study focused on the last 5 years of life for 96 individuals aged 75 and older. They received their initial long-term care certification after 2016 and died during the fiscal year 2021. These individuals lived in a small rural municipality with a population of less than 20,000, an aging rate of 37.9%, and a long-term care certification rate of 19% in Japan. Individually, we linked medical fees and records of the long-term care insurance. Ultimately, we identified the location of end-of-life care. Subsequently, we categorized individuals with hospitalization expenses in the last month as ‘hospital-deaths’, while those without hospitalization expenses as ‘community-deaths’. Highlights, Results, or Key Findings: The average total care costs over the last five years amounted to US $116,241, including hospitalization expenses of US $55,250, outpatient expenses of US $25,997, and long-term care costs of US $34,995. The 80-84 age group had the highest total care costs. Places of death comprised 62.5% in hospital-deaths and 37.5% in community-deaths. The final severity of care required (range 0-5) for community-deaths was significantly higher at 3.5, compared to 2.9 for hospital-deaths. The residency at care facilities was significantly longer for community-deaths (8.4 months) than hospital-deaths (3.8 months) . Total care costs were markedly elevated for hospital-deaths, reaching US $129,830, in contrast to US $93,594 for community-deaths. Especially in the last month, total care costs were significantly higher, reaching US $7,616 for hospital-deaths and US $2,796 for community-deaths. Conclusion: This study examined the total care costs for elderly people with long-term care certification in a small municipality over the five years before death and analyzed the places of end-of-life care. The final severity of care required in community-deaths was significantly higher than that in hospital-deaths and the duration of residency in care facilities was significantly longer. This suggests that elderly people with substantial care and medical needs lived in the community to the end of lives. Meanwhile, the total care costs during the last five years were higher in hospital-deaths, particularly in the last month before death. In Japan, the community-based integrated care system since 2006 has facilitated end-of-life care in long-term care services and changed the situation where hospital deaths accounted for over 80% in 2005. This system appears to have gradually improved.

Has the long-term care insurance resolved disparities in mortality for older Koreans? examination of service type and income level

In comparison to residential care services, home and community care services in Hong Kong remain underfunded and underdeveloped. The government's long-term care policies have resulted in an overreliance on subsidized long-term care services in the form of institutional care services. The quality of services offered by private residential care facilities is a cause for concern. Population aging, evolving family structures, and changes in residential living patterns are expected to continue to put a strain on resources for services for the elderly in the near future. This article provides an overview of the many issues surrounding long-term care in Hong Kong and offers potential directions for the future development of long-term care services.

Disagreement between a public insurer’s recommendation and beneficiary’s choice of long-term care services in Korea

Background: This study examined the relationships of dementia, stroke, and combined multimorbidity with long-term care utilizations among older people in South Korea. Methods: A nationally representative sample of 10,130 older adults who used long-term care services in 2010 were analyzed. We used the 5% sample of aged 65 years or older linked with National Health Insurance Corporation registry data of long-term care insurance system. The sample was categorized into three groups: dementia only (47.6%), stroke only (36.3%), and both dementia and stroke (16.1%). We estimated the use of institutional care, home care, and total expenditure of long-term care services, adjusting for the severity of each function (such as daily life, behavior or cognitive change, nursing care needs, and rehabilitation care needs) and sociodemographic characteristics. Results: Having dementia symptoms was positively associated with the use of institutional care services, on the other hand, having stroke symptoms was positively related with the use of home care. The total long-term care cost was higher in the group of having both dementia and stroke. Conclusion: Older persons with dementia symptoms and stroke symptoms have different patterns of long-term care utilization, and the multimorbidity increased the overall expenditure of long-term care utilization. These findings imply a need for differentiated management strategy targeting physically and cognitively impaired older persons, and special concerning for persons with multimorbidity conditions for long-term care insurance program in Korea.

BackgroundIt is unclear how formal long-term care (LTC) availability affects formal /informal caregiving patterns and caregiver health. We tested the impact of reduced formal LTC availability on formal LTC service use, intensity of informal caregiving, and caregiver health.MethodsUsing a representative, repeated cross-sectional sample of Japanese caregivers providing care to co-resident family members from 2001 to 2016, we applied a difference-in-differences approach by observing caregivers before and after the major reform of the public Japanese LTC insurance (LTCI) in 2006. The reform reduced coverage benefits for non-institutionalized older persons with low care needs, but not for those with high care needs. We analyzed 12,764 caregivers aged ≥30 years (mean age 64.3 ± 11.8 years, 73.5% women) and measured indicators of formal LTC use, hours of informal caregiving, and caregiver self-reported health outcomes after propensity score matching to balance caregivers’ background characteristics.ResultsWe found the 2006 LTCI reform relatively reduced the use of formal LTC services and relatively increased the percentage of experiencing long hours of informal caregiving (> 3 h per day) among the caregivers for seniors with low care needs compared to those for seniors with high care needs. The effects of the LTCI reform for the caregivers for seniors with low care needs were 2.2 percentage point higher on caregivers’ experiencing poor self-rated health (95% confidence interval [CI]: 0.7–3.7; p = 0.01), 2.7 percentage point higher on experiencing symptoms of a depressive state (95%CI: 0.5–4.8; p = 0.03), and 4.7 percentage point higher on experiencing symptoms of musculoskeletal diseases (95%CI, 3.6–5.7; p < 0.001), compared to those for seniors with high care needs.ConclusionsReduced formal care availability under the Japanese LTCI reform increased hours of informal caregiving corresponding to reduced use of formal LTC and deteriorated multiple dimensions of caregiver health. Our findings may highlight the importance of enhancing the availability of formal LTC services for caregiver health.

BackgroundChinese government launched a pilot study on public long-term care insurance (LTCI) recently. Guangzhou is one of the fifteen pilot cities, officially started providing LTCI in August 2017. An in-depth analysis of experimental data from the pilot city may provide suggestions for developing a fair and effective LTCI system. This study aimed to evaluate the LTCI pilot by exploring the characteristics and care needs of claimants, and performance of the assessment tool.MethodsA retrospective cross-sectional study in which claims data between July 2018 and March 2019 in the Guangzhou pilot was analyzed. LTCI claimants during the study period were included. The care needs were determined based on claimants’ physical function assessed by the Barthel Index and their medical conditions. Rasch analysis was used to explore the performance of the Barthel Index.ResultsAmong 4810 claimants included, 4582 (95.3%) obtained LTCI benefits. Of these beneficiaries, 4357 (95.1%) were ≧ 60 years old, and 791 (17.3%) had dementia. Among 228 (4.7%) unsuccessful claimants, 22 (0.5%) had dementia. The prevalence of stroke was high in beneficiaries with (38.1%) or without dementia (56.6%), as well as in unsuccessful claimants with (40.9%) or without dementia (52.4%). Beneficiaries without dementia needed more support for basic activities of daily living and nursing care than those with dementia, while beneficiaries with dementia were more likely to be institutionalized. Five (22.7%) unsuccessful claimants with dementia and 48 (23.3%) unsuccessful claimants without dementia were disabled in at least two basic self-care activities. Regarding Barthel Index, Rasch analysis showed threshold disordering in “mobility” and “climbing stairs”, and the narrow interval was observed between all the adjacent categories of the ten items (< 1.4 logits).ConclusionsStroke and dementia were two common reasons for needing long-term care in LTCI claimants. The Barthel Index is not suitable for assessing and dividing LTCI claimants, because of inappropriate items and narrow category responses. A comprehensive assessment and grading system is required, together with needs-led care services. The eligibility should be expanded gradually based on balance finance solutions.

Long-term health care in Greece is covered by a variety of health structures. In contrast to other northern European countries, it is incomplete and fragmented or even absent. The demand for long-term care has been addressed through informal caregiving, provided by family members supporting voluntarily or caregivers getting informal compensation. In recent years, efforts have been made to restructure long-term health care and to introduce services and structures that are conducive to this purpose. In our country there is no corresponding planning or any support for informal care. The provision of informal care has multiple benefits, mainly financial and organizational, for patients, health systems and the state. Compared to Greece, other European countries support informal care through various financial, insurance and social benefits for its providers, thus favoring and facilitating their work. Given that the need for long-term health care and, by extension, the need for informal care will increase continuously and exponentially over time, it is important to recognize and meet the needs of informal caregivers and to formalize this form of care provision. The development of a policy of formal recognition of informal care and the establishment of supportive measures, such as financial assistance, insurance, and education will ensure the sustainability of long-term health care and the health system in general.