Jin-Won Noh, Jinseok Kim, Min-Hee Heo, Young Dae Kwon
Among adults who survive to older ages, LTCI applications and approvals tend to occur well beyond the initial eligibility age of 65 years. Differences in mean ages at entry across subgroups may reflect both variation in help-seeking and differential survival, and our descriptive comparisons cannot disentangle these mechanisms. These patterns provide baseline evidence on ages at entry among survivors and are consistent with possible socioeconomic and informational barriers. Targeted outreach, strengthened health literacy, and more responsive administrative support are therefore best viewed as plausible policy responses and as priorities for future analytic research that explicitly accounts for competing mortality.
BACKGROUND: This study examined how individual socioeconomic and health characteristics shape the timing of entry into Korea's Long-Term Care Insurance (LTCI) system by comparing the ages at application and approval.
METHODS: Using the National Health Information Database, a nationally representative Korean claims dataset, we analyzed data from 1,068,669 adults aged ≥ 41 years who were followed from 2008 to 2022. This exploratory descriptive study used administrative records to determine ages at LTCI application and approval. Associations with gender, disability, income level, insurance type, and multimorbidity were assessed using descriptive statistics, bivariate comparisons (t-tests, F-tests), and kernel density plots to visualize distributional patterns across subgroups.
RESULTS: The mean age at LTCI application was 79.98 years, and the mean age at approval was 80.95 years, indicating that most beneficiaries enter the system well beyond the initial eligibility age of 65 years. Women, people without disabilities, and individuals with fewer chronic conditions tended to enter and be approved later, whereas individuals with greater disease burden entered earlier and were typically approved earlier. Both the lowest- and highest National Health Insurance contribution groups showed later entry than middle-income groups, while Medical Aid beneficiaries entered earlier than those covered by employment-based or region-based insurance.
CONCLUSIONS: Among adults who survive to older ages, LTCI applications and approvals tend to occur well beyond the initial eligibility age of 65 years. Differences in mean ages at entry across subgroups may reflect both variation in help-seeking and differential survival, and our descriptive comparisons cannot disentangle these mechanisms. These patterns provide baseline evidence on ages at entry among survivors and are consistent with possible socioeconomic and informational barriers. Targeted outreach, strengthened health literacy, and more responsive administrative support are therefore best viewed as plausible policy responses and as priorities for future analytic research that explicitly accounts for competing mortality.
CLINICAL TRIAL NUMBER: Not applicable.