Home Personal Assistance for the Elderly and Its Effects on Health Care Utilization: Evidence From South Korea
Name: Catherine Myong
School: Vagelos College of Physicians and Surgeons, Class of 2023. Varmus Global Scholar 2020
Mentor: John Rowe, MD and Hongsoo Kim, MD
In 2008, South Korea created the Long-Term Care Insurance program (LTCI) for the elderly, supplemented by a program for low-income frail elders. While use of home services is encouraged as cost-saving, there is mixed evidence on effects of paid care on elderly health care utilization. Our research questions were: were there differences in utilization of outpatient, inpatient, dental services between elderly people with functional limitations who received paid personal assistance versus those who did not? Among those who did, what effect did personal assistance have on utilization? Using the Korean Longitudinal Study of Aging (KLoSA), a cross-sectional analysis compared health care utilization of 128 respondents who received paid care in 2016 to 256 matched controls. A sub-analysis examined the effect of paid care on health care utilization, using multivariate linear regressions. There was no significant difference in utilization except that the number of days in hospitalization was higher in those that received paid help (88.4 vs 30.5 days within last 2 years, p=0.003). Within the cohort, amount of paid help received was positively associated with days of hospitalization (p=0.002). The distribution of days of hospitalization was dramatically skewed, with almost all taking place in the last decile. Eliminating the last decile showed no difference in hospitalizations between the remaining cohort and control. For the most frail elderly, provision of paid home care does not influence utilization of health care services. Their hospitalization rates are very high, suggesting that initial hospitalization might identify a subpopulation that would benefit from enhanced services.