장기요양보험서비스 이용의사 결정요인

Abstract

본 연구는 앤더슨 모형을 적용하여 선행요인, 자원요인, 필요요인에 따른 장기요양보험서비스 이용의사를 독거노인과 가족동거노인으로 구분하여 두 집단 간의 차이를 알아보고 결정요인을 비교하는 것을 목적으로 한다. 본 연구에서 사용된 자료는 국민노후보장패널조사(Korean Retirement and Income Study: KReIS)의 4차년도 본조사와 부가조사 머지데이터이다. 조사대상은 4차년도 조사대상 9,081명에서 본조사와 부가조사에 모두 응답한 조사대상 총 6,109명 중 65세 이상 노인 3,705명을 대상으로 하였으며, 독거노인 856명, 가족동거노인 2,849명이다. 종속변수는“장기요양보험서비스 이용의사”이고, 독립변수는 크게 3가지로 선행요인, 자원요인, 필요요인으로 살펴보았다. 선행요인에는 성별, 연령, 교육수준이 포함되고, 자원요인에는 공적연금 수급여부, 기초노령연금 수급여부, 경제활동상태, 자녀수, 가계총소득, 거주형태, 서비스 인지여부, 거주 지역이 포함된다. 필요요인에는 신체적 건강상태, 만성질환 유무, 장애진단 경험 유무, ADL, IADL이 포함된다. 자료의 분석방법은 SPSS 18.0을 활용하여, 기술통계 및 t-test, 교차분석 그리고 로지스틱 회귀분석을 실시하였다. 본 연구의 주요 결과는 다음과 같다. 첫째, 선행요인에서 독거노인이 가족동거노인에 비해 남성과 여성의 비율 차이가 컸으며, 특히 여성의 비율이 남성에 비해 현저히 높게 나타났고, 연령은 65세에서 70세 미만의 비율이 낮고, 75세 이상의 비율이 높게 나타나 고연령의 노인 비율이 더 높은 것으로 나타났다. 교육수준에서는 독거노인이 가족동거노인에 비해 무학 비율이 2배 이상 높고, 중학교 이상 비율이 더 낮게 나타나 상대적으로 교육수준이 더 낮은 것으로 나타났다. 자원요인에서는 독거노인이 가족동거노인에 비해 공적연금 수급비율이 적고, 기초노령연금 수급비율이 많으며, 비취업자가 많으며, 단독주택 거주자가 많고, 장기요양보험서비스에 대해 인지도가 적으며, 도지역에 많이 거주하고 있으며, 경제적 수준이 낮은 것으로 나타났다. 욕구요인에서는 독거노인이 가족동거노인에 비해 주관적으로 인식하는 신체건강상태가 더 좋지 않고, 만성질환을 가진 비율이 높으며, 장애진단 경험 유무는 비슷하였다. ADL과 IADL에서는 비슷하지만 독거노인이 조금 더 상태가 좋은 것으로 나타났다. 마지막으로 장기요양보험서비스 이용의사가 독거노인이 가족동거노인에 비해 높게 나타났다. 둘째, 세 가지 요인에 따른 장기요양보험서비스 이용의사 차이에서 독거노인은 선행요인에 따른 장기요양보험서비스 이용의사는 유의한 차이를 보이지 않았으나, 가족동거노인의 경우 연령에서 유의한 차이를 보였다. 자원요인에 따른 결과에서는 독거노인 가족동거노인 모두 거주형태, 거주 지역, 자녀수에 따라 장기요양보험서비스 이용의사에 차이를 보였고, 가족동거노인은 공적연금 수급여부에 따라서도 차이를 보였다. 욕구요인에 따른 결과에서는 독거노인은 유의한 차이를 보이는 것이 없었으나, 가족동거노인에서는 장애진단 경험여부에 따라 장기요양보험서비스 이용의사에 유의한 차이를 보였다. 셋째, 로지스틱 회귀분석 결과 독거노인의 경우 연령, 거주형태, 거주지역이, 가족동거노인의 경우 공적연금 수급여부, 자녀수, 거주형태, 거주 지역, 장애진단 경험 유무가 장기요양보험서비스 결정요인으로 나타났다. 독거노인의 경우 연령이 높아질수록, 단독주택에 비해 아파트에 거주할수록, 서울에 비해 광역시나 도지역에 거주할수록 이용의사가 높아졌다. 가족동거노인의 경우 공적연금을 수급 받을수록, 단독주택에 비해 연립/다세대 등에 거주할수록, 서울에 비해 광역시나 도지역에 거주할수록, 장애진단 경험이 있을수록 이용의사가 증가하였으나 자녀수가 많아질수록 이용의사는 감소하였다. 본 연구는 우리나라의 노인장기요양서비스 이용의사에 관한 연구로, 기존 연구에서는 장기요양보험 서비스 전체 보다는 재가서비스, 시설서비스 등에 관한 개별 서비스에 대한 영향요인 연구이거나, 수발자인 가족을 대상으로 한 연구가 대다수를 이루었다. 특히, 노인 장기요양보험 서비스 이용의사 결정요인 중 가구형태 즉, 독거여부를 변수로 넣어 진행된 연구는 다수 있으나 독거노인과 가족동거노인을 각각 대상으로 한 비교 연구는 없었다. 따라서 본 연구는 이전에 시도된 적 없는 연구로 함의를 가진다. 노인 장기요양보험제도가 2008년 시행된 후 7년이 흐른 현 시점에서 증가하는 노인 수뿐만이 아니라 급증하는 독거노인 수를 감안하여, 보호와 관심이 더욱 필요한 독거노인이 장기요양보험제도를 통해 서비스를 이용하고 또한 보호받을 수 있도록 제도가 개편될 필요가 있다고 본다.;This study aims to find out differences between the elderly living along and the elderly living with their families and compare determinants of their intention of using long-term care insurance service between the two groups according to antecedent factors, resource factors and need factors with Anderson Model applied The data used for this study is merge data of the 4th year’s main survey and additional survey of KReIS (Korean Retirement and Income Study). As research subjects, this study selected 3,750 senior citizens, 856 ones living alone and 2,849 ones living with their families, out of the 6,109 senior citizens who responded to both the main and additional surveys out of all the 4th year’s research subjects, 9.081 senior citizens. The dependent variable was ‘Intention of using long-term care insurance service’, and the independent variables were largely divided into predisposing factors, enabling factors and need factors. The predisposing factors included gender, age and educational background, and the enabling factors included whether to receive public pensions, whether to receive the basic old-age pension, economic activity status, the number of children, household gross income, residential type, whether to perceive service and residential area. The need factors included physical health status, whether to have chronic diseases, whether to have experience of disorder diagnoses, ADL and IADL. To analyze data, this study conducted descriptive statistics and t-test, crossover analysis, logistic regression analysis using SPSS 18.0. The main results of this study can be summarized as below. First, in predisposing factors, the elderly living alone showed a larger difference in the ratio between males and females than the elderly living with their families. Especially, the ratio of females was remarkable higher than that of males. In age, the ratio of senior citizens at the age between 65 and 70 was low, while that of senior citizens over 75 was high, which indicates that the ratio of older senior citizens was higher. In educational background, the non-educational background of the elderly living alone was twice higher than that of the elderly living with their families, and the over-middle school graduation ratio of the elderly living alone was lower than that of the elderly living with their families, which indicates that the elderly living alone had a relatively lower educational background. In enabling factors, the elderly living alone showed a lower ratio of receiving public pensions and a higher ratio of receiving the basic old-age pension than the elderly living with their families, and many of the elderly living alone were non-employed, lived in detached houses, perceived long-term care insurance service less and resided in provincial areas with lower economic status. In need factors, the physical health status the elderly living alone subjectively perceived was lower than that of the elderly living with their families, and they had a higher ratio of chronic diseases, but they showed a similar ratio of having disorder-diagnose experience to the elderly living with their families. Both the groups showed similar ADL and IADL to each other, but the elderly living alone showed a little better status in ADL and IADL. Lastly, the elderly living alone showed higher intention of using long-term care insurance service than the elderly living with their families. Second, as analyzing differences in intention of using long-term care insurance service by the three kinds of factors, this study found out that the elderly living alone showed no significant difference in intention of using long-term care insurance service by predisposing factors, but the elderly living with their families showed a significant difference by age. As a result of analyzing the enabling factors, this study found out that both the elderly living alone and the elderly living with their families showed differences in intention of using long-term care insurance service by residential type, residential area and the number of children, and the elderly living with their families even showed a significant difference by whether to receive public pensions. As a result of analyzing the need factors, this study found out that the elderly living alone showed no significant difference, but the elderly living with their families showed a significant difference in intention of using long-term care insurance service by whether to have experience of disorder diagnoses. Third, as a result of the logistic regression analysis, it was found that for the elderly living alone, determinants of using long-term care insurance service were age, residential type and residential area, and for the elderly living with their families, determinants of using long-term care insurance service were whether to receive public pensions, the number of children, residential type, residential area and whether to have experience of disorder diagnoses. The elderly living alone showed a higher intention of using long-term care insurance service as they were older, lived in apartments rather than attached houses and resided in metropolitan or provincial areas rather than Seoul. On the other hand, the elderly living with their families showed a higher intention of using long-term care insurance service as they received public pensions, lived in row/multiplex houses rather than detached houses, resided in metropolitan or provincial areas rather than Seoul and had experience of having disorder diagnoses, but their intention decreased as they had more children. This study was conducted on senior citizens’intention of using long-term care insurance service in Korea by targeting the elderly at the age over 65, which is differentiated from most of the previous studies conducted on individual services, such as home-care service and care facilities, rather than the entire long-term care insurance service, or on their families as care-givers. Especially, there were many researches conducted by taking the household type out of all the determinants of senior citizens’ intention of using long-term care insurance service for a variable, that is, whether to live alone. but there was no comparative research on the elderly living alone and the elderly living with their families respectively. In this light, this study has significance and implication. It has been 7 years since the long-term care insurance system for the elderly was first enforced in 2008, and in consideration of the rapidly increasing number of the elderly living alone as well as that of senior citizens, it seems necessary to reorganized the present system so that more of the elderly living alone can use services from the long-term care insurance system and be protected and cared better.