Health Policy Manag.  2016 Dec;26(4):305-314. 10.4332/KJHPA.2016.26.4.305.

Long-Term Care Utilization among End-of-Life Older Adults in Korea: Characteristics and Associated Factors

  • 1Office of Policy Development for Healthy Society, Seoul National University College of Medicine, Seoul, Korea.
  • 2Department of Health Science, Seoul National University Graduate School of Public Health, Seoul, Korea.
  • 3Institute of Aging, Seoul National University, Seoul, Korea.
  • 4Institute of Health and Environment, Seoul National University, Seoul, Korea.
  • 5Asian Development Bank, Metro Manila, Philippines.


The purpose
of this study is to examine the characteristics of and factors associated with long-term care (LTC) utilization under public long-term care insurance (LTCI) among end-of-life older adults in Korea.
Using a 5% sample of older people aged 65 or older and their health and LTC insurance data, two-part model analyses were conducted. We compared LTC uses and their determinants during the last year of life among decedents in the year 2010 with those of survivors. We also compared the medical uses of the same sample with their LTC uses.
The end-of-life elderly were more likely to use LTC, and their expenditure on LTC was higher than their counterparts. Whether or not older people used LTC during their last year of life was significantly affected by age, sex, health insurance, household income, and living alone; however, LTC costs of the decedents were only affected by functional status, which may have been due to the reimbursement scheme of the current LTCI, which is mainly based on functional dependency level. For the survivors, having chronic diseases significantly increased the likelihood of LTC use, which was not the case for the decedents. End-of-life elderly with relatively low social economic status were more likely to use the LTC other than medical services, while the health conditions affected their medical uses most significantly.
The study findings provide key information for predicting demand related to the increasing LTC needs of Korean older people at the end of life.


End-of-life care; Decedents; Long-term care; Long-term care insurance; Older adults
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