Regional trends in the utilization of home-based care covered by the social security system in Korea among older adults: using Korea National Health Insurance Service Senior Cohort (Preprint)

BACKGROUND As Korea is rapidly transitioning into a super-aged society, the demand for home-based care (HBC) services is increasing. Although HBC services, such as hospital-based home health nursing care (HHNC), community-based home care (CBHC), and community-based home nursing care (CBHNC), have been implemented under the national social security system, their regional differences and temporal trends remain unclear. OBJECTIVE This study examined regional and temporal trends in the use of HBC services among older adults in Korea using data from the National Health Insurance Service Senior Cohort from 2008 to 2019. METHODS Data from 2008 to 2019 were analyzed to calculate the annual HBC utilization rates (users per 1,000 older adults) across 17 administrative regions. HBC services were categorized as HHNC, which are reimbursed under the National Health Insurance Service, and CBHC and CBHNC, both of which are covered by the Long-Term Care Insurance for older adults. Trends were analyzed separately for each category. Spatial clustering was assessed using Global Moran’s I and Getis–Ord Gi* statistics. Spatiotemporal analysis was conducted using the Mann–Kendall trend test and Sen’s slope estimator to assess regional trends over time. RESULTS From 2008 to 2019, the utilization rates of CBHC and CBHNC increased significantly, whereas HHNC utilization showed a non-significant upward trend. Spatial analysis revealed increasing clustering of HHNC utilization, particularly in Seoul and its surrounding regions (Moran’s I: 0.770, p < .001). Spatiotemporal trend analysis revealed significant increases in HHNC utilization in the capital regions of Sejong, Chungcheongnam-do, and Gangwon-do. All regions except Jeju showed significant increases in CBHC. Incheon and Jeollabuk-do showed significant increases in CBHNC, whereas Gyeongsangbuk-do exhibited a significant decreasing trend. CONCLUSIONS Although HBC services are provided under the social security system, regional differences in utilization rates were observed across different service types. As Korea’s population continues to age, recognizing these regional disparities and promoting a balanced and sustainable delivery of HBC services tailored to the unique needs and characteristics of each region are essential. Insights from Korea on regional differences in the use of various home-based care services may help guide policy planning in other aging populations.