Our study examined long-term care (LTC) service expenditures and informal care costs during hospitalization as key components of care costs in old age in Korea, with a focus on inequalities by population group and region. Using National Health Insurance Service claims data and Korea Health Panel data bertween 2015 and 2023, we estimated annual LTC service use, total LTC expenditures, and out-of-pocket LTC payments, and annual informal care costs during hospitalization for older adults aged 65 and older. Informal care costs during hospitalization were calculated by applying the rate of care by sex, age group, and type of hospital, presenting separate estimates of costs for paid caregivers, family caregivers, and other caregivers, and then aggregating them. For caregiving by family members, we implemented both the opportunity-cost and replacement-cost approaches to reflect different assumptions about the caregiving time.
Between 2015 and 2023, LTC insurance expenditures in Seoul increased from about 430 billion KRW in 2015 to 1.53 trillion KRW in 2023 (around 3.5-fold), with a rising share of home-based services. In 2023, women and adults aged 80 years and older accounted for about 74% and 75% of total LTC expenditures, and older adults with disabilities bore an LTC cost burden roughly seven times their population share.
During the same period, national informal care costs during hospitalization increased from approximately 6.04 trillion KRW to 7.42 trillion KRW (about 1.2-fold), peaking at around 9.5 trillion KRW in 2019 before declining slightly, while Seoul’s informal care costs reached about 870 billion KRW in 2023 (around 12% of the national total). The burden was highly concentrated among specific groups. In 2023, women, adults aged 80 years and older, and older adults with disaiblities had substantially higher per capita annual informal care costs during hospitalization, paying 2.78 million, 5.08 million, and 4.58 million KRW nationally and 1.99 million, 3.75 million, and 3.89 million KRW in Seoul, respectively. By hospital type, users of long-term care hospitals incurred markedly higher per capita annual informal care costs during hospitalization (13.68 million KRW nationally and 12.07 million KRW in Seoul) in 2023. Additionally, using the sum of health insurance contributions a proxy for ability to pay, we discovered that women, adults aged 80 years and older, and older adults with disabilities bore relatively higher costs of care. Nationally, the size of informal care costs for women, older adults aged 80 and older, and people with disabilities were 9.0, 17.9, and 18.8 time higher than their insurance contributions combined.
These results show that informal care costs during hospitalization impose heavy and unequal burdens, particularly on women, the oldest-old, and older adults with disabilities, and that costs of caregiving by family members accounts for most of them. While informal care during hospitalization should ultimately be provided by public systems, in the interim there is a need for targeted policies to alleviate such burden. Based on the group-specific costs, relative burden indicators, and care recipient characteristics presented in this study, the Seoul Metropolitan Government may design a “Seoul-type Family Caregiving Cost Support Program” that prioritizes groups with the greatest absolute and relative burdens and sets support levels based on the estimated family caregiving costs during hospitalization, taking into account ability to pay, required caregiving time, and opportunity costs such as wage loss. In addition, the observed regional variation in informal care costs during hospitalization highlights the need for follow-up research to quantify and compare caregiving burdens across districts within Seoul and to estimate the demand and burden associated with other types of care for older adults, including the support for daily living, using new survey data where existing quantitative data are lacking.