Equity of access under Korean national long-term care insurance: implications for long-term care reform.

Ju Moon Park

doi:10.1186/s12939-015-0210-y

Ju Moon Park

Open Access

https://doi.org/10.1186/s12939-015-0210-y

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Abstract

BackgroundThe national long-term care insurance was implemented in July 2008. Few studies have been conducted with representative national survey data since the long-term care insurance was introduced. Therefore, this study examines the extent to which equity in the use of long-term care has been achieved in Korea.MethodsThe Aday-Andersen model was used as a conceptual model, based on the Korean Health Panel Study which was conducted in 2011. Descriptive and logistic regression analysis was performed to examine the relationship between the dependent and independent variables and the relative importance of factors as predictors of utilization.ResultsThe results of this study indicated that those who rated his or her health to be fair, good, and very good, had no limited activities, were disabled, and had insurance coverage were more likely to use long-term care services, respectively. Their decision to use long-term care was primarily affected by need (health status, limited activity, disability) and enabling (insurance coverage) factors. The findings also indicated that the introduction of a national long-term care insurance program did not yield a fully equitable distribution of services.ConclusionsLong-term care reforms in Korea should continue to concentrate on expanding insurance coverage and reducing the inequities reflected in disparities in consumer cost-sharing and associated patterns of utilization across plans. The subsequent impact on managed care and expenditures need to be more fully understood.

Highlights

The national long-term care insurance was implemented in July 2008
Study sample The present study focuses on cross-sectional analyses, using the Korea Health Panel Survey (KHPS), which was released to the public in 2014
This study suggests that two main policy implications for long-term care reform in Korea may be drawn from the findings reported upon here: (a) a “universal” national insurance plan does not insure that everyone has access to care, and (b) a mixed public and private system is likely to produce wide variability in both the scope of plan benefits and the burden of consumer cost-sharing

Summary

Introduction

The national long-term care insurance was implemented in July 2008. Few studies have been conducted with representative national survey data since the long-term care insurance was introduced. The Korean long-term care insurance covers two categories of service benefits: home care and institutional care [3,4,5]. It is possible to choose between institutional care and home-care if one is eligible for long-term care insurance benefits. The long-term care insurance provides coverage for individuals aged 65 or older and those below 65 with debilitating conditions, along with eligibility test through the national care needassessment system [3]. Those younger than 65 years of age suffering from a senile disease may be recognized as those requiring long-term care, and they accounted for 7.4 % of persons in need of long-term care as of June 2011 [6, 7]. In order to be eligible for the long-term care insurance benefit, the insured persons request a care needs assessment from the National Health Insurance

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