As the year 2025 unfolds, health and welfare policies will face both ongoing challenges and emerging opportunities. Low birthrates, demographic aging, changes in the labor market and family structures, and growing economic uncertainties continue to shape policies in health care, social service, income security, and population. These trends underscore the need for active, forward-looking policymaking to make Korea more inclusive and sustainable. The Health and Welfare Forum this month examines prospects and critical challenges in these four policy areas and suggests directions to consider for 2025 and beyond. The feature articles explore in turn healthcare reform measures directed at reducing regional disparities in health service access, alternative income security programs adapted to socioeconomic changes, strategies for allocating quality social services to those most in need, and population policies for building a sustainable social foundation. We hope that through this January issue, readers gain insights into the future directions within each of, and across, the health and welfare policy areas discussed. We also hope to see our readers actively participate in shaping health and welfare policies for not only responding to immediate needs but creating a future with resilience and a vision.

Strengthening local healthcare should maintain the priority it has been given as one of the top agenda items of the times and proceed continuously as part of the Ministry of Health and Welfare’s effort to reform healthcare delivery. In this article, I explore key policies to be implemented in 2025 and associated tasks. I expect that policy measures will be introduced in earnest in 2025 across various healthcare areas to shift current approaches toward a more value-based system. These policies aim to adjust the allocation of acute care beds to healthcare institutions with different designated functions as necessary to meet changing needs, increase policy interventions to reduce existing disparities in fee-for-service rates, broaden the scope of the public fee-for-service reimbursement scheme, and expand alternative reimbursement models that link performance to incentives. In proceeding with these policies, the government should expand the role of public finances, respect patients’ right to choose, and provide information on the outcome of performance evaluation on small and medium-sized hospitals to help consumers make more informed healthcare decisions. Healthcare delivery system reforms must progress stepwise, with programs targeting healthcare institutions―including regulations and incentives―each playing distinct roles as part of a whole system.

This article examines the changing policy environment for income security programs, provides an outlook on the future direction of related policies, and offers an overview of program reforms that may significantly impact the income security system. As the population of older adults continues to grow, rapid changes are taking place in the sociodemographic landscape, with households becoming smaller and one-person households increasing. These trends are especially pronounced among households receiving National Basic Living Security benefits. Poverty rates, after declining for some time, have plateaued in recent years. Poverty among older adults and one-person households continues to be a significant issue for the income security system. Meanwhile, as various income security programs are introduced and implemented, the system is becoming more complex, with the constituent programs becoming interconnected and interdependent. In the changing policy environment, efforts are ongoing to overcome the problems and limitations of existing programs, driven by discussions on how best to coordinate and integrate income security programs, along with considerations of alternative approaches, which are likely to be implemented by and by. The existing income security system has shown a clear trend of its target population resolving into distinct groups with different income support needs. If tailoring income support programs to these needs proves challenging, integrating them with other social security programs targeting similar groups may be considered, with a view to keeping the income security system simple, effective, efficient, and sustainable.

This article discusses the state of social service policy in 2024, examining both general services and those targeting specific groups―disabled individuals, children, and older adults. We also explore challenges expected in 2025. Our focus for disabled people is on ‘Integrated Care for Individuals with Severe Developmental Disabilities,’ ‘Personal Budgets Scheme for Disabled Persons,’ and ‘Comprehensive Health Care Management Plan for People with Disabilities.’ For children, we examine ‘child protection’ services, and for older adults, we address ‘Aging in Place’ services. We find that social services, in general and for specific groups, require improvements in both quality and quantity. To meet users’ needs more effectively, local-level efforts are essential to strengthen the infrastructure and policies supporting social service delivery.

In the face of rapid demographic changes characterized by low birthrates and population aging, the government has pursued medium-to-long-term policies in the framework of the pan-ministerial Basic Plan on Low Fertility and Aging Society, which, first launched in 2006 and renewed every five years, is now in its fourth iteration. The last of the years covered by the 4th Basic Plan on Low Fertility and Aging Society, this year marks an important juncture to assess the plan’s overall outcomes, evaluate its final-year initiatives, and prepare medium- and long-term strategies for the upcoming 5th Basic Plan. This year is also one in which the “Measures to Reverse Low Birthrates,” announced in June 2024, will be implemented in earnest. It is expected that these policy efforts, as they progress, will contribute to greater happiness in marriage, childbirth, and childrearing, thus helping to lay a foundation for making our society sustainable.