29(1), 2009, 213-235 Health and Social Welfare Review 1~3. (HLM). Andersen 2 1~3 5,989 9.,,,,,,.,,,,,, ( ),. * ( ). 213
29(1), 2009, 213-235 Health and Social Welfare Review..,., 1~3 60% (, 2008).,..,.... (, 2004;, 2003;, 2001;, 2005 ).. 214
,,. (Andersen, 1995)...,.,..,.....,,. (formal care) (informal care). 215
29(1), 2009, 213-235 Health and Social Welfare Review (Kane, Kane & Ladd, 1998).. (Kane, Kane & Ladd, 1998).. (Home and community-based care service) (Institutional care service)..,,,,,, (nursing home). 1980. (Merlis, 2000). (aging in place), (, 1999). (medically-oriented care) (sociallyoriented care) (, 2005). (acute care).,.. 216
. 1. 4.,,,,,,. Andersen (Health Service Behavior Model). Andersen 30 (Piecy & Blieszner, 1999; Kadushin, 2004), (, 2001;, 2003). Andersen ( 2). Andersen. ( ) 217
29(1), 2009, 213-235 Health and Social Welfare Review (predisposing characteristics), (enabling factors), (need factors) (Andersen 1995). ( ) (predisposing characteristics).,. (demographic),, (Andersen & Newman, 1973). (social structure),, (life style), (Andersen & Newman, 1973). (health beliefs),,. (enabling factor).,.,,,,,,,, (Andersen & Newman, 1973). (need factor). 218
(perceived need) (evaluated need). Andersen,, (Bass and Noelker, 1987 ; Guendelman, 1991; Portes, Kyle, and Eaton, 1992). (Andersen,1995). Andersen Aday Newman. Andersen,,.,,. (Borrayo, et al., 2002; Miller & Weisser, 2000; Calsyn & Winter, 2000).,. Mui & Burnette(1994) 80. Bass & Noelker(1987) Johnson & Wolinsky(1996). Hanley, et al.(1990), Murtaugh, et al.(1990) Miller & Weissert(2000).,. (Borrayo, et al., 2002), Borrayo, et al.(2002) 1).,.. 219
29(1), 2009, 213-235 Health and Social Welfare Review.. Miller & Weisser(2000) 21 13, 8.,,,. (Miller & Weisser, 2000; Wallace, et al., 1998; Coward et al., 1996).. Dansky et al.(1998) Medicaid. Eustis, N., et al.(1984),. Medicaid. (Mui & Burnette, 1994; Norgard & Rodgers, 1997; Tennstedt, et al.,1993). Wallace, et al.(1998) (Medicaid). Bass & Noelker(1987) (-), (+).., (Coward & Dwyer, 1992). Grabbe, et al.(1995). Mitchell & Krout(1998),. 220
. (ADL) (IADL) (+) (Borrayo, et al., 2002; Miller & Weisser, 2000; Miller, et al., 1999; Cagney & Agree, 1999).. (Borrayo, et al., 2002; Miller & Weisser, 2000),. 1~3. 2 1~3. 3. 1 1~5, 2 1~3. 2. 2 2006 5 11 1~3 5,989.,. 9 2). < 1>. 2) 2 8,. 221
29(1), 2009, 213-235 Health and Social Welfare Review ( ) 65 106 79.0(7.7) ADL 12 36 23.8(7.0) IADL 2) 6 21 17.6(3.8) 0 5 2.3(1.9) 0 10 2.0(2.2) 0 7 0.3(0.7) 10 30 16.0(4.9) 18.9 73.4 35.3(16.1) 4.0 6.0 5.4(0.73) 0.0 4.0 1.3(1.6) (, ) 3,581 59.8 2,408 40.2 1,757 29.3 4,232 70.7 1,632 27.2 224 3.7 4,133 69.0 4,019 67.1 1,970 32.9 5,001 83.5 988 16.5 1) 1,779 35.6 1,412 28.3 1,806 36.1 1 2,160 36.1 2 1,339 22.4 3 2,490 41.6 2 22.2 5 55.5 2 22.2 : 1) 988 4 4,997. 2) 164 5,825 5,989 / 9 222
0, 1. 59.8%... 3:7, 79.0. 65,.,,,.,,. 27.2%, 3.7%, 69.0%. 10.3%(2008 ) 3..,,. 32.9% 67.1%, 16.4% 83.5%. 28.3%, 35.6%, 36.1%. (ADL), (IADL),,,,. 1, 1 36.1%, 2 22.4%, 3 41.6%. ADL IADL ADL 12~36 23.8, IADL 6~21 17.6.,. 0~5 2.3, 0~10 2.0. 0~7 0.3, 10~30 16.0. 223
29(1), 2009, 213-235 Health and Social Welfare Review. 1,000,,,.,,,,. 2, 5, 2, 1,000 18.9, 73.4 3.9. 4 6. 4. (Multilevel analysis). 2. (, 1991), (ANOVA),,,, (, 1995).. (dichotomous variable) Bernoulli, (logit). SPSS10.0 HLM 6.0. 224
., U0 U0.. (Conditional Model) 3) < 3>.,., 25%. Hanley, et al.(1990) Norgard & Rodgers(1997)..,., G00 0.38 0.15 2.54* 1.46, U0 0.47 0.22 226.2*** ***p<0.001, *p<0.05 3). 225
29(1), 2009, 213-235 Health and Social Welfare Review 0.23 0.07 3.21** 1.25-0.00 0.00-0.21 1.00 ( = ) -1.17 0.35-3.32** 0.31-0.96 0.31-3.13** 0.38-0.12 0.22-0.57 0.88 0.56 0.42 1.32 1.75 ( = ) -0.52 0.45-1.15* 0.60-0.65 0.38-1.69* 0.52 ADL 0.02 0.01 1.75# 1.01 IADL -0.04 0.03-1.05 0.96 0.00 0.02 0.04 1.00 0.06 0.02 3.62*** 1.06-0.17 0.04-3.79*** 0.84-0.00 0.01-0.21 1.00-0.14 0.06-2.18* 0.87 ( = ) 0.65 0.22 2.93# 1.92 0.53 0.11 4.77** 1.69-0.10 0.06-1.72 0.91 0.23 0.06 3.58# 1.26-0.17 0.03-6.01*** 0.84, G00 0.82 0.70 1.17 2.26 0.91 0.83 26.28*** 0.87 0.76 105.11*** 0.55 0.31 28.22*** 1.22 1.49 76.86*** 1.30 1.69 100.72*** 1.11 1.23 85.96*** IADL 0.10 0.00 92.03***, U0 1.14 1.29 32.64*** ***P<0.001, **P<0.01, *P<0.05, #P<0.1 226
. (Borrayo, et al., 2002; Hayley, et al., 1990; Miller & Weisser, 2000 )....,. 69%, 62%.,, > >.. Medicaid (Dansky et l., 1998; Eustis, N., et al., 1984), (Wallace, et al., 998)..,,., (Hayley, et al., 1990; Miller & Weisser, 2000; Wallace, et al., 1998; Newman, et al., 1990, Coward et al., 1996). ( vs )....,. 227
29(1), 2009, 213-235 Health and Social Welfare Review 40%, 48%.,. (ADL),,,.,., (1 ). 13%., 3 1 26%. ADL,. ADL,., 1 5%.. ADL ADL...,... 1.92, 1.69. Coward & Dwye(1992) 228
.,.. 4). 1,000..,.. 1 16%.,,.. (HLM).,,, ADL, IADL,,,.. 4) (2006) 62.1% 69.2%, 17.5% 28.0%. 229
29(1), 2009, 213-235 Health and Social Welfare Review,.....,...,..,.,.,..,..,, 230
..,. ADL. ADL,,.,.....,..,.. 231
29(1), 2009, 213-235 Health and Social Welfare Review (2004)., (4), pp.123~147. (1999).. (2003)., pp.105~128., (2001)., (2), pp.113~214. (2005)., pp. 29~47.,,, (2005).. Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter, Journal of Health and Social Behavior, 36(1), pp.1~10. Bass, D. & Noelker, L. (1987). The influence of family caregivers on elder s use of in-home services: An expanded conceptual framework, Journal of Health and Social Behavior, 28, pp.184~196. Borrayo,E. A., Salman, J. R., Polivka, L., & Dunlop, B. D. (2002), Utilization across the continuum of long-term care services, The Gerontologist, 42(5), pp.603~612. Bullock, K., Crawford, S. L., & Tennstedet, S. L. (2003), Employment and caregiving: Exploration of African American caregivers, Social Work, 48(2), pp.150~162. Burnette, D., & Mui, A.C. (1995), In-home and community-based service utilization by three groups of elderly Hispanics: A national perspective, Social Work Research, 19(4), pp.197~206. Cagney, K. A., & Agree, E. M. (1999), Racial differences in skilled nursing care and home health use: The mediating effects of family structure and social class, Journal of 232
Gerontology: Social Sciences, 54B(4), pp.s223~s236. Calsyn, R. J. & Winter, J. P. (2000), Predicting different types of service use by the elderly: The strength of the behavioral model and the value of interaction terms. The Journal of Applied Gerontology,19(3), pp.284~303. Chumbler, N., Beverly, C., & Beck, C. (1998), Determinants of in-home health and support service utilization for rural older adults, Research in the Sociology of Health Care, 15. pp.205~227. Coughlin, T. A., McBride, T. D., Perozk, M., & Liu, K. (1992), Home Care for the disabled elderly: Predictors and expected costs, Health Services Research, 27(4), pp.453~479. Coward, R. T., Netzer, J. K., & Mullens, R. A. (1996), Residential differences in the incidence of nursing home admissions across a six-year period, Journal of Gerontology: Series B, Psychological Sciences & Social Sciences, 51(5), pp.258~267. Dansky, K, H. et al. (1998), Profiles of Hospital, Physician, and Home Health Service Use by Older Persons In Rural Areas, The Gerontologist, 38(3): pp.320~330. Branch, L., & Lambert, R. (1995), Functional status and the use of formal home care in the year before death, Journal of Aging and Health, 7, pp.339~364. Hawranik, P. (1998), The role of cognitive status in the use of in-home services: Implications for nursing assessment, Canadian Journal of Nursing Research, 30, pp.45~65. Hooyman and Gonyea. (1995), Feminist Perspectives on Family Care, Sage Publication. Houde, S. C.(1998), Predictors of elders and family caregivers use of formal home services, Research in Nursing and Health, 21, pp.533~543. Kadushin, G. (2004), Home Health care utilization: a review of the research for social work, Health and Social Work, 29(3), pp.219~244. Kane, R. A., Kane, R. L. & Ladd, R. C. (1998), The heart of long-term care, New York: Oxford University Press. Logan, J. R. & Spitz, G. (1994), Informal support and the use of formal services by older Americans, Journal of Gerontology: Social Sciences, 49(1), pp.s25~34. Miller, B., Campbell, R., Davis, L., Furner, S., Giachello, A., Prohaska, T., Kaufman, H., Li, 233
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Factors of Long Term Care Service Use by the Elderly YunKyung Lee (Korea Institute for Health and Social Affairs) The aim of this study is to pin down determinants of long-term care service use of those who are eligible for the LTCI (Long Term Care Insurance). The study is based on Health Service Behavior Model of Andersen. The factors influencing the decision include such individual predisposing characteristics, enabling factors and need factors, and long term care service resources in the community. Data used here are from the 2nd pilot program for the Long Term Care Insurance scheme in which service patterns of 5,989 aged individuals and nine districts are included. Analytical method used is Hierarchical Linear Model (HLM) that can be used for the analysis of nested data structure available with current data set. The findings of the study were as follows. Women receive more benefits than men, and the proportion of those receiving care is higher in those who are eligible for National Basic Livelihood Security System (NBLSS) that in the middle income class and the low income class. In addition, the higher the family care is available, the lower the taking part in the service. Furthermore, the greater the level of difficulty with ADL functioning, the higher the abnormal behavior and the greater the care quality; and we observe higher participation rate for the scheme. Also, the higher the nursing need, the lower the service utilization we observe. In big cities and mid sized cities, more people participate in the program than in rural, and wider the available services, service utilization is higher. Also, if there exists a variety of nursing hospitals, a substitutionary entity for facility care, less people take part in the scheme in the community. Keywords: Long-Term Care Insurance, Long-Term Care Service, Service Use Pattern, HLM 235