Progress and determinants of transition from non-graded older persons to being beneficiaries for long-term care insurance system: A longitudinal study

Abstract

Purpose: The purpose of this study is to identify the progress of transition from the non-graded to the approved for Long-term Care Insurance (LTCI) and analyze the factors affecting becoming beneficiaries. Methods: This study was designed as a prospective cohort study. Study population was the non-graded for LTCI in 2018. We tracked and observed study population until December 2020 by using big data. Variables in the analysis consisted of the individual (socioeconomic characteristics, health status, medical service usage) and community-related (physical environment, local infrastructure, local older population, local social capacity, health policy) factors. Competing risks regression analysis was used to identify determinants of transition from the non-graded to beneficiaries for LTCI. Results: We analyzed 52,308 non-graded for LTC insurance. The average period of transition from the non-graded to beneficiaries was about 15.61 months, the cumulative transition rate for 6 months was 4.8%, and the cumulative transition rate for 36 months was 49.6%. The individual factors (higher age, female, low income, lower daily living ability, lower cognitive-behavioral score, dementia, low back pain, and lower medical expenses), as well as the community factors (rural areas) were determinants for the transition to beneficiaries. Conclusion: To prevent non-graded from being persons with LTC needs, we suggested that it is necessary to develop a policy that can establish an integrated community-based support system by selecting vulnerable groups such as rural residents and low-income groups. In addition, additional research is needed to evaluate the effect of preventive programs for the non-graded on maintaining and improving their health and functional status.