'Community Care' to lower dependency on large hospitals

By Lee Kyung-min

The government will implement a “Community Care,” program whereby senior citizens and the disabled staying at home or in group homes receive healthcare services, as an alternative to being admitted to hospitals or nursing homes.

Restricted mobility at the medical institutions has long been cited as a core problem for possible human rights violations by many international health agencies. Soaring healthcare costs at these institutions are another issue.

The Ministry of Health and Welfare said specifics on the strengthened, local community-based primary healthcare program will be unveiled in July and it will implement the program gradually.

Under the plan, the number of elderly eligible for the state-run Long-Term Care (LTC) services will be increased from 8 percent to 9.6 percent by 2022. The ministry will increase the number to one similar to that of countries like France (10.3), Finland (11.4), Germany (13.4) and Japan (18.6). According to the Organization for Economic Cooperation and Development (OECD), more than half of LTC recipients are over 80 and nearly four out of five are over 65.

The measure comes amid increasing calls to reduce the number of individuals in hospitals or long-term care facilities despite the relatively manageable degree of illness or disability, further supported by a fast increase in that demographic. Ministry data showed the number of long-term care medical institutions for the elderly has increased by an average of 7.6 percent over the past six years, while a separate survey last year showed over half of the elderly, or 57 percent, said they wished to live the ends of their lives at home, a much more comfortable environment than a hospital. About 8.76 million people are the elderly and the disabled, the core recipients of the welfare plan, accounting for 17 percent of the population. The number is expected to reach 22.9 percent in 2026. The number of long-term care beds relative to the population in Korea is seven times the OECD average and that of annual outpatient visits in Korea are twice the OECD average.

OECD recommendation

The ministry's efforts is in line with an assessment from the OECD Health Care Quality Reviews released last October which concluded that better primary care is key to improving Korea's healthcare system. The plan is also in line with strengthening primary healthcare advocated by World Health Organization, which recommends reducing exclusion and social disparities in receiving healthcare and organizing needs- and expectations-based healthcare policies.

The OECD report said that health spending in Korea since 2002 had grown at nearly 8 percent each year, more than double the OECD annual average of 3.6 percent, due in large part to an over-reliance on hospitals. The report said that Korea has 55 hospitals per million people with 8.3 beds per 1,000 people, many more than most OECD countries relative to the population.

Despite a rapid increase in investment, hospitals and new technologies, the report said, the Korean health system was not delivering proportionately higher-quality care, suggesting that better care in the community could both improve health and reduce the number of hospital visits.

In 2009, 127.5 hospital visits per 100,000 people were made by diabetes sufferers, more than double the OECD average of 50.3 per 100,000. And once admitted to hospital, Korean patients were likely to remain there more than twice as long as the OECD average of nine days.

Health spending in Korea, with one of the fastest-growing elderly populations in the OECD, would continue to rise rapidly because the country treats more patients living with multiple health problems, it said. Poor health due to rising smoking and obesity rates would also contribute to the problem. Korea's substantial policy reforms over the past decades indicate further reforms can be pursued, it added, and therefore the review recommended that Korea build a stronger primary care system by increasing financial support for preventive healthcare and patient counseling in community-based clinics, and reduce doctors' reliance on minor surgical procedures and diagnostic tests to support their incomes.

Financial reward should be given to hospitals for proper healthcare and medical services, not for the number of services they deliver, it added. Korea should, it said, make the most of its world-class health information infrastructure to identify and reward healthcare service providers that deliver high quality of care and target services to patients who need them most. The report also said Korea needed to expand its quality of care strategies beyond select institutions to the entire health system, improve the skills of health professionals and encourage clinical practice guidelines.