Regional trends in home-based care utilization among older adults in Korea: a longitudinal study using the national health insurance service senior cohort

Most older adults prefer to remain home as they age, and supporting aging in place has become a major policy goal in many countries. In Korea, growing demand for home-based care (HBC) has led to the expansion of HBC services within the national social security system. However, regional disparities and temporal trends in service utilization remain insufficiently understood. Therefore, this study examined regional and temporal trends in HBC service utilization among older adults in Korea using data from the National Health Insurance Service Senior Cohort from 2008 to 2019. Data from 2008 to 2019 were analyzed to calculate the annual HBC utilization rates (users per 1,000 older adults) across administrative regions. HBC services were categorized as hospital-based home health nursing care (HHNC), which is reimbursed under the National Health Insurance Service, and community-based home care (CBHC) and community-based home nursing care (CBHNC), both of which are covered by the Long-Term Care Insurance for older adults. Trends were analyzed separately for each category. Spatial clustering was assessed using Global Moran’s I and Getis–Ord Gi* statistics. Spatiotemporal trends were assessed using the Mann–Kendall trend test and Sen’s slope estimator. From 2008 to 2019, CBHC and CBHNC utilization rates increased significantly, whereas HHNC utilization showed a non-significant upward trend. Spatial analysis revealed increasing spatial clustering of HHNC utilization over time (Global Moran’s I: 0.696, p = 0.001 in 2019), with hotspots concentrated in Seoul, Gyeonggi-do, and Chungcheongnam-do based on Getis–Ord Gi* analysis. Spatiotemporal analysis revealed significant increases in HHNC utilization in Incheon, Gyeonggi-do, Chungcheongnam-do, Seoul, and Gangwon-do. Incheon and Jeollabuk-do showed significant increases in CBHNC, whereas Gyeongsangbuk-do exhibited a significant decrease. All regions except Jeju showed significant increases in CBHC. Although HBC services are provided under the social security system, regional differences in utilization rates were observed across service types. These findings underscore the need for regionally tailored service delivery models and policy interventions that account for geographic differences in HBC utilization, thereby supporting older adults in aging in place.