1. - 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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).

12. 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)

13. 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)

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

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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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%

22. 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

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

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

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

26. 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)

27. 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

28. 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)

29. 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%

30. 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

31. 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

32. 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

33. 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

34. 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)

35. Late Breaker Abstract Submission Opens December 15, 2016