Fee for long-term care insurance in Korea are determined in proportion to
resources utilized according to severity rather than based on categorization of
beneficiaries in consideration of the characteristics of resource utilization. This
adoption is based on the assumption that as beneficiaries of long-term care
insurance, characteristically, demands social services rather than needs medical
treatments, the characteristics of beneficiaries and the quality of utilized resources
are comparatively homogenous. Therefore, the proposition is that the size of
resource consumed by beneficiaries in the same grade is identical. However, even
in the same grade, the level of utilized resources is different depending on the
characteristic of beneficiaries.
In this regard, this study is to examine whether there are differences in the
volumes of utilized resources depending on the characteristics of beneficiaries evenin the same grade. We analyzed time study data for 2003, 2005, 2006 which
conducted by the Korea Institute for Health and Social Affairs. To look at
differences in the volumes of utilized resources, we identified characteristics of
beneficiaries that influence utilized resource volumes and categorized services
provided by facilities into the rehabilitation treatment category, the problematic
behavior category, and the physical malfunction category. Then, we examined each
service in consideration of service difficulty levels and wage weights.
The result of examination showed that differences in utilized resource volumes
exist in all three grades depending on the characteristics of beneficiaries.
Especially, in the first grade with a high level of seriousness, utilized resource
volumes were different for those three service categories and the problematic
behaviour category considered dementia was found to consume the largest volume
of resources. Moreover, there was the inversion phenomenon of utilized resources
volumes between the grades. This result indicates that utilized resource volumes
are different even in the same grade depending on the characteristics of
beneficiaries and it is required to consider case-mix for reflection of the volumes
of utilized resources depending on the characteristics of beneficiaries.