- Lessons Learnt from South Korea Long-Term Care System for Older Persons - Lessons Learnt from South Korea 8 December 2016 2ND IAGG Africa Region Conference of Gerontology and Geriatrics Nairobi, Kenya Heung Bong Cha, PhD IAGG President International Association of Gerontology and Geriatrics

Contents World Population Development Global Challenge : Long-Term Care Ageing Korea Policy Development in Korea Long-Term Care Insurance in Korea LTC Performance In Korea Issues of Long-Term Care in Korea

World Population Development Billions The last century has been characterized by a huge intensive industrial development, by the growth in the population on earth, by a significant elongation of life expectation, by an overall increasing of standards of life quality This positive aspects of our recent history have been combined, however, with the appearance of related problems like: Global Ageing

Global Challenge : Long-Term Care Long-Term Care Need Increasing trend of old-old persons with chronic diseases and functional impairments Rapid increase in number of older persons Global Aging Rapid increase in medical expenses for older persons Rapid change of family function supporting older persons

Global Challenge : Long-Term Care Concept WHO World Report on Ageing and Health (2015) - Healthy Ageing : the process of developing and maintaining the functional ability that enables well-being in older age - Long-Term Care : The activities undertaken by others to ensure that people with or at risk of a significant ongoing loss of intrinsic capacity can maintain a level of functional ability consistent with their basic rights, fundamental freedoms and human dignity

Global Challenge : Long-Term Care WHO Global Strategy and Action Plan Five strategic objectives Fostering healthy ageing in every country Aligning health systems to the needs of the older populations Developing long-term care systems Creating age-friendly environments Improving measuring, monitoring and understanding

Global Challenge : Long-Term Care Global Responses in Common All developed countries have built social protection system for LTC service in the aged society Institutional care developed first, community home care later Emphasis on public responsibility of government & connected with the existed social security system Worrying about financial burden

Global Challenge : Long-Term Care Key Components of LTC Policy in Common Equitable access to needed service High quality of care provided Effective service delivery system Financing and efficiency Sustainable Development - Long-term care policy hand by hand economic growth

Global Challenge : Long-Term Care Global Trend in Difference Difference in public responsibility and government intervention Difference in financing, management and administration In accordance with medical system and health care security type Difference in what is emphasized for service delivery system - Institutional care, community care, home care and so on

Social Insurance System Global Challenge : Long-Term Care Difference of LTC System Tax System Social Insurance System Hybrid Universal Selective Finance National Tax Local Tax Contribution (Premium) Copayment Government Coverage Universal Coverage Needy Voluntary +Social Security Service delivery Central Government +Civilian agency Local Government +Civilian agency Civilian agency +Government Civilian Agency Administration Central Government +Local Government Insurer (Government, Corporation, Society) Organizations Country UK, Sweden, Denmark, Finland, Italy, New Zealand, Norway, Spain Germany, Netherland, Japan, S.Korea USA

Ageing Korea Population Ageing Increasing of older persons aged 65+ (Thousand persons) 1960 2000 2015 2030 2060 Total population 25,012 47,008 50,617 52,160 43,959 Older population (65+) 726 3,395 6,624 12,691 17,622 % 2.9 7.2 13.1 24.3 40.1 Source : Statistics Korea, Population Projections (2011).

Ageing Korea Increasing Trends of Older Population Older population is expected to increase sharply, compared to decreasing child population. 100 90 80 70 60 50 40 30 20 10 Source : Statistics Korea, Population Projections (2011)

Ageing Korea Ageing Speed Increasing trend of older persons compared to OECD countries Korea(37.4) Japan(36.5) Spain(35.0) Germany(27.9) Sweden(27.1) France(26.4) USA(20.0)

Ageing Korea Old-old Population Increasing trend of old-old population(80+) Source: OECD, Labour Force and Demographic Database (2010).

Ageing Korea Dementia Increasing of older persons with dementia Population aged 65+ with dementia (thousand persons) Prevalence of dementia(%)

Policy Development in Korea Economic Development and Welfare for Old Persons Until 1960s, S. Korea had been one of the poorest countries in the world S. Korea started its first economic development plan in 1961 and made much progress in economic growth here in after, entering an advanced country Before 1970s, no national policy for older persons, depending on traditional family care 1977 Health Care Insurance System implemented 1981 Welfare Law for Older Persons 1986 National Pension System implemented

Policy Development in Korea Long-Term Care Policy 1999~2002 Government agenda set and study for LTC 2003~2004 Ministerial Planning Committee for LTC 2004~2005 Ministerial Implementation Committee for LTC 2005~2006 LTC demonstration projects 2007 Long-Term Care Insurance Law enactment - 26 years after Welfare Law for Older Persons 2008 Long-Term Care System implementation

Long-Term Care Insurance in Korea Policy Goals of Long-Term Care Universal Coverage for Older Persons who need long-term care Quality Care for Older Persons to achieve maximum possible functioning and independence and to enable dignity in older age Effective Delivery System to provide accessible long-term care service Efficient Financing System to assure as much money as possible and to reduce cost inflation of long-term care

Long-Term Care Insurance in Korea Target and Service Target group Eligibility : Older persons 65+ and those under 65 having geriatric diseases Subjects : Those certified as Grade 1~5 long-term care Type of service benefit Residential care : living and care in facility Home-visit care : visiting care, visiting bath, visiting nursing, day and night time care, short term care, welfare equipment - Special cash benefits : family care benefit for exceptional case such as rural area etc. Total in 2014 G1 G2 G3 G4 G5 424,527 37,655 72,100 170,329 134,032 10,456

Long-Term Care Insurance in Korea Service Provider Nursing facility - Residential care - Short-term care - Group home : for dementia, etc. In-home service facility - Home visit care, day and night care Nursing hospital - Not applicable to LTC insurance

Long-Term Care Insurance in Korea Financing Insurance + Government + Copayment Insurance contribution(premium) - 67.4% of TIR in 2014 - From the insured of National Health Insurance (whole population) Government subsidy for needy people, etc - 32.6% of TIR Copayment - Residential care 20% - Home care 15%

long–term care service Long-Term Care Insurance in Korea Management system Supervision Ministry of Health and Welfare Supervision Subsidy NHIS National Health Insurance Service Subsidy authorization Local Gov’t Service Provider application Client contract Residential care Screening committee need assessment Insured long–term care service (copayment) Certification Home care Insurance Financing & Fund Contribution (Premium) Reimbursement

LTC Performance in Korea LTC Service Approval Certificated Approval Certificated Approval rate of older population (Number)

LTC Performance in Korea 141 In-home service center Aged care facility Total LTC Service Provider

LTC Performance in Korea LTC Financing Revenue Expenditure (hundred million KRW)

Issues of Long-Term Care in Korea Universal Coverage Principle : Universal Coverage for Older Persons who need long-term care Coverage at Present - 7.6%(489,528 persons) of total older population(65+) Issues : To expand service recipients - Normative need : 15% of total older population(65+) - from 7.6% to 15.0%(978,000 persons)

Issues of Long-Term Care in Korea Basic System Issue Pro Social Service - Public responsibility - Government budget(taxation system) Pro Social Insurance - Universal coverage - Limitation of Government budget : Not easy to ensure Government budget - Easy to collect premium and to finance connecting to existing National Health Insurance system Result : Social Insurance - Social insurance system chosen

Issues of Long-Term Care in Korea Facility Issue ‘Too early’ group : business group, some professional group - Insisted introducing LTC system in late 2010s - Because of few facilities in start line ‘Too late’ group - Insisted introducing LTC system in 2007 - Because of rapidly ageing society, social problems of older persons rapidly deterioration of family system Result - Implementation in 2008, too many facilities in 2009 “When LTC system made, money will make facility” (Water and Fish Proverbs)

Issues of Long-Term Care in Korea Service Provider Issue Pro Public - Public responsibility : Public 70%, private 30% Pro Private - To secure service provider through market system : Private 80%, public 20% - Service quality competition Result - To utilize private provider : Private 76%, public 24%

Issues of Long-Term Care in Korea Man Power Issue Professional man power - Medical doctor, nurse, social worker, care manager, care worker etc Issues of how to ensure care worker and educate them - too many certified care worker in early stage : 1.3 million 2009 2010 … 2014 CAGR Social worker 4,944 5,862 11,298 18.0% Medical doctor 852 997 1,324 9.2% Nurse 6,969 8,055 10,924 13.5% Care worker 172,889 228,955 266,538 9.0% Others 1,886 2,148 2,805 -6.5% Total 187,540 246,017 292,889 9.3% * CAGR : Compound Annual Growth Rate

Issues of Long-Term Care in Korea Toward Proper Delivery and Quality Care Continuum of care integrating prevention-heath care-social care Seamless continuum of acute care and long-term care Health Care Social Care Long-Term Care Prevention

Issues of Long-Term Care in Korea Toward Integrated Community Service Integrating institution-based care and various community-based care Integrated care management systems - Care manager system - Integrated services of NHIS and providers Collaboration with social service delivery system Linkage between NHIS and local government

Issues of Long-Term Care in Korea Toward Complementarity Model Despite long tradition of family culture caring for older persons, It’s deterioration has been fast in rapidly aging society Complementarity model of family care and social service is desirable Family care benefit to be carefully examined Family care Social service long-term care Work division emotional care : physical care night care : day care

Issues of Long-Term Care in Korea Toward Efficient Financing Sustainable development To finance effectively To operate efficiently To address the indefiniteness of LTC need To reduce cost inflation of LTC system by more appropriate use of existing resources(informal support etc)

Late Breaker Abstract Submission Opens December 15, 2016