Raising Nurses' Share at Long-Term Care Facilities by 10 Percentage Points... "Cuts National Health Insurance Medical Expenses by 7.7%"
An analysis has found that increasing the share of experienced registered nurses employed at long-term care facilities for older adults, rather than nursing assistants, can reduce conditions such as urinary tract infections and pressure ulcers among residents and significantly cut National Health Insurance medical expenses.
A 10-Percentage-Point Increase in the Share of Nurses Cuts National Health Insurance Medical Expenses by 7.7%
According to a KDI Focus report titled "Effects of Expanding the Skilled Nursing Workforce at Long-Term Care Facilities for Older Adults and Policy Directions," published on November 3 by Kwon Jeong-hyeon, a research fellow at the Korea Development Institute (KDI), a 10-percentage-point increase in the share of skilled nurses at long-term care facilities was associated with a 7.7% reduction in National Health Insurance medical expenses.
Kwon reached this conclusion by tracking and analyzing long-term care insurance claims and National Health Insurance statements for recipients of facility-based benefits at 2,890 long-term care facilities from January 2016 to December 2023. Here, skilled nurses refers to nurses with regular licenses, as opposed to nursing assistants.
Nursing Assistants Replaced Nurses More Rapidly After Minimum Wage Hikes... Putting Patients' Health at Risk
Under current staffing standards for long-term care facilities for older adults, facilities with at least 30 residents must employ one nurse or nursing assistant for every 25 residents, with no distinction between the two roles. However, under the Nursing Act, nurses are responsible for nursing assessment and care, as well as assisting with medical treatment under a physician's direction, while nursing assistants are generally limited to supporting nurses, creating a difference in professional expertise.
The problem is that after the minimum wage rose sharply in 2018, increasing employment costs, long-term care facilities restructured their workforces around nursing assistants, who are paid relatively less than nurses. In fact, in the wake of the minimum wage hike, the share of nurses among nursing staff at long-term care facilities fell by 4.25 percentage points.
This change in workforce composition was found to have negatively affected residents' health. The analysis found that when the share of skilled nurses rose by 10 percentage points, the total number of days residents received medical care fell by 0.33%, while their hospital stays decreased by 0.49%. National Health Insurance medical spending also declined as a result.
In particular, the use of medical services for pressure ulcers, a condition directly linked to the quality of care, fell by 0.1%, while use of services for urinary tract infections declined by 0.03%. Healthcare use for infectious diseases such as influenza and pneumonia, as well as for dementia, also decreased. This shows that investing in a workforce centered on skilled nurses can improve residents' health and help strengthen the financial sustainability of the National Health Insurance system.
"Set Separate Staffing Standards for Nurses and Link Funding to Them"
Kwon proposed urgently improving the current staffing system, which is based solely on the total number of nursing staff without distinguishing between nurses and nursing assistants.
Increasing the number of skilled nurses, who command higher wages, may raise spending by the Long-Term Care Insurance system, but it can ease the financial burden on the National Health Insurance system. Therefore, the two systems' finances should be considered together when formulating policy, Kwon said.
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Kwon said, "We should consider revising the staffing standards to specify a required share of nurses, who are skilled professionals, among nursing staff." He added, "The cost-effectiveness of financial investments, such as employment support for nursing staff and additional reimbursement, should be assessed by considering the finances of the Long-Term Care Insurance and National Health Insurance systems together."
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