Disagreement between a public insurer's recommendation and beneficiary's choice of long-term care services in Korea

Abstract

This study examined the disagreement between an insurer's recommendation for long-term care (LTC) services and beneficiaries' choices and analyzed the factors associated with the disagreement. Data from the National Long-Term Care Insurance (LTCI) and the Standard Care Plan were merged to create a dataset of 43,319 LTCI beneficiaries. The dependent variable was the disagreement between beneficiaries and insurers. Predisposing, enabling, and needs factors were independent variables based on the Andersen's Model. Disagreement between the insurer's recommendation of home care services and the beneficiaries' choice of institution service was 6.7% (n = 2357). The opposite disagreement occurred in 23.0% (n = 1820) of cases. A multivariate analysis showed that the OR for disagreement between insurer-recommended home care services and beneficiary-selected institution services increased with age, living with someone, having Medical Aid, living in a facility, and having high care needs, dementia, and poor subjective hearing. The OR for disagreement between insurer-recommended institution service and beneficiary-selected home care service increased for men and decreased for those 90 years or older, living with someone, having Medicaid etc, and living at institution. Korean beneficiaries of LTCI have a high preference for aging in their home, and changes in LTCI contents must be made to address the needs of this population.