It was analyzed that if the employment of nurses instead of nursing assistants increases in elderly care facilities, residents' use of medical services for urinary tract infections and bedsores will decrease, and health insurance treatment costs will also decrease.
According to the KDI Focus 'Effects and Policy Directions of Expansion of Skilled Nurses in Elderly Nursing Facilities' published by Research Fellow Kwon Jeong-hyun of the Korea Development Institute (KDI) on the 3rd, if the proportion of skilled nurses increases by 10 percentage points, health insurance medical expenses decrease by 7.7%.
Researcher Kwon derived these results by analyzing the long-term care insurance claim details and health insurance statements of facility benefit recipients admitted to 2,890 nursing facilities between January 2016 and December 2023.
A skilled nurse refers to a nurse who is not a nursing assistant among nursing facility nursing staff.
According to the current staffing standards for elderly care facilities, nursing facilities with more than 30 residents must deploy one nurse or nursing assistant for every 25 residents.
According to the Nursing Act, nurses' unique duties include nursing judgment, nursing, and medical assistance under the guidance of doctors. On the other hand, nursing assistants are, in principle, limited to personnel assisting nurses and have relatively low expertise in nursing work.
As employment costs have risen since the minimum wage was sharply increased in 2018, elderly care facilities have reorganized their workforce to focus on nursing assistants, whose wages are relatively lower than nurses.
In fact, due to the minimum wage increase, the ratio of nurses among the nursing staff in nursing facilities decreased by 4.25% points.
However, it was analyzed that these results could have a negative impact on the health of nursing facility residents.
When the proportion of skilled nurses increased by 10 percentage points, the total number of days of hospitalization for nursing facility residents decreased by 0.33% and the number of days of hospitalization decreased by 0.49%.
Accordingly, health insurance medical expenses also decreased.
This suggests that investing in long-term care services, mainly skilled nurses, may ultimately lead to a positive effect on health insurance finances.
It was found that the use of medical services due to bedsores, a representative disease directly affected by the quality of long-term care services, decreased by 0.1%, and the use of medical services due to urinary tract infections decreased by 0.03%.
The use of medical services due to infectious diseases such as influenza and pneumonia and dementia was also found to decrease.
Researcher Kwon suggested that the current staffing at elderly care facilities, which is based only on the total number of nursing staff, without distinction between nurses and nursing assistants, should be improved.
As the number of highly skilled nursing personnel increases, financial expenditures under long-term care insurance will increase, but the financial burden of health insurance will decrease, so these two finances must be considered integrated.
Researcher Kwon emphasized, “There is a need to review improvements in specifying requirements for the proportion of skilled nurses in the nursing staff placement standards.”
He continued, “The cost-effectiveness of financial investments, such as support for hiring nursing staff and additional fees, must be evaluated by considering the integration of long-term care insurance and health insurance finances.”
