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

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  • Sohn, Minsung
  • O'Campo, Patricia
  • Muntaner, Carles
  • Chung, Haejoo
  • Choi, Mankyu

Abstract

The long-term care insurance (LTCI) has been implemented to help the government take responsibility for social prevention and protection measures to maintain and improve older adults' health and well-being since 2008. This study aimed to evaluate the effects of LTCI on mortality of elders in South Korea. The data used from the national representative Elderly Cohort Database for 2009 to 2013. We analyzed longitudinal panel data from 61,235 persons aged 65 years and older. We generated Kaplan-Meier survival curves and Cox proportional hazard models by use and type of long-term care services (LTCSs) (e.g., non-user, facility, and in-home benefits) and income level. The covariate-adjusted approximate mortality rates by LTCSs type for facility and in-home benefits group compared to non-LTCS users were 0.761 and 0.803, respectively. The approximate mortality rates were higher in the middle low- (Hazard Ratio [HR] = 1.131, p < .001), low- (HR = 1.125, p < .001), and middle- (HR = 1.122, p < .001) than the high income group. In particular, the disparities in mortality by income gap in in-home care users of LTCS was greater than that of facility care users in Korea. Consequently, these findings point to the need for program improvements to the quality and quantity of the in-home LTCSs for elderly Koreans. Ensuring a “continuum of care” through education for service providers and stronger relationships with the recipients’ families could improve overall quality. There is a particular need to devote more attention to the needs of low-income elderly who currently lack sufficient the health coverage.

Suggested Citation

  • Sohn, Minsung & O'Campo, Patricia & Muntaner, Carles & Chung, Haejoo & Choi, Mankyu, 2020. "Has the long-term care insurance resolved disparities in mortality for older Koreans? examination of service type and income level," Social Science & Medicine, Elsevier, vol. 247(C).
    • Handle: RePEc:eee:socmed:v:247:y:2020:i:c:s0277953620300319
    DOI: 10.1016/j.socscimed.2020.112812
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    References listed on IDEAS

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    1. Rhee, Jong Chul & Done, Nicolae & Anderson, Gerard F., 2015. "Considering long-term care insurance for middle-income countries: comparing South Korea with Japan and Germany," Health Policy, Elsevier, vol. 119(10), pages 1319-1329.
    2. Likwang Chen & Winnie Yip & Ming‐Cheng Chang & Hui‐Sheng Lin & Shyh‐Dye Lee & Ya‐Ling Chiu & Yu‐Hsuan Lin, 2007. "The effects of Taiwan's National Health Insurance on access and health status of the elderly," Health Economics, John Wiley & Sons, Ltd., vol. 16(3), pages 223-242, March.
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    2. Longduoqi A & Hang Ma & Mohan Wang & Biao Yang, 2022. "Research on Urban Community Elderly Care Facility Based on Quality of Life by SEM: Cases Study of Three Types of Communities in Shenzhen, China," Sustainability, MDPI, vol. 14(15), pages 1-23, August.
    3. Sungje Moon & Mankyu Choi & Minsung Sohn, 2021. "Suicide among Older Adults with Dementia: Effects of Korea’s Long-Term Care Insurance System," IJERPH, MDPI, vol. 18(12), pages 1-14, June.
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    7. Hollingsworth, Bruce & Ohinata, Asako & Picchio, Matteo & Walker, Ian, 2022. "Does It Matter Who Cares for You? The Effect of Substituting Informal with Formal Personal Care on the Care Recipients' Health," IZA Discussion Papers 15457, IZA Network @ LISER.
    8. Lin, Zhuoer & Chen, Xi, 2022. "Long-term services and supports and disease management among older Chinese adults in different stages of cognitive impairment," The Journal of the Economics of Ageing, Elsevier, vol. 23(C).
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    10. Lin, Lin & He, Min & Sun, Wenkai, 2025. "Security fosters generosity: Social security protection and charitable giving," World Development, Elsevier, vol. 196(C).
    11. Tianli Yang & Zhong Zhao, 2025. "Public Long‐Term Care Insurance and Retirement Intentions of Urban Workers: Evidence From China," Health Economics, John Wiley & Sons, Ltd., vol. 34(9), pages 1537-1559, September.

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