농어촌 지역의 노인 장기요양보험제도에 대한 인식이 제도이용에 미치는 영향 평가

윤인희 ( In Hee Youn ) 한국도서학회 2015 韓國島嶼硏究 Vol.27 No.4

본 연구는 천안시 성환읍 노인들을 대상으로 장기요양보험제도에 대한 올바른 인식도가 농촌 노인들의 장기요양보험제도의 이용율에 영향을 미치는지를 평가하고, 그 결과에 따른 장기요양의 문제점을 제시합으로서 장기요양보험제도의 발전과 개선점을 제안하고자 시행되었다. 이를 위해 성환읍에 거주하는 150명의 노인들을 대상으로 설문조사한 결과 다음과 같다. 노인 장기요양보험제도의 시행 인지 여부의 분포를 살펴보면 총 150명 중 알고 있다 26%(39명), 모른다 74%(111명)으로 나타나, 노인들은 노인 장기요양보험제도의 시행 인지여부가 매우 낮은 걸로 조사되었다. 이 결과는 지역적인 영향 즉, 정보의 접근성인 낮은 농촌지역의 특수성의 영향인 것으로 추정된다. 연령이 낮을수록, 건강상태가 양호하지 않을수록 제도의 시행인지가 높았으며 이웃, 친지, 가족 인지한 경우가 높게 나타났다. 노인 장기요양 보험제도의 관심의 분포를 살펴보면 총 150명 중 보통이다가 54%(81명)이 가장 높게 나타났다. 남성보다 여성이, 연령이 높을수록, 독거노인 일수록 관심도의 빈도가 높았으며, 이는 통계적으로 유의한 차이를 보였다(χ²=23.674, p=.023). 노인장기요양보험제도의 필요성에 대하여서는 65.2%이상이 필요하다고 조사되었고, 변수에대한 유의미한 차이는 없는 것으로 나타났다. 향후 노인장기요양보험제도 이용의향에 대하여서는 인식도가 높은 응답자 일수록, 고령일수록, 몸의 불편한 정도가 심하며, 여성일수록 이용의사가 유의미한 차이가 있는 것으로 조사되었으며, “반드시 이용하겠다 가 ”62.3%로 조사되어 인식도가 노인장기요양보험제도의 이용율에 영향이 있는 것으로 나타났다. 이러한 노인 장기요양보험제도의 인식에 대한 분석결과를 바탕으로 노인들이 장기요양보험제도의 올바른 인식과 태도를 가져 성공적인 제도가 될 수 있도록 몇 가지 방안을 제시한 다음과 같다. 첫째, 노후생활의 안정을 도모하고, 의료비 사용의 효율화 하는 노인 장기요양보험제도에 대한 제도의 인식을 높이기 위해서는 본 연구에서 나타났듯이 이웃, 친지, 가족을 통하여 인지하는 사람들이 많았다. 그리고 낮게 나온 일반홍보물에서 나왔는데 플래카드, 일반홍보물 등을 통해 꾸준히 홍보가 지속되어야 할 것이다. 둘째, 노인 장기요양보험제도에 대한 내용과 서비스의 이용방법에 대하여 노인들에게 장기 요양보험제도에 대한 교육을 통해 제도의 인지와 바른 태도를 갖도록 한다. 향후 장기요양제도가 정착하기 위해서는 제도에 대한 적극적인 홍보, 교육, 내용과 이용방법 등을 개인 및 국가차원에서 적극적인 홍보 노력이 요구되며 이러한 방안을 제도적으로 보완,강구할 것을 제언한다. This study evaluates the affect the availability of long-term care insurance scheme of a correct perception of the long-term care insurance system in rural elderly targeting Cheonan seonghwaneup elderly and long-term care insurance as the fight the problem of long-term care according to the results It was conducted to propose the development and improvement of the system. This survey examined the results for the following targets of 150 elderly living in seonghwaneup. Seniors can look at the distribution of whether the implementation of long-term care insurance aware of a total of 150 people 26% (39 patients), it may appear as 74% (111 people), older people whether very low that the enforcement of the elderly long-term care insurance geolro were investigated. This result is believed to be affected by the low specificity of access rural areas of influence that is, information. The lower the age, the higher the cognitive state of health was not good implementation of the scheme The neighbors, friends, family, and whether the case was high. Looking at the distribution of the interests of the elderly long-term care insurance is normally 54% of the total of 150 people (81 people) is highest. Women than men, the higher the age, the elderly living alone was higher the more the frequency of interest, which showed a statistically significant difference(χ²=23.674, p=.023). Elderly long-term care insurance system has been reflecting on the need for research that requires more than 65.2%, there was no significant difference for the variables. Future seniors the more the higher the perception of respondents rates on long-term care insurance use intentions, older the more, the discomfort degree of the body severe, women the more was the use of physician survey that there is a significant difference, "Be sure that we will use" research by 62.3% is the perception that showed that the impact on the utilization of the elderly long-term care insurance. The elderly seniors based on the analysis of the perception of long-term care insurance are some of the measures proposed to be correct recognition and attitude brought a successful system of long-term care insurance as follows: First, the stability of the retirement plan, and in order to raise awareness of long-term care insurance system for the elderly to medical use efficiency As indicated in this study, neighbors, relatives, people who were aware through the family. And out came out low and general promotional material will be continued steadily through the publicity placards, general promotional materials. Second, the elderly and the elderly on how the use of information and services for long-term care insurance have the right attitude and perception of institutions through training for long-term care insurance. Future long-term care institutions for the institutions to actively promote settlement, education, information, and how to use aggressive promotional efforts at personal and national levels, such as is required and complement these measures with institutional and suggestions to be taken.

老人長期療養報障制度에 대한 比較法的 硏究

장두순 한국비교노동법학회 2009 노동법논총 Vol.16 No.-

In Korea, the number of the elderly has rapidly increased. In 2007, the percentage of the population aged 65 years or older has reached 9.9%. In this society of the old, the problem of the long-term care of the elderly is not only a problem for the individual family but for the society as a whole. In Germany and Japan, the long-term care insurance system has emerged as an answer to the problem of the rising medical costs of the elderly. Now, the Republic of Korea is trying to resolve the problem of the long-term care of the elderly by adopting a similar long-term care insurance scheme. The resulting recommendations for an improvement plan of the long-term care insurance of the elderly include: (1) Areas of a service supplementation. Firstly, it is difficult to enlarge caretaking facilities on short notice. Even if the numbers of the facilities are sufficient, new problems of the management of these facilities arise. To resolve these problems, it is necessary to increase the extent of the homecare service. Here, in order to prevent the waste of the insurance premiums, services not covered by the regulations should be paid by the family. Moreover, a national supplement policy for the elderly is needed, that supports the self-care community of the elderly. As in the case of Sweden, allowing specialized hospitals for the elderly to provide home-visit nursing care can be a solution for the shortage of nursing hospitals. Secondly, caretaking professional teaching programs must be improved. In the case of Germany and Japan, the training periods forthe caretakers are set at two to three years for a systematic education and the national licensing exam. In Korea, there are no definite provisions in the long-term care insurance law for the enforcement of regulations about the education of the caretakers. The government should make clear regulations concerning education periods and, especially, the period of the practical education. The organization of the exercise program should be licensed to caretaking hospital as well as to general hospitals. Thirdly, the "Family Long-term Care System" must be expanded. This system is only permitted in areas of the countryside that lack professional long-term caregivers and in the case of natural disasters. It is more economical to expand the Family Long-term Care System to lessen the expenses for the caretaker facility enlargement. Fourthly, the numbers of the management work force have to be raised. The supervisory system must be regulated in a way that clearly outlines the limitsof long-term care service. This means that a qualified management work force training system is needed. Fifthly, a volunteer system must be included in the long-term care service system. To foster a climate of volunteering services, a revision of the education law is needed so that related education programs can be newly introduced. (2) The objectives of the long-term care giving services should be enlarged. Firstly, the law of the objectives of the payment must be revised. Here, as beneficiaries, the disabled should be included. The disabled should be recipients of the long-term care giving service regardless of age. The financial resources for them should comefrom welfare budgets for the disabled. Secondly, the final entitlement evaluation should be done only by doctors; if the persons concerned are dissatisfied, a secondary evaluation should be made. The contents of the evaluation should be easy to be understood by common people. Thirdly, the concept of dementia must be defined. The improvement of the dementia symptoms is difficult judge. The law has no clear definitions of dementia, which will invite legal disputes. Fourthly, the scope of recipients of the elderly long-term care insuranceexcludes patients with severe symptoms. This will lead to objections by thepatients. Objective standards about recipients and payment regulation should be revealed (3) We should recheck the medical treatment service in the long-term insurance system. Firstly, we should recheck the effectiveness of the wireless paging project. We should establish a "mutual self-help system of the elderly". Especially, volunteer networking systems should be encouraged. Secondly, we should establish a voucher system and a preventive welfare system for the elderly. Thirdly, there are no provisions terminally ill patients. Care services for them must be included. Fourthly, we should prepare for payment systems and their control. Without proper control systems, there will be moral hazards with the imbursement of family medical treatment costs. (4) We should establish an objective entitlement level evaluation and control system. The decision process should be opened to the public by internet and public notice board. Firstly, level evaluations should be given after careful consideration in two stages. The supervision of service institutes and personal should be strengthened. Secondly, we should make multiple investigations for the preparation of reports of the medical situation. With recipients who receive high amounts of financial support, the medical certificates must be submitted to the authorities. Through this certification process, costs for those patients can be saved. (5) We should prepare sound financial planning for the long-term care of the elderly. Firstly, medical expenses for the aged and nursing expenses are increased like in Sweden. We should investigate the introduction ofa publicmedical public management, which unifies the welfare and medical services. Secondly, staying in long-term care hospitals is quite expensive. A self-supporter community, like in the United States, is recommendable to residents who live in the countryside and outskirts of the cities in Korea. In an industrialized country, staying at home is more common than staying at s hospital. Thirdly, we should introduce an insurance system for parents. In Korea, most of the old generation is not prepared for their declining years. Therefore, we should introduce an insurance system for parents financed by their sons and daughters. Fourthly, subdividing the levels of medical treatment is problematic. Presently, there are three levels of medical treatment. However, the gaps between each level are too large. Therefore, the financial situation of the insurance may change for the worse because of excessive payments. By subdividing the medical treatment levels, establishing preventive medical treatment systems may reduce medical payments. Fifthly, elderlyperson who applied for the long-termcare service should pay for their meals and room costs. This may prevent excessive payments by the long-termmedical treatment insurance. Only the poor people who receive livelihood expenses by the government need not pay for their meals in hospitals. Sixthly, for the financial stability, the retiring age should be extended. For this purpose, wage peak systems and job training systems for the elderly must be introduced. Seventhly, preventive measures against diseases of the elderly should be established. If one becomes sick, he will be a burden to his family and himself and medical costs will be increased. Therefore, we should establish a system of health support for the aged and support the aged who exercise through subsidies by the government. Eighthly, the present government tries to privatize the national health insurance. However, the privatization should be considered as a supplement for problematic fields of the public insurance sector. Private insurance should be made available along with national health insurance according to one's choice. In conclusion, the introduction of the long-time medical treatment insurance for the elderly is inevitable because of our progressing to an aging society. However, the financial maintenance of this system remains the core problem. For the prevention of moral hazards in the implementation of this system, we should establish various control systems.

장기요양서비스 수요의 결정요인

정완교 한국개발연구원 2009 KDI Journal of Economic Policy (KDI JEP) Vol.31 No.1

A new public insurance for long-term care was introduced in July 2008 to provide for the rising demand for long-term care as the population is aging rapidly. The demand for long-term care is expected to rise further because more and more elderly are living alone or in households with only other elderly, such as his/her spouse, without informal care of their adult children. Even when the elderly are living together with their adult children, daughters and daughters in law, once the main informal care-givers, are not available because they choose to become economically active and work more over time. Experiences of countries such as Japan and Germany with similar public long-term care insurance scheme highlight the importance of detailed analysis on the demand for long-term care for the financial stability of the insurance scheme. Countries which had underestimated the demand for long-term care at the time of adopting the scheme went through financial instability of insurance schemes. This study analyzes the determinants of the demand for long-term care using data from the second demonstration project (April 2006~April 2007) of the long-term care insurance scheme for the elderly in Korea. Taking full advantage of detailed data on the long-term care, this paper analyzes the eligibility for the long-term care insurance scheme and its use. According to study results, even when common diseases among the elderly such as cancer, diabetes, arthritis, dementia, hypertension, etc. are controlled together with other individual and socioeconomic factors, limitations the elderly are faced with in their twelve activities of daily living significantly affect the eligibility for the Korean Long-term Care Insurance Scheme. This means that limitations in daily living activities are more critical than common diseases among the elderly are to the eligibility for the Korean Long-term Care Insurance Scheme. Bathing and toileting problems have been found to be the most important factor affecting the eligibility for the insurance scheme, followed by eating, dressing and moving around inside the house. Moreover, the choices of whether to use long-term care and which to use between home care and institutional care are found to be significantly influenced by health status and various socioeconomic factors of the elderly. In particular, those with more limitations in daily living activities and the female elderly are more likely to use long-term care and institutional care rather than home care. As for home care users, those living alone or with adult children and those with monthly household income of more than 500,000 won are more likely to use home care. Most importantly, even when the monthly household income of the elderly is controlled, the elderly recipients of the National Basic Living Security, who are not charged for long-term care, are more likely to choose home care. This implies that price as well as income is a critical factor for the decision to use long-term care. Further study on the duration of long-term care use will surely enhance the long-term care policy, when panel data is available for simultaneous analysis of the likelihood of long-term care use and its use duration. 본 논문은 65세 이상 고령인구의 수와 노인들의 건강상태 등만을 중심으로 한 기존의 연구에 더하여, 노인장기요양보험제도 제2차 시범사업의 자료를 이용한 계량분석을 통해 장기요양서비스 수요의 결정요인을 분석하였다. 분석 결과에 따르면, 우선 노인장기요양보험제도상 장기요양서비스 이용에 대한 보험 적용 대상자를 정하는 등급판정에 일상생활활동에서의 장애가 노인들이 많이 앓고 있는 고혈압, 관절염, 치매 등의 질환을 통제하고서도 통계적으로 유의한 영향을 미쳤다. 또한 노인들의 건강상태, 여성, 기초생활수급자 여부, 노인가구 형태, 노인가구의 월평균 소득 등이 장기요양서비스 이용 및 이용 양태에 통계적으로 유의한 영향을 미치는 것으로 나타났다. 특히, 노인가구의 월평균 소득을 통제하고서도 장기요양서비스를 무료로 이용할 수 있는 기초생활수급 대상 노인들의 재가서비스 이용확률이 높게 나타나는데, 이는 소득과 더불어 장기요양서비스의 가격도 장기요양서비스 이용을 결정하는 중요한 요인임을 의미한다.

노인장기요양보험 급여비의 결정요인분석 -시·군·구 데이터를 중심으로-

사공진,윤소영,조명덕 한국보건행정학회 2011 보건행정학회지 Vol.21 No.4

The purpose of our study is to analyze the determinants of the benefits of the long-term care insurance in Korea using 2008 and 2009 cross-sectional data. Per capita long-term care insurance benefits can be divided into home care services utilization rate, institutional care services utilization rate, per capita home care services benefits, and per capita institutional care services benefits, which are used as the dependent variables in our regression analysis. Admission rate and the ratio of the admitted to the applicant also used as the dependent variables. The results of our analysis show that the explanatory variables such as income level, needs for care, family type, access to the services, and regional characteristics are statistically significant to explain the dependent variables, the long-term care insurance benefits. The higher is the regional income and the more of the female residents, the more are the long-term care insurance benefits. The easier is the access to the services, the more are the insurance benefits. In the rural area, the level of the insurance benefits is relatively high. We propose that copayment rates of the long-term care insurance should be examined and monitoring on the over-use of the services should be done. Also preventive services and care by the family member should be expanded.

노인장기요양보험법의 문제점과 개선방안

고준기 동아대학교 법학연구소 2012 東亞法學 Vol.- No.57

With entry into an aged society, numerous problems of the aged to health of the elderly among the elderly are associated with chronic disease in elderly individuals with disabilities and their activities of daily living, such as the morbidity and instrumental activities of daily living from carrying on the family as alleviate caregiver burden and redundant use of National Health Insurance Act due to a system for reducing the fiscal deficit as from 1 July 2008 are being conducted nationwide. The Long-Term Care Insurance plan has been successfully enforced in many ways, such as an increase number of recipients of the service and improvement of the qualify of elderly life etc. However, problems in the Long-Term Care Insurance Act for the aged since the Act has been put into effect include service quality and effectiveness of care issues. Effective management of Long Term Care of the elderly by providing ways to improve the quality of life, ease the burden of the family. This study is to review the Long-Term Care Insurance Act in Korea in order to find some implications and suggest policy alternatives for the improvements of the system. The main contents of this paper are diagnosis of present state and problems of long-term care insurance system, directional establishments in constructing new system and consideration of practical alternatives of new system. Some lessons from foreign experiences show that the more wide range of the aged could get the Long-Term Care Insurance services by giving them proper legal rights. At the same time it requires as well as more public funds and its efficient management and fully qualified home helper and education program for them. However, one of the most important issues, whether or not providing cash benefit, is still unresolved. This paper suggest that the cash benefit in long-term care insurance is indispensible in achieving the goal of the long-term care system. The law must be presented in elders protections for social insurance to settle the home service, day-night care service and counseling system. Welfare of the aged Act is just welfare service law for the aged focusing on facilities welfare and about care for the aged Long-term Care Insurance Act for Aged plays an important part. In the perspective of Welfare of the aged Act, the enforcement of the plan has to solve the newly rised problem about the blind spot as well as to lead the various and extensive role on preventive and complementary part of the service. Nonetheless Welfare of the aged Act does not adequately cope with these kind of problems. To solve these problems, relationship between two parties has to be clearly defined according to the aim and the purpose of the law and based on that, following problems, such as the scope of the recipients, details of the service, comparison with other countries, and financial matter has to be examined. 사람은 고령화되면 건강이 쇠퇴하며, 육체적․정신적으로 매우 허약해지고, 장애의 발생이 높아 다른 사람에게 의존 가능성이 커진다. 또한 노인계층의 상병구조도 만성질환 중심으로 변화하면서 완치가 불가능하여 질병을 관리하는데 많은 비용을 소요하게 하여 부담을 늘리게 한다. 만성질환은 장애를 수반하는 경우가 많다. 장애는 만성질환과 결부되어 만성질환 이환율이 높아지는 만큼 삶의 질을 저하시킨다. 우리나라는 2008년 7월부터 노인장기요양보험제도를 시행하고 있다. 노인장기요양보험법은 가족의 노인장기요양부담을 완화하고 노인의 삶의 질을 향상시키려는 목적으로 제정되었다. 이 논문에서는 공적노인요양보장 법제의 구조 등 노인보건의료에 관한 법적 체계와 현행법상의 나타나고 있는 개별적인 문제점을 도출하고 노인장기요양서비스의 질적 제고와 다양화 및 급여확대를 위한 법적 개선방안을 마련하고자 하였다.

비영리법인의 운영수익성에 대한 연구:노인장기요양보험 노인요양시설을 중심으로

배성호 한국세무학회 2021 세무와 회계저널 Vol.22 No.1

The long-term care insurance system, which has been in place since 2008, has started to show different perspectives from each other as there are various interested groups. Representatively, there is a difference in opinion on operating profitability between the National Health Insurance Corporation, which operates the long-term care insurance system, and the long-term care service provider. Therefore, this study analyzes the operating profitability by focusing on the elderly care facilities among the payment types of the long-term care insurance system. Specifically, six institutions were selected among the nationwide elderly care facilities, and the major financial ratios of the target institutions (cash inflow-outflow ratio, long-term care margin, net profit margin) were compared with previous studies. Next, it was estimated how the major financial ratios would change when applying the reimbursement standards for nursing care workers recommended by the Ministry of Health and Welfare. Finally, the break-even point was analyzed by estimating the cost function. As a result of the analysis, the cash inflow-outflow ratio was 1.95%, the long-term care margin was -3.09%, and the net profit margin was 0.41%. These are lower than those of previous studies. The long-term care profit margin worsened to -18.35% and net profit margin to -14.87% when applying the reimbursement standards for nursing care workers recommended by the Ministry of Health and Welfare. The number of residents per day at the break-even point of the sample institution is estimated to be 72, but the average number of residents per day at the actual sample institution was 57, below the break-even point. The results of this study are contrary to the opinion of the policy authorities claiming that the operation of elderly nursing facilities is profitable, which means that long-term care institution profitability analysis and long-term care fees need to be reviewed. In addition, it implies that it is necessary to revise and implement unified accounting standards applicable to long-term care institutions. 2008년부터 시행된 장기요양보험제도는 다양한 이해관계집단이 존재함에 따라 각자의 입장에서 서로 다른 시각차이가 나타나기 시작했다. 대표적으로 장기요양보험제도의 운영주체인 국민건강보험공단과 장기요양서비스 제공 주체 간 운영수익성에 대한 견해차이를 들 수 있다. 이에 본 연구는 장기요양보험제도의 급여형태 중 노인요양시설에 초점을 두어 운영수익성을 분석한다. 구체적으로 전국 노인요양시설 중 6개 기관을 선정하여 대상 기관의 주요 재무비율(수지차율, 장기요양이익률, 당기순이익률)을 선행연구와 비교하였으며, 보건복지부가 권고한 요양보호사 급여기준을 적용하였을 경우 주요 재무비율이 어떻게 변하는지, 원가함수를 추정하여 손익분기점이 얼마인지를 분석하였다. 분석 결과 수지차율은 1.95%, 장기요양이익률은 -3.09%, 당기순이익률은 0.41%로 나타났다. 이는 선행연구의 수치에 비해 낮은 것이다. 보건복지부가 권고한 요양보호사 급여기준을 적용하였을 경우 장기요양이익률이 —18.35%, 당기순이익률이 -14.87%로 더 악화되는 것으로 나타났다. 표본 기관의 손익분기점 1일 입소자 수는 72명으로 추정되나, 실제 표본 기관의 1일 평균 입소자 수는 손익분기점 이하인 57명이었다. 이러한 본 연구의 결과는 노인요양시설 운영에 수익성이 있다고 주장하는 정책당국의 견해와는 상반되는 것으로, 장기요양기관 수익성 분석 및 장기요양수가에 대한 재검토가 필요하다는 것을 의미한다. 또한 장기요양기관에 적용할 수 있는 통일되고 명확한 회계기준의 개정 및 시행이 필요함을 시사한다.

노인장기요양보험에서 지역자원의 활용방안에 관한 연구

조추용,박선애,정윤태 한국통합사례관리학회 2009 한국케어매니지먼트연구 Vol.2 No.-

본 연구는 노인장기요양보험, 지역자원, 노인장기요양보험과 노인복지서비스의 관계, 그리고 노인장기요양보험에서 지역자원 활용방안을 모색하는 것이다. 그러나 실질적으로 노인장기요양보험 하에서 지역자원을 잘 활용할 수 있도록 하기 위해서는 여러 가지 전제조건이 있어야 한다. 즉 충분한 지역자원과 케어매니저가 있어야 하고, 또 그 매니저가 일본의 사례에서 보았듯이 어느 조직이나 기관에 소속되어서는 공정성, 객관성, 형평성을 훼손할 수 있다. 이와 같은 것을 고려한다면 우리나라 노인장기 요양보험에서 지역자원의 활용방안을 모색할 수 있을 것이다. 노인장기요양보험과 지역자원의 활용문제에 관하여 제언하면 다음과 같다. 첫째 노인장기요양보험이 주로 신체적 기능에 대한 요양중심의 서비스를 제공하고 있는데, 유감스럽게도 우리나라의 노인장기요양보험에는 예방급여가 결여되어 있다. 이 예방급여는 주로 지역자원과 밀접한 관련성을 지니고 있는데, 일본 개호보험에서 지역포괄지원센터를 설치한 것은 좋은 사례가 될 것이다. 둘째 비공식적 지역자원은 노인에게는 매우 중요한 요소이다. 제도로서 노인을 케어할 수 없는 부분은 모두 비공식적 자원인 가족, 지역사회, 이웃, 자원봉사자, 종교등에서 커버가 가능할 것이다. 노인장기요양보험을 성공적으로 이끌고 정착시키기 위해서는 비공식적 자원의 활용을 어떻게 하느냐 하는 문제도 중요하다. 셋째 노인장기요양보험과 노인복지서비스와의 관계와 역할이 재정립되지 않은 가운데 노인장기요양서비스가 제공되고 있고, 그 사각지대에 놓인 노인도 다수가 존재하고 있다. 또한 그 사이에 서비스를 연계해 주는 조직이나 기구도 존재하지 않고 있으며, 제도나 법적인 체계도 확립되어 있지 않다. 이를 뒷받침해 줄 조직이나 기구가 필요하다. 케어매니지먼트 제도로서 대응이 가능하다. The purpose of this study lies in finding the relationship between long-term insurance and the regional resources, the relationship between long-term insurance and welfare services for the aged and the means to utilize the regional resources in long-term care insurance in reality, however, several prerequisites need to be set in order to make the best use of the regional resources in long-term care insurance. That is, it requires sufficient regional resources and care managers, which, as can be seen in the case of Japan, may undermine fairness, objectivity and equity if the care managers belonged to a certain organization. While considering these issues, we attempted to find the means to utilize the regional resources in long-term care insurance in Korea. Our suggestions are as follows: First, the long-term care insurance mostly focuses on medical services of physical functions and unfortunately it lacks the protection system in Korea. This protection system is closely related to the regional resources, and community total support centers of Japan's care insurance are a good example. Second, non-formal regional resources are a very important factor for the aged. All non-formal resources such as families, regional communities, neighbors, volunteers, and religious bodies may cover the part that system is unable to care for the aged. The issue of how we can make the best use of the non-formal resources is also important in upbringing and finally settling the long-term care insurance system. Third, long-term medical services for the aged are being offered with the relationship between long-term care insurance and welfare service for the aged and their roles not properly reestablished and there are many old people in the medical dead zone. Neither are there organizations that link the services in between long-term care insurance and welfare services for the aged, nor are there appropriate legal systems established. Organizations that support long-term care insurance and welfare service for the aged are urgently needed, which will help establish the care management system.

제3보험의 가입 요인: 간병보험을 중심으로

박복희 ( Bok-hee Park ),전희주 ( Heuiju Chun ) 한국리스크관리학회 2018 리스크 管理硏究 Vol.29 No.3

고령사회 진입과 소득수준의 향상은 장기 생존 시 필요로 하는 노후 자금과 노후간병기에 대한 필요자금의 준비욕구를 증가 시키고 있다. 본 연구는 장기간병보험 가입자 예측모형 적합을 통해 계약분석을 하였다. 간병보험 가입율은 31.3%로 가입자 1인당 약 1.4건의 계약을 보유하고 있으며 생명보험을 통해서 2배이상 더 많이 가입하고 있었다. 상품유형은 간병보험을 단독으로 보장하는 중점보장형태보다 특약부가 형태를 더 선호하는 것으로 나타났다. 다중로지스틱 회귀모형에 의한 분석 결과, 간병보험 가입에 가장 큰 영향을 주는 요인은 질병보험 보유이고 두 번째 요인이 상해(재해)보험의 보유이었다. 또한 월 납입보험료가 높은 고객일수록 간병보험 가입가능성이 높아져 간병보험 가입률에 영향을 주지만 연 의료비 지출액은 간병보험 가입률에 영향을 미치지 않았다. 보험소비자의 생활 패턴으로는 규칙적인 운동을 할수록 간병보험 가입 가능성이 높게 나타나 건강한 사람은 역선택이 아닌 순선택(advantageous selection)을 할 수 있는 가능성을 보여준다. 인구통계학적 요인으로는 거주지, 연령, 세대주 유무 순으로 결정되었다. 거주지가 서울, 대구, 광주 지역일수록 세대주일수록 간병보험 가입가능성은 큰 현상을 보였다. 연령은 50대가 간병보험 가입 가능성이 가장 높고 60대 이상과 20대는 낮은 결과를 보였다. 50대의 7천만원~1억원의 소득을 가진 대도시에 거주하는 세대주 그룹을 간병보험 가입자의 특성으로 볼 수 있다. 이들은 규칙적인 운동과 질병보험 가입으로 적극적으로 건강리스크를 관리하고 있다. The entry of the aging society and the improvement of the income level are increasing the need to prepare the necessary funds for nursing the aged and the old age funds needed for long-term survival. In this study, the contract analysis is performed through the fitting of the long-term care insurance buyer forecasting model. The rate of nursing insurance coverage is 31.3%, with 1.4 contracts per person, more than twice as many as life insurance. The product type showed preference to the special supplement type rather than the guarantee type that guarantees the care insurance alone. As a result of the analysis by the multiple logistic regression model, the most important factor for the participation in long-term care insurance is disease insurance and the second factor is injury (accident) insurance. In addition, the higher the monthly premiums, the higher the possibility of joining long-term care insurance, which affects the rate of long-term care insurance coverage. As the life pattern of the insurance consumers, the more likely they are to exercise regularly, the more likely they are to buy long-term care insurance. However, the annual medical expenditure did not affect the long-term care insurance coverage rate. In the life pattern of insurance consumers, the more regular exercise, the higher the possibility of nursing insurance coverage, and the healthy person shows the possibility of making an advantageous selection rather than the adverse selection. Demographic factors were determined by the residence, age, and householder. In Seoul, Daegu and Gwangju regions and case of householder, the possibility of joining long-term care insurance showed a big phenomenon. Age is likely to be in the 30s to 50s for long-term care insurance, but it is lower for those in their 60s and 20s. Householder, lives in a big city with an income of 70,000 and 100 million won in the 30s and 50s and monthly household expenditure premium of over 1 million won can be regarded as a characteristic of long-term care insurance policy contractor. They actively manage health risks through regular exercise and disease insurances.

중국 장기요양보험 시범사업 비교연구

천합 유,신동면 경희대학교(국제캠퍼스) 국제지역연구원 2022 아태연구 Vol.29 No.3

This study aimed to analyze the institutional characteristics of China's long-term care insurance pilot project, clarify its achievements and limitations, and present desirable institutional measures ahead of the nationwide expansion of long-term care insurance in 2025. This study targeted three areas (Shanghai, Qingdao, Shandong, and Nantong, Jiangsu) and compared institutional characteristics in terms of allocation, benefit, delivery system, and finance. The three regions implemented long-term care insurance for all basic medical insurance subscribers, but Shanghai limited local subscribers to those aged 60 or older. Long-term care benefits are provided by home care, nursing care at nursing institutions, and medical care at medical institutions, and the benefit level differs between regions at 50-90% of basic living expenses and long-term care expenses. The three regions selected respectively a government-operating type, a private enterprise consignment type, and a state-owned enterprise consignment type in the delivery system. In terms of finance, the financial resources for the long-term care insurance fund and the insurance premium rate differed by regions. Next, this paper evaluated the achievements and limitations of the long-term care insurance pilot projects in terms of the comprehensiveness of subscribers, the adequacy of benefits, the accountability of delivery system, and the financial stability, and based on these, four desirable institutional measures were proposed. First, it is necessary to include residents in rural areas and establish standards for evaluation of loss of living ability. Second, the coverage rate of long-term care insurance should be set at 80% and home care service must be at least 3 hours a time. Third, it is desirable to select the government-operating type of Shanghai, and the government should strengthen its role as a regulator for the provision of care services by private institutions. Fourth, the government’s financial support should be limited to personnel expenses of the operating institutions. 이 논문은 중국 장기요양보험 시범사업의 제도적 특징을 분석한 후 그 성과와 한계를 밝히고, 2025년 장기요양보험의 전국적 확대를 앞두고 제도적 방안을 제시하는 것을 목적으로 한다. 장기요양보험 1차 시범사업이 시행된 상하이시, 산둥성 칭다오시, 장쑤성 난퉁시 3개 지역을 사례연구 대상으로 삼고, 대상자, 급여, 전달체계, 재원 차원에서 제도적 특성을 비교하였다. 세 지역은 기본의료보험 가입자를 대상으로 시범사업을 시행하였지만, 상하이시는 주민은 만 60세 이상을 대상으로 한다는 점에서 차이를 보였다. 요양급여는 재가요양, 요양기관요양, 의료기관요양을 시행하며, 급여수준은 기본생활비와 요양비 대비 50-90% 수준으로 차이를 보였다. 전달체계에서 정부운영형, 민간기업위탁형, 국영기업위탁형을 선택하였고, 장기요양보험기금의 재원과 보험료율이 지역별로 차이를 보였다. 다음으로 장기요양보험 시범사업의 성과와 한계를 대상자 포괄성, 급여 적정성, 전달체계 책임성, 재정 안정성 측면에서 평가하였고, 이를 바탕으로 제도적 방안을 제안하였다. 첫째, 농촌지역을 포함시키고, 생활능력상실평가 기준을 마련하여 장기요양보험에 대한 사회적 신뢰를 높여야 한다. 둘째, 요양급여 보장율을 80% 수준으로 설정하고, 재가요양 서비스 시간을 1회당 최소 3시간 이상으로 연장해야 한다. 셋째, 정부 운영형을 선택하고, 정부는 민간기관에 대한 규제자 역할을 강화해야 한다. 넷째, 보험료는 정률방식으로 부과하고, 정부의 재정지원은 운영기관 인건비로 제한해야 한다.

노인 장기요양보험 이용실태 및 서비스내용에 대한 인식

정재연 ( Jae Yeon Jung ),김수화 ( Soo Hwa Kim ),김영경 ( Young Kyung Kim ),안세연 ( Se Youn Ahn ),유은미 ( Eun Mi Yoo ),최부근 ( Boo Keun Choi ),황윤숙 ( Yoon Sook Hwang ),한수진 ( Su Jin Han ) 한국치위생학회 2016 한국치위생학회지 Vol.16 No.3

Objectives: The purpose of the study is to investigate the awareness toward use and service contents of long term care for the elderly. Methods: A self-reported questionnaire was completed by 296 adults from August 13 to October 20, 2014. The questionnaire consisted of general characteristics of the subjects, awareness toward long term care insurance for the elderly, awareness toward long term oral health care services, use of long term care service and use intention for the long term care insurance. Data were analyzed by SPSS 18.0 program. Results: Those who were aware of the long term care insurance accounted for 55.4 percent. Approximately 50 percent of the respondents recognized long term care service items, home visit care, home visit bathing, and home visit nursing. Most of the respondents had information of long term care services by way of mass media and direct contact. Only 13.4 percent of the respondents were aware of the oral health service in the long term care insurance. The subjects were aware of denture cleaning, oral cleaning and oral health education out of oral health service in order; and oral health services that needed to be offered were denture cleaning, oral health education and professional toothbrushing. They reported that dental hygienists were the most important manpower that offered the efficient oral health care services. They answered that professional manpower and financial support are required for oral health services. The positive thinking to long term care insurance accounted for 89.2 percent and 91.3 percent had use intention for oral health services. Conclusions: Many elderly people have mastication or dysphagic problems due to systemic diseases. Therefore, it is necessary to announce the long term care insurance and long term care services for the elderly people.