Impact of a New Long-Term Care Benefit on Health Care Use and Costs in Older Adults with Dementia

Background

To help combat issues caused by rapid population aging, in 2018, South Korea introduced a cognitive assistance grade (CAG) to expand long-term care (LTC) benefits to older adults with mild dementia. In this study, we evaluated the impact of the CAG on health care utilization and costs.

Methods

We examined the data of 27,344 participants from the South Korean National Health Insurance Service’s National Health Information Database. A quasi-experimental design using propensity score matching and difference-in-differences compared healthcare outcomes between 13,672 CAG beneficiaries and matched non-beneficiaries.

Results

CAG resulted in a significant decrease in the number of outpatient visits (RR = 0.942, p < 0.0001) and outpatient healthcare expenditure (RR = 0.8972, p < 0.0001) among beneficiaries compared with non-beneficiaries. Conversely, this policy led to a significant increase in inpatient length of stay (RR = 1.199, p < 0.0001), inpatient healthcare expenditure (RR = 1.1319, p < 0.0001), and total healthcare expenditure (RR = 1.100, p < 0.0001).

Conclusions

CAG was associated with reduced outpatient use, indicating improvements in preventive care among older adults with mild dementia. However, increased inpatient utilization highlights the need for integrated care models linking long-term care and medical services. These findings highlight the importance of expanding and refining dementia-specific long-term care policies.

Key messages

• This study underscore the need for integrated care models connecting long-term and medical services to promote efficiency, equity, and sustainability in dementia care delivery.

• This study examines older adults with early-stage dementia, a group with limited evidence, offering insights to design interventions that support stability, delay decline, and reduce hospitalizations.