지역별 노인 만성기 의료 및 요양ㆍ돌봄 공급체계 특성에 따른 서비스 이용과 건강 결과 = Service Utilization and Health Outcomes by Regional Delivery System for Elderly Chronic Health Care and Long-Term Care

다국어 초록 (Multilingual Abstract)

Background: As Korea undergoes rapid population aging, the need for integrated, community-based care systems for older adults is increasing. A previous study proposed a typology of regional delivery systems based on levels of chronic medical and long-term care needs. This study examines how the characteristics of these regional systems influence service utilization and health outcomes among older adults. Methods: We used national claims data from 2015 to 2019, targeting individuals aged 65 or older with identified needs for chronic medical or long-term care. Primary outcomes included annual healthcare expenditures, long-term care costs, total combined costs, and mortality. Regional care delivery systems were assessed for their adequacy in meeting need-based service criteria. Generalized linear models and mixed models were used to examine associations, adjusting for individual and regional variables. Results: Older adults living in regions with adequate systems for short-term rehabilitation or medical care had lower annual healthcare expenditures and higher long-term care costs. Regions with nursing homes staffed with more registered nurses were associated with significantly lower healthcare and total care costs, as well as reduced mortality. These associations remained significant after controlling for regional socioeconomic conditions. Conclusion: The adequacy of regional care delivery systems tailored to the diverse needs of older adults significantly influences both service utilization and health outcomes. Expanding integrated, needs-based care systems is essential to enhance the effectiveness and equity of elderly care across regions.