Development of a practical framework and indicators for monitoring integrated long-term health and care needs and service use.

This case study presents an evidence-building approach to support policy planning for integrated health and care delivery for older adults. We developed an integrated needs-assessment framework to monitor the complex long-term medical and care needs of older individuals, using routinely collected, standardized needs-assessment and utilization data from the public health and long-term care (LTC) insurance systems in South Korea. We also developed a set of misuse indicators and analyzed service utilization patterns, while accounting for their varying types of needs. Approximately 11 % of older Koreans were identified as having complex long-term medical and care needs, which were categorized into four distinct need groups. More than one-third of those in the higher-medical/lower-care needs group stayed in LTC hospitals for six months or more during the year, and about one-third of those in the higher-medical/higher-care needs group inappropriately resided in LTC facilities, where medical services are limited. The newly developed integrated needs-assessment framework and misuse indicator set provide practical tools for monitoring the extent and nature of complex needs, as well as patterns of over- or under-utilization of health and care services over time. The empirical evidence gathered here highlights the need for reforms in South Korea's health and LTC systems.