Measures to Strengthen Community-based Medical-Nursing-Care Systems with the Super Aged Society
: Exploring Public Long-Term Care Insurance’s Community-Based Care Services of Japan
1.There is a pressing need to ensure the financial soundness of insurance systems and to improve the quality of life for older individuals.
■With one of the fastest aging populations, Korea faces significant challenges, including the declining quality of life for the elderly and escalating social burdens. These are deteriorating long-term care insurance financial stability, posing significant issues for the country.
■Korea has structural limitations that have a dichotomous medical system: family caregiving and hospital-based treatment.
■These limitations highlight the need for more accessible, diverse, and community-based medical-nursing-care services catering to beneficiaries through changes in the healthcare service delivery system.
2.History and Limitations of the Community-based medical-nursing-care system in Korea
■Korea has provided several care services to establish community-based medical-nursing-care service systems, including homecare nursing, long-term care insurance’s centralized homecare service, centralized community care service, outreach healthcare service, outreach health screening service, and Seoul Care – Health Dolbom (care).
■The decentralized delivery of community-based medical-nursing-care services by various service providers and through different implementation systems has resulted in significant challenges. These include the suspension or duplication of services and confusion among users.
3.Implications of the Community Comprehensive Care System and Community-based Care Services in Japan’s Public Long-term Care Insurance (Kaigo-Hoken)
■This approach allows users to access a combination of the Community Comprehensive Care System and Community-based Care Services tailored to their needs directly within their homes and communities.
■Japan’s Community Comprehensive Support System adopted community-based and user-centered service delivery and solved issues arising from the fragmented service provision by offering services categorized by systems and beneficiaries.
■Since Japan’s Public Long-term Care Insurance is operated independently by each local government, each region operates its insurance system autonomously and voluntarily, tailored to its circumstances.
4.Proposals to provide seamless medical-nursing-care services in local communities
■Service providers: The Ministry of Health and Welfare and the National Health Insurance Service’s local branch could serve as institutions that can rate the grade of seniors, design care plans, and proceed with service assessments to integrate fragmented community care services.
■Service Delivery System: it is crucial to restructure the delivery system of community-based medical-nursing-care services. This new structure should be community-oriented, user-centered, continuous, and integrated. Additionally, establishing a homecare nursing system that effectively connects healthcare and care services is essential.
■Finance: The structural cause of the fragmentation in community services is separating finances into tax, national health insurance, and long-term care insurance. Services sharing the same financial resources should be integrated, and a potential medium to long-term approach could involve centralizing the funding sources for national health insurance and long-term care insurance. The overall funding could then be distributed at the regional local government level, with allocations made considering the specific risks residents face.
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