Associations Between Regional Supply and Integration of Home and Community-Based Service Providers and Risk of Institutionalization: Evidence From South Korea

Background and Objectives To examine whether the regional density of integrated home and community-based services (HCBS) providers affects long-term care (LTC) service utilization pattern and institutionalization risk in South Korea. Research Design and Methods This observational study utilized data from the National Health Insurance Service (NHIS) on individuals aged 65 and older who became newly eligible for LTC insurance benefits in 2018. The final sample excluded individuals admitted to long-term care hospitals during the previous year or those living away from home, resulting in a total of 91,302 individuals included in the study. We analyzed the impact of regional HCBS and integrated care provider density on 4 outcomes: choice of HCBS over LTC facilities (LTCF) as first LTC service, intensity and comprehensiveness of HCBS use, and risk of institutionalization within a year. Results Higher regional densities of integrated care providers are associated with increased odds of using HCBS as the first LTC service (odds ratio 1.066, model 1, p < .01). Increased density was also associated with higher odds of using multiple HCBS (Odds Ratio 1.108, model 1, p < .01). Additionally, higher density of integrated care providers was associated to decreased risk of institutionalization into LTC facilities (hazard ratio 0.98, model 1, p < .01). Discussion and Implications The density integrated care providers significantly reduce institutionalization rates, by increasing the possibility of choosing HCBS over LTCF as their first LTC service and using a more comprehensive combination of HCBS services. Further investment in integrated care models may enhance the effectiveness of LTC systems.