September issue of Health and Welfare Policy Forum Published
- Date 2022-09-20
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KIHASA has published the September issue of Health and Welfare Policy Forum, No. 311, with the monthly focus on "the current status and challenges of Korea's public health care exposed by Covid-19."
Foreword: The Current Status and Challenges of Korea's Public Health Care Exposed by Covid-19
Article I: "Measures for Strengthening Public Health Care," Yim Jun, University of Seoul Graduate School of Urban Health
The need for strengthening public health care is growing as the Korean health care system, which is characterized by the pursuit of private interests, has caused a serious health care crisis in line with the rapid aging of the population structure. In the past, publicness was emphasized in health care due to the high possibility of market failure. Recently, with the growth of civil society, health care is accepted as a universal right, and the publicness of health care is even more emphasized. At the very least, the policy direction of guaranteeing essential medical services related to the life and safety of the people is being established. In particular, an active role of the government and society is required to reduce regional disparities in essential medical resources, medical use, and health outcomes. It is necessary to support capital costs necessary for the reinforcement of essential medical infrastructure to all medical institutions in charge of essential medical care, and to support current expenses through public policy fees. In order to strengthen the responsibility for all residents in the service area, public hospitals should be assigned as accountable medical institutions and equipped with the capacity and system for leading private hospitals.
Article II: "Measures to Strengthening the Capability of Municipal Health Care Institutions," Cho Seung-yeon, Incheon Medical Center
Since the introduction of modern medicine, Korea’s health care has been established around private hospitals and has developed into a profit-oriented medical system, and public medical institutions have remained in charge of unmet medical care that the private sector is not interested in due to low profits. Korea is now set to become the world's 10th-largest economy, but the weak public side of its health care system makes it difficult to narrow health care gaps between regions, classes and sectors. The government is making efforts to bring public health care to the center of national health care through fair provision of essential medical services, but municipal health care institutions, which are key means, are very vulnerable in many sectors. Increasing the number, reinforcing the size and facilities, and securing sufficient medical personnel for Municipal regional medical centers to serve as a proper regional responsible medical institution will be an urgent task and an indicator of performance for the normalization of public health care that will lead to balanced regional development.
Article III: "Reimbursement Schemes and Financial Support to Local Public Hospitals," Bae Jaeyong, KIHASA
This paper aimed to propose reimbursement schemes and financial support plans to provide local public hospitals with sufficient compensation for appropriate delivery of health care services and population health projects so that they can fulfill their missions as local public hospitals. I reviewed major roles, current status, and characteristics of local public hospitals as well as the reimbursement and financial support system for local public hospitals in Korea. My suggestions to improve reimbursement and financial support system for public hospitals in Korea include 1) developing and implementing customized models not only to cope with needs in communities but also to consider the current status and characteristics of local public hospitals, 2) securing sufficient compensation for essential healthcare services as well as population health projects, 3) expanding financial support to fund operating costs and labor costs for local public hospitals.
Article IV: "Current Status and Challenges for Public Health Care Governance in South Korea," Sohn Jeong-in, National Medical Center
The rationale for public health governance consists of the social model of health, population aging, and people-centeredness. The principles of action involved are inclusiveness and comprehensiveness in terms of health system and community-based perspective. The Public Health and Medical Service Act in 2012 and the National Plan of Public Health Care Development in 2018 contributed to the establishment of universal public health care, the strengthening of regional government accountability, and the building of public health governance infrastructures in South Korea. The main actors of public health governance are 17 regional governments, 16 Public Health Care Institutes and 58 Accountable Care Hospitals in South Korea. They support the health care policy governance and oversee service delivery in order to ensure access for residents to essential health care in community. Therefore, central and regional governments in South Korea need to hear the community experts and front-line actors and provide support using the national plans, budgets, health insurance payments, administrations, human resources, organizations, information systems etc.
Article V: "Changes in Social Relations and Activities of the Elderly in Korea," Kim Se-jin & Lee Sun-hee, KIHASA
Based on data from the 2008-2020 National survey of Older Koreans, this article aims to analyze changes in the social capital of the elderly in Korea, focusing on social relationships and social activities, and suggest policy measures to strengthen the social capital of the elderly. The social network of the elderly, diversified as a network of friends, neighbors, and relatives, has expanded away from the existing family- and child-centered relationships. Social participation activities tended to concentrate on economic and social group participation. The proportion of those wishing to take part in social activities that are more active than the ones in which they currently participate has increased over time. Based on these findings, this study suggests strengthening the relationship with the elderly, seeking ways to maintain independent living of the elderly alone, securing leisure experiences reflecting the level of desire, seeking policy measures due to increased non-face-to-face social participation, and emphasizing individual and society's continuous efforts and attention.
Article VI: "Issues and Implications of Korea's Long-term Care Insurance Payment System," Lee Yun-Kyung, KIHASA
The payment system of long-term care insurance for the elderly shows the direction in which the long-term care policy is headed, and acts as the main means of inducing the provider to select the management strategy and determine the type of service use by the user according to the direction proposed. In particular, at this time, when most of elderly long-term care is provided through private providers, the fee payment system so important that the success the long-term care insurance depends on it. In this article, we will examine the rationality of the payment system and the rationality of the payment compensation system of long-term care insurance as to whether it is operating in accordance with the purpose of care. The rationality was examined in terms of the equity of home and facility benefits according to the degree of care needs, the equity of the number of benefits types by long-term care class, and the equity of the number of service types by service type through the long-term care benefit price standard. Based on its findings, this study suggests aligning reimbursement with the goal of long-term care, reducing the difference in the monthly use limit between at-home care and facility-based care, strengthening the differential compensation by grade of facility-based service and home-visit service, improving reimbursement equity by taking into account the facility benefit and short-term protection, installation of facilities in day and night care, and the resource input of the personnel standard, and introducing various additive systems to improve the quality of services.