본 연구는 노인장기요양보험이라는 정책에 대한 개입(policy intervention)과 변화(policy change)에 대한 정책평가를 수행하고자 하였다. 첫째, 장기요양 이용자의 욕구에 맞는 서비스를 결정하는 과정이 작동되고 있는지 살펴보기 위한 형성평가(과정평가)를 실시하기 위해 인의 욕구(의료적 욕구, 장기요양 욕구, 의료·장기요양 욕구)에 따른 노인장기요양보험의 급여 이용 및 미이용 결정을 살펴보기 위해 로지스틱분석(...
본 연구는 노인장기요양보험이라는 정책에 대한 개입(policy intervention)과 변화(policy change)에 대한 정책평가를 수행하고자 하였다. 첫째, 장기요양 이용자의 욕구에 맞는 서비스를 결정하는 과정이 작동되고 있는지 살펴보기 위한 형성평가(과정평가)를 실시하기 위해 인의 욕구(의료적 욕구, 장기요양 욕구, 의료·장기요양 욕구)에 따른 노인장기요양보험의 급여 이용 및 미이용 결정을 살펴보기 위해 로지스틱분석(Logistic Regression analysis) 및 일반화추정방정식(Generalized Estimating Equation, GEE)분석을 실시하였다. 이용결정 분석 결과 노인장기요양보험 급여이용에 주요한 영향을 주는 것으로 나타났으며, 의료·장기요양 욕구 및 장기요양 욕구를 가질수록 의료적 욕구에 비해 노인장기요양보험 급여를 이용할 확률이 높은 것으로 나타났다. 둘째, 욕구에 의해 결정된 서비스의 이용경험이 기대했던 욕구를 충족하였는지 살펴보기 위한 총괄평가(효과성 평가)를 실시하기 위해 이용효과분석을 실시하였다. 이에 따라 이용효과 분석은 이중차이(Difference in Difference, DID) 및 삼중차이(Difference in Difference in Difference, DDD) 분석을 이용하여 건강상태(총 진료비·본인부담) 및 기능상태(일상생활수행척도)의 변화를 살펴보았다. 제도의 이용효과를 살펴본 이중차이(DID) 및 삼중차이(DDD) 분석결과, 노인장기요양보험 도입 이후 장기요양 이용을 할수록 의료이용량(총 진료비 및 본인부담)이 감소되는 것으로 나타났으나, 욕구에 따른 의료이용량 감소는 유의하지 않게 나타났다. 그러나 입소/요양병원 모형에서는 장기요양 욕구를 가지는 노인이 입소시설을 이용할 때 의료이용량(총 진료비 및 본인부담)이 유의하게 감소하는 것으로 나타났다. 본 연구는 첫째, 의사소견서 내 욕구변수를 활용하여 전문가로부터 평가되고 진단된 욕구 변수를 활용하였다는데 의의를 가진다. 둘째, 과정평가인 이용결정분석과 총괄평가인 이용효과분석을 함께 실시하여 노인장기요양보험제도를 통합적으로 분석하였다는 것에 의의를 가진다.
본 연구는 노인장기요양보험이라는 정책에 대한 개입(policy intervention)과 변화(policy change)에 대한 정책평가를 수행하고자 하였다. 첫째, 장기요양 이용자의 욕구에 맞는 서비스를 결정하는 과정이 작동되고 있는지 살펴보기 위한 형성평가(과정평가)를 실시하기 위해 인의 욕구(의료적 욕구, 장기요양 욕구, 의료·장기요양 욕구)에 따른 노인장기요양보험의 급여 이용 및 미이용 결정을 살펴보기 위해 로지스틱분석(Logistic Regression analysis) 및 일반화추정방정식(Generalized Estimating Equation, GEE)분석을 실시하였다. 이용결정 분석 결과 노인장기요양보험 급여이용에 주요한 영향을 주는 것으로 나타났으며, 의료·장기요양 욕구 및 장기요양 욕구를 가질수록 의료적 욕구에 비해 노인장기요양보험 급여를 이용할 확률이 높은 것으로 나타났다. 둘째, 욕구에 의해 결정된 서비스의 이용경험이 기대했던 욕구를 충족하였는지 살펴보기 위한 총괄평가(효과성 평가)를 실시하기 위해 이용효과분석을 실시하였다. 이에 따라 이용효과 분석은 이중차이(Difference in Difference, DID) 및 삼중차이(Difference in Difference in Difference, DDD) 분석을 이용하여 건강상태(총 진료비·본인부담) 및 기능상태(일상생활수행척도)의 변화를 살펴보았다. 제도의 이용효과를 살펴본 이중차이(DID) 및 삼중차이(DDD) 분석결과, 노인장기요양보험 도입 이후 장기요양 이용을 할수록 의료이용량(총 진료비 및 본인부담)이 감소되는 것으로 나타났으나, 욕구에 따른 의료이용량 감소는 유의하지 않게 나타났다. 그러나 입소/요양병원 모형에서는 장기요양 욕구를 가지는 노인이 입소시설을 이용할 때 의료이용량(총 진료비 및 본인부담)이 유의하게 감소하는 것으로 나타났다. 본 연구는 첫째, 의사소견서 내 욕구변수를 활용하여 전문가로부터 평가되고 진단된 욕구 변수를 활용하였다는데 의의를 가진다. 둘째, 과정평가인 이용결정분석과 총괄평가인 이용효과분석을 함께 실시하여 노인장기요양보험제도를 통합적으로 분석하였다는 것에 의의를 가진다.
In 2008, long-term care insurance for the elderly was introduced to distinguish health needs from the need for long-term care, and to provide long-term care services to the elderly with long-term care needs. However, this has led to a split in the use of benefits between long-term care insurance and...
In 2008, long-term care insurance for the elderly was introduced to distinguish health needs from the need for long-term care, and to provide long-term care services to the elderly with long-term care needs. However, this has led to a split in the use of benefits between long-term care insurance and national health insurance. Previous studies have discussed the redundant roles and functions of nursing homes and nursing hospitals, and how to improve them. However, these studies were limited in that they only considered improvement plans from the hospital or nursing home side. This study was designed to evaluate the policy intervention and policy change in the area of long-term care insurance for the elderly. First, the determinants of the use of long-term care insurance benefits were analysed in a formation evaluation (process evaluation). This analysis was conducted to check what factors determine the use of services that meet the elderly’s needs (i.e., health needs and long-term care needs). A logistic regression analysis and a generalized estimating equation (GEE) analysis were conducted to examine the determinants of long-term care insurance benefits. Second, an analysis of the utilization effects of long-term care insurance benefits was performed in an effectiveness evaluation (outcome evaluation). The second analysis aimed to evaluate whether the experience of the service use helped to meet the needs. Therefore, a utilization effect analysis was conducted using the Difference in Difference (DID) and Difference in Difference in Difference (DDD) methods to examine the effect on the change in health status (total medical expenses and out-of-pocket) and in functional status (activity of daily living, ADL). As a result of the analysis of the usage determinants for each year, it was found that the elderly with long-term care needs and those with both health needs and long-term care needs had a higher probability of long-term care benefit use than those with health needs only. The results of the GEE analysis were similar to those from the logistic analysis by year, showing that the needs had a significant influence on the utilization of long-term care insurance benefits. The group with long-term care needs had a higher probability of use of long-term care facilities than other groups. The likelihood of the use of services provided by nursing homes and nursing hospitals was highest in the long-term care needs group. The patients who had long-term care needs and health needs were more likely to choose a long-term care facility than those who had health needs only, but they were more liable to choose nursing hospitals than the group with long-term care needs only. The results of the effect analysis between the treatment group and the control group based on propensity score matching were as follows. As a consequence of the variance analysis, it was found that the group with long-term care needs only had low medical expenses before the introduction of the long-term care insurance for the elderly (in 2007). In this group, one subgroup used long-term care insurance benefits after the introduction of long-term care insurance for the elderly, while another subgroup did not use them or a nursing hospital. Their results were different. The group that had long-term care needs and used long-term care benefits had reduced its medical expenses by 2013, as compared with 2007. By contrast, the group that only had long-term care needs and did not use long-term care benefits had seen its medical expenses rise dramatically by 2013. The ADL was deteriorated in both users and nonusers. As a result of the difference in difference (DID) regression analysis for the effects of long-term care insurance, it was found that the medical expenses had significantly decreased after the introduction of long-term care insurance for the elderly. The DDD analysis was mostly insignificant, except in the nursing home/nursing hospital model. In this model, older adults with long-term care needs had significantly decreased their medical expenses by using nursing homes. However, most of the ADL models were not significant in the DID nor DDD. It is meaningful to analyze the long-term care insurance system for the elderly by examining the determinants of its use in a process evaluation, and the effects of the usage in an outcome evaluation.
In 2008, long-term care insurance for the elderly was introduced to distinguish health needs from the need for long-term care, and to provide long-term care services to the elderly with long-term care needs. However, this has led to a split in the use of benefits between long-term care insurance and national health insurance. Previous studies have discussed the redundant roles and functions of nursing homes and nursing hospitals, and how to improve them. However, these studies were limited in that they only considered improvement plans from the hospital or nursing home side. This study was designed to evaluate the policy intervention and policy change in the area of long-term care insurance for the elderly. First, the determinants of the use of long-term care insurance benefits were analysed in a formation evaluation (process evaluation). This analysis was conducted to check what factors determine the use of services that meet the elderly’s needs (i.e., health needs and long-term care needs). A logistic regression analysis and a generalized estimating equation (GEE) analysis were conducted to examine the determinants of long-term care insurance benefits. Second, an analysis of the utilization effects of long-term care insurance benefits was performed in an effectiveness evaluation (outcome evaluation). The second analysis aimed to evaluate whether the experience of the service use helped to meet the needs. Therefore, a utilization effect analysis was conducted using the Difference in Difference (DID) and Difference in Difference in Difference (DDD) methods to examine the effect on the change in health status (total medical expenses and out-of-pocket) and in functional status (activity of daily living, ADL). As a result of the analysis of the usage determinants for each year, it was found that the elderly with long-term care needs and those with both health needs and long-term care needs had a higher probability of long-term care benefit use than those with health needs only. The results of the GEE analysis were similar to those from the logistic analysis by year, showing that the needs had a significant influence on the utilization of long-term care insurance benefits. The group with long-term care needs had a higher probability of use of long-term care facilities than other groups. The likelihood of the use of services provided by nursing homes and nursing hospitals was highest in the long-term care needs group. The patients who had long-term care needs and health needs were more likely to choose a long-term care facility than those who had health needs only, but they were more liable to choose nursing hospitals than the group with long-term care needs only. The results of the effect analysis between the treatment group and the control group based on propensity score matching were as follows. As a consequence of the variance analysis, it was found that the group with long-term care needs only had low medical expenses before the introduction of the long-term care insurance for the elderly (in 2007). In this group, one subgroup used long-term care insurance benefits after the introduction of long-term care insurance for the elderly, while another subgroup did not use them or a nursing hospital. Their results were different. The group that had long-term care needs and used long-term care benefits had reduced its medical expenses by 2013, as compared with 2007. By contrast, the group that only had long-term care needs and did not use long-term care benefits had seen its medical expenses rise dramatically by 2013. The ADL was deteriorated in both users and nonusers. As a result of the difference in difference (DID) regression analysis for the effects of long-term care insurance, it was found that the medical expenses had significantly decreased after the introduction of long-term care insurance for the elderly. The DDD analysis was mostly insignificant, except in the nursing home/nursing hospital model. In this model, older adults with long-term care needs had significantly decreased their medical expenses by using nursing homes. However, most of the ADL models were not significant in the DID nor DDD. It is meaningful to analyze the long-term care insurance system for the elderly by examining the determinants of its use in a process evaluation, and the effects of the usage in an outcome evaluation.
주제어
#노인장기요양보험 요양시설 요양병원 이용결정 이용효과 long-term care insurance needs determinants of utilization effects of utilization GEE DID DDD
학위논문 정보
저자
신혜리
학위수여기관
연세대학교 사회복지대학원
학위구분
국내박사
학과
사회복지학전공
지도교수
김진수
발행연도
2017
총페이지
x, 172 p.
키워드
노인장기요양보험 요양시설 요양병원 이용결정 이용효과 long-term care insurance needs determinants of utilization effects of utilization GEE DID DDD
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