Graduate School of Public Health Department of Public Health Sciences, Institute of Health and Environment & Institute of Aging, Seoul National University, Seoul, Republic of Korea.
SOCIUM - Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany.
Int J Health Policy Manag. 2023;12:6640. doi: 10.34172/ijhpm.2022.6640. Epub 2022 Nov 19.
Establishing universal coverage of formal long-term care (LTC) services is an urgent policy need for aging populations that requires efficient management of quality and financing. Although current variation in LTC service use between and within countries suggests the potential for improvement by efficient management, this topic remains underexamined. We aimed to identify the sources of variance in LTC use and expenditures through a unique cross-country comparison of Japan and South Korea, which have formal public LTC insurance (LTCI) schemes that are analogous but have unique operational and demographic structures.
Taking administrative regions as the unit of analysis, we assembled data on the LTC utilization rate of people aged ≥65 years, and expenditures per recipient from 2013 to 2015 as the outcome variables. Explanatory variables included demand-related factors, such as regional demographic and economic conditions, and supply characteristics derived from existing public databases. We conducted weighted least squares regression with fixed effects for the pooled data and used Blinder-Oaxaca decomposition to identify sources of outcome variance between the two countries.
The average LTC utilization rate was 6.8% in Korea and 18.2% in Japan. Expenditures per recipient were approximately 1.4 times higher in Japan than in Korea. The difference in the utilization rate was mostly explained by between-country differences in supply- and demand-related factors, whereas the difference in expenditures per recipient was largely attributed to unobserved country-specific factors.
The current findings suggest that LTC utilization is determined largely by the demographic and functional characteristics of older people, whereas expenditures are more likely affected by institutional factors such as the insurance governance scheme and the policy choice of the target population segment and coverage. The results suggest that strategic choice of LTC institutional schemes is required to ensure financial sustainability to meet changing demands caused by population aging.
为老龄化人口建立全面的正规长期护理（LTC）服务覆盖是一个紧迫的政策需求，这需要对质量和资金进行有效的管理。尽管目前各国之间和各国国内的长期护理服务使用情况存在差异，表明通过有效的管理可以提高服务水平，但这一主题仍未得到充分研究。我们旨在通过对具有类似正规公共长期护理保险（LTCI）计划但具有独特运营和人口结构的日本和韩国进行独特的跨国比较，确定长期护理使用和支出的差异来源。
我们以行政区域为分析单位，收集了 2013 年至 2015 年 65 岁及以上人群的长期护理利用率和每位受助人的支出数据作为因变量。解释变量包括与需求相关的因素，如区域人口和经济状况，以及从现有公共数据库中得出的供应特征。我们对汇总数据进行了带有固定效应的加权最小二乘回归，并使用 Blinder-Oaxaca 分解来确定两国之间结果差异的来源。
韩国的长期护理利用率平均为 6.8%，日本为 18.2%。每位受助人的支出在日本约为韩国的 1.4 倍。利用率的差异主要归因于两国之间与供应和需求相关的因素的差异，而每位受助人的支出差异则主要归因于无法观察到的特定国家的因素。
目前的研究结果表明，长期护理的使用在很大程度上取决于老年人的人口和功能特征，而支出更可能受到机构因素的影响，如保险治理方案以及目标人群和覆盖范围的政策选择。这些结果表明，需要对长期护理机构计划进行战略选择，以确保财务可持续性，以满足人口老龄化带来的不断变化的需求。
