As the number of long-term care hospitals has quickly increased in Korea with a rapidly aging population, it is time to provide appropriate services for patients not only quantitative but also qualitative perspective. Professional nursing services which are provided in long-term care hospitals that performs as an intermediary care-given institution between acute care facilities and nursing homes, is very important to ensure patients safety. It is considered that the level of staff-mixing reflects the quality of nursing service. However, the current system that allows nursing aides to serve as part of registered nurses and the competitive characteristics of medical service market as a whole have influence on the long-term care hospitals' intent to recruit nurses and their actual recruiting practice. This study aims to clarify the influences that competition of health care market and the institutional characteristics on the staff-mixing level of elderly hospitals.
Data were obtained from the health insurance reimbursement records of 377 long-term care hospitals for claims made to the Health Insurance Review and Assessment Service between January 1, 2008, and December 31, 2010. Data were analyzed using one-way fixed panel regression. The dependent variable was the ratio of nurses to nursing resource(including nursing aides). The independent variables were the regional availability of acute and long-term care beds, the annual increase rate of beds. The characteristics of each long-term care hospitals (number of doctors, number of beds and number of inpatients, increase rate of beds, and owner type) and patients(severity, age) were included.
The results of the study are as follows. 1) The ratio of nurses showed low in regions with high level of availability of beds of long-term care hospitals. 2) Ratio of nurses showed lower with increasing number of beds for acute care hospitals, while it showed higher with increasing number of beds of long-term care hospital. 3) As for patient’s characteristics, the ratio of nurses decreased with increasing number of patients per beds and the ratio of number of aged patients, which increased with increasing severity of patients. 4) As for the characteristics of long-term care hospitals, ratio of nurses increased with increasing numbers of doctors and hospitals, while nurse recruiting rate stayed lower for long-term care hospitals established by individuals or incorporations, as compared to those established by public organizations.
In conclusion, as the level of staff-mixing which is essential to ensure adequate nursing service, varies with the type of patients, regions, and long-term care hospitals, a monitoring system and policy-making that assures quality of long-term care hospitals by government are needed.