장기요양서비스 수요의 결정요인
Determinants of Demand for Long-Term Care
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본 논문은 65세 이상 고령인구의 수와 노인들의 건강상태 등만을 중심으로 한 기존의 연구에 더하여, 노인장기요양보험제도 제2차 시범사업의 자료를 이용한 계량분석을 통해 장기요양서비스 수요의 결정요인을 분석하였다. 분석 결과에 따르면, 우선 노인장기요양보험제도상 장기요양서비스 이용에 대한 보험 적용 대상자를 정하는 등급판정에 일상생활활동에서의 장애가 노인들이 많이 앓고 있는 고혈압, 관절염, 치매 등의 질환을 통제하고서도 통계적으로 유의한 영향을 미쳤다. 또한 노인들의 건강상태, 여성, 기초생활수급자 여부, 노인가구 형태, 노인가구의 월평균 소득 등이 장기요양서비스 이용 및 이용 양태에 통계적으로 유의한 영향을 미치는 것으로 나타났다. 특히, 노인가구의 월평균 소득을 통제하고서도 장기요양서비스를 무료로 이용할 수 있는 기초생활수급 대상 노인들의 재가서비스 이용확률이 높게 나타나는데, 이는 소득과 더불어 장기요양서비스의 가격도 장기요양서비스 이용을 결정하는 중요한 요인임을 의미한다.
Abstract
A new public insurance for long-term care was introduced in July 2008 to provide for the rising demand for long-term care as the population is aging rapidly. The demand for long-term care is expected to rise further because more and more elderly are living alone or in households with only other elderly, such as his/her spouse, without informal care of their adult children. Even when the elderly are living together with their adult children, daughters and daughters in law, once the main informal care-givers, are not available because they choose to become economically active and work more over time. Experiences of countries such as Japan and Germany with similar public long-term care insurance scheme highlight the importance of detailed analysis on the demand for long-term care for the financial stability of the insurance scheme. Countries which had underestimated the demand for long-term care at the time of adopting the scheme went through financial instability of insurance schemes. This study analyzes the determinants of the demand for long-term care using data from the second demonstration project (April 2006~April 2007) of the long-term care insurance scheme for the elderly in Korea. Taking full advantage of detailed data on the long-term care, this paper analyzes the eligibility for the long-term care insurance scheme and its use. According to study results, even when common diseases among the elderly such as cancer, diabetes, arthritis, dementia, hypertension, etc. are controlled together with other individual and socioeconomic factors, limitations the elderly are faced with in their twelve activities of daily living significantly affect the eligibility for the Korean Long-term Care Insurance Scheme. This means that limitations in daily living activities are more critical than common diseases among the elderly are to the eligibility for the Korean Long-term Care Insurance Scheme. Bathing and toileting problems have been found to be the most important factor affecting the eligibility for the insurance scheme, followed by eating, dressing and moving around inside the house. Moreover, the choices of whether to use long-term care and which to use between home care and institutional care are found to be significantly influenced by health status and various socioeconomic factors of the elderly. In particular, those with more limitations in daily living activities and the female elderly are more likely to use long-term care and institutional care rather than home care. As for home care users, those living alone or with adult children and those with monthly household income of more than 500,000 won are more likely to use home care. Most importantly, even when the monthly household income of the elderly is controlled, the elderly recipients of the National Basic Living Security, who are not charged for long-term care, are more likely to choose home care. This implies that price as well as income is a critical factor for the decision to use long-term care. Further study on the duration of long-term care use will surely enhance the long-term care policy, when panel data is available for simultaneous analysis of the likelihood of long-term care use and its use duration.
참고문헌 (44)
- 국민건강보험공단, "노인장기요양보험제도 2차 시범사업 운영결과", ~ (2007)
- 노인수발보험제도 시범사업 평가연구(1차), "선우덕", 보건복지부․ 한국보건사회연구원, ~, pp.정책보고서 2006-17 (2006)
- 노인장기요양보험제도 시범사업 평가연구(2차), "선우덕", 보건복지부․ 한국보건사회연구원, ~, pp.정책보고서 2007-22 (2007)
- 윤희숙, "민간의료보험 가입이 의료이용에 미치는 영향", 한국개발연구, 30(2), pp.99~128 (2008), 한국개발연구원
- 임금자, "독일의 수발보험제도", 의료정책포럼, 4(2) (2006)
- 정완교, "노인장기요양보험제도의 문제점과 개선방향", 정책포럼, (202) (2008), 한국개발연구원
- 정완교, "장기요양서비스의 수요 분석", 한국개발연구원, ~ (2008), 정책연구시리즈 2008-05
- Cohen, M. A, "The Changing Face of Long-Term Care Insurance in 1994: Profiles and Innovations in a Dynamic Market", Inquiry, 34, pp.50~61 (1997)
- Long-Term Decline in Disability among Older Men: Medical Care, Public Health, and Occupational Change, "Costa,D.L", National Bureau of Economic Research, ~, pp.NBER Working Paper 7605 (2000)
- An Economic Analysis of Life Care, "Feinstein, J. S", National Bureau of Economic Research, ~, pp.NBER Working Paper 4155 (1992)
- Foster, L, "Improving the Quality of Medicaid Personal Assistance through Consumer Direction", Health Affairs, Web exclusive, 162~175 (2003)
- Long-Term Care, Wealth, and Health of the Disabled Elderly Living in the Community, "Garber,A.M", National Bureau of Economic Research, ~, pp.NBER Working Paper 2328 (1987)
- Garber, A. M, "Predicting Nursing Home Utilization among the High-Risk Elderly, in Issues in the Economics of Aging", pp.173~200 (1990), University of Chicage Press
- Garber, A. M, "Nursing Home Discharges and Exhaustion of Medicare Benefits", Journal of the American Statistical Association, 88, pp.727~736 (1993)
- Grabowski, D. C, "Medicaid Reimbursement and the Quality of Nursing Home Care", of Health Economics, 20(4), pp.549~569 (2001)
- Grabowski, D. C, "A Longitudinal Study of Medicaid Payment, Private-Pay Price and Nursing Home Quality", Journal of Health Care Finance and Economics, 4(1), pp.5~26 (2004)
- Moral Hazard in Nursing Home Use, "Grabowski, D. C", National Bureau of Economic Research, ~, pp.NBER Working Paper 11723 (2005)
- Headen Jr., A. E, "Time Costs and Informal Social Support as Determinants of Differences between Black and White Families in the Provision of Long-Term Care", Inquiry, 29, pp.440~450 (1992)
- Hoerger, T. J, "Public Subsidies, Private Provision of Care and Living Arrangements", Review of Economics and Statistics, 78(3), pp.428~440 (1996)
- Hughes, S. L, "Impact of Long-Term Home Care on Hospital and Nursing Home Use and Cost", Health Services Research, 22(1), pp.19~47 (1987)
- Kemper, P, "Lifetime Use of Nursing Home Care", New England Journal of Medicine, 324, pp.595~600 (1991)
- Kemper, P, "The Effect of Public Provision of Home Care on Living and Care Arrangements: Evidence from the Channeling Experiment. in Long-Term Care: Economic Issues and Policy Solutions", pp.125~146 (1996), Kluwer Academic Publishers
- Klein, T., "Determinants of Institutionalization in Old Age. in Long-Term Care: Economic Issues and Policy Solutions", pp.103~113 (1996), Kluwer Academic Publishers
- Levit, K. R, "National Health Expenditures", Health Care Financing Review, 19(1), pp.161~200 (1997)
- Liu, K, "Home Care Expenses for the Disabled Elderly", Health Care Financing Review, 7(2), pp.51~58 (1985)
- Liu, K, "Risk of Entering Nursing Homes for Long versus Short Stays", Medical Care, 32(4), pp.315~327 (1994)
- Miltenburg, Th. E. M, "Evaluatie-onderzoek Persoonsgebonden Budget in Nederland (Evaluation Research on Personal Care Budgets in the Netherlands)", Tijdschrift voor Gezondheidswetenschappen, 77(7), pp.422~429 (1999)
- Morris, C. N, "Parametric Duration Analysis of Nurisng Home Usage. in Case Studies in Biometry", pp.231~248 (1994), John Wiley and Sons
- Murtaugh, C. M, "Risky Business: Long-Term Care Insurance Underwriting", Inquiry, 32, pp.271~284 (1995)
- Murtaugh, C. M, "The Amount, Distribution, and Timing of Lifetime Nursing Home Use", Medical Care, 35(3), pp.204~218 (1997)
- Naon, D., "The Impact of the Community Long-term Care Insurance Law on Services for the Elderly in Israel, in Long-Term Care: Economic Issues and Policy Solutions", pp.115~123 (1996), Kluwer Academic Publishers
- Nocera, S, "Women’s Role in the Provision of Long-term Care, Financial Incentives, and the Future Financing of Long-term Care, in Long-Term Care: Economic Issues and Policy Solutions", pp.79~102 (1996), Kluwer Academic Publishers
- Norton, Edward C, "Long-Term Care, in Handbook of Health Economics, Chapter 17", North Holland, 955~994 (2000)
- Norton, E. C, "Policy Options for Public Long-Term Care Insurance", Journal of the American Medical Association, 271(19), pp.1520~1524 (1994)
- Nyman, J. A, "The Private Demand for Nursing Home Care", Journal of Health Economics, 8(2), pp.209~231 (1989)
- OECD, "Long-term Care for Older People, OECD Health Project", OECD, ~ (2005)
- OECD, "OECD Economic Surveys: Korea", OECD, ~ (2007)
- Pezzin, L. E, "Does Publicly Provided Home Care Substitute for Family Care? Experimental Evidence with Endogenous Living Arrangements", The Journal of Human Resources, 31(3), pp.650~676 (1996)
- Reschovsky, J. D, "Demand for and Access to Institutional Long-Term Care: The Role of Medicaid in Nursing Home Markets", Inquiry, 33, pp.15~29 (1996)
- Reschovsky, J. D, "The Roles of Medicaid and Economic Factors in the Demand for Nursing Home Care", Health Services Research, 33(4), pp.787~813 (1998)
- Rhoades, J, "Nursing Homes - Structure and Selected Characteristics", Agency for Health Care Policy and Research, ~ (1998), MEPS Research Finding No. 4, AHCPR Publication No. 98-0006
- Rowe, J. W, "Health Care of the Elderly", New England Journal of Medicine, 312, pp.827~835 (1985)
- Stone, R, "Caregivers of the Frail Elderly: A National Profile", The Gerontologist, 27(5), pp.616~626 (1987)
- Wooldridge,J.M, "Econometric Analysis of Cross Section and Panel Data" (2002), The MIT Press