Increasing the proportion of registered nurses (RNs)—rather than nursing assistants (NAs)—in elderly care facilities significantly reduces medical service utilization among residents, such as treatments for pressure ulcers and urinary tract infections, ultimately lowering national health insurance expenditures, a recent study shows.

According to a report titled "The Effects and Policy Directions of Expanding Skilled Nursing Workforce in Elderly Care Facilities," released on March 3 by Kwon Jung-hyun, a research fellow at the Korea Development Institute (KDI), a 10-percentage-point increase in the proportion of skilled nurses leads to a 7.7% reduction in health insurance medical costs.

Kwon analyzed the long-term care insurance claim records and health insurance statements of residents across 2,890 nursing facilities from January 2016 to December 2013 [Note: referring to the study's timeframe].

In this context, "skilled nurses" refer exclusively to licensed registered nurses, distinguishing them from nursing assistants. Under current staffing standards for elderly care facilities in South Korea, facilities with 30 or more residents are required to employ at least one nurse or nursing assistant per 25 residents. Under the Nursing Act, registered nurses perform independent nursing judgments and care, along with medical assistance under a physician's guidance. Conversely, nursing assistants are fundamentally limited to supporting roles, offering relatively lower professional nursing expertise.

Following steep minimum wage hikes in 2018, rising labor costs prompted elderly care facilities to restructure their staffing by favoring nursing assistants over higher-paid registered nurses. In fact, the analysis showed that the proportion of registered nurses among care facility nursing staff dropped by 4.25 percentage points following the minimum wage increases.

However, the KDI report highlights that this shift could negatively impact residents' health. When the proportion of skilled nurses rose by 10 percentage points, total outpatient visit days for residents decreased by 0.33%, and inpatient hospital days dropped by 0.49%.

Consequently, health insurance expenditures fell accordingly. This suggests that investing long-term care service resources into skilled nurses can yield positive financial outcomes for the national health insurance budget.

Medical service utilization for conditions directly influenced by the quality of long-term care—specifically pressure ulcers—declined by 0.1%, while usage related to urinary tract infections fell by 0.03%. Medical utilization for infectious diseases such as influenza and pneumonia, as well as dementia-related care, also decreased.

In light of these findings, Kwon recommended reforming current nursing staff allocation standards, which currently focus only on the total headcount of nursing personnel without distinguishing between RNs and NAs.

While expanding skilled nursing staff—who command higher service rates (suga)—would increase financial expenditures under the long-term care insurance scheme, it simultaneously alleviates the financial burden on the national health insurance fund. Therefore, Kwon argued that these two distinct public insurance funds should be evaluated in an integrated manner.

"It is necessary to review improvements such as explicitly mandating a minimum requirement for the proportion of registered nurses within nursing staff allocation criteria," Kwon emphasized. He added that the cost-effectiveness of financial investments—such as nursing workforce employment subsidies and fee additions—should be assessed by jointly considering both long-term care insurance and health insurance finances.

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