Updated: Jun 28, 2020
By Sungwon Cho
As the number of aging people in Korea increases, the nation needs to create a system of better-organized care for the elderly. Although this country has recently implemented several programs for the aging population, such as an extension of hospice care, the Korean systems to aid the elderly are only in their beginnings. To expedite the process for establishing a satisfactory society for elderly citizens, the government must study good examples of elderly care in other countries. The Community-Based Integrated Care System from Japan has the potential to improve the quality of lives for the elderly in various aspects.
What Is The Community-Based Integrated Care System?
It is a system that provides care for the elderly with chronic disease or disabilities in a comprehensive way, taking social security costs into account.
Initially, the Community-based Integrated Care System was not implemented as a national policy, but as a small local program in Mitsugi, where a large section of the elderly population was bedridden. As this new system in Mitsugi showed positive outcomes that improved the overall health of the aging population, the Long-term Care Insurance (LTCI) program was adopted. This system is expected to be introduced and integrated throughout Japan by 2025.
Why/How It Was Established?
- To improve the elderly care in response to the growing elderly population, who need long-term care without incurring social security costs
- By combining outpatient and inpatient services in one comprehensive program
- By creating home-based services
- To lessen the burdens of younger population who must support their elderly relatives
- By providing care specialists and health workers and home-visit care services
- By providing a friendly, pleasant environment where the elderly stay
What are some positive outcomes?
To help understand the impact of the Community-based Integrated Care System in Japan, I will outline the three main positive outcomes and explain them with a comparison of the town of Mitsugi to the entirety of the Hiroshima Prefecture.
Reduced number of bedridden people:
Patients usually ended up bedridden due to improper care at home following acute treatment in a hospital. Regular home-visit care services and the efficient collaboration of care workers successfully prevented discharged patients from becoming bedridden.
Reduced medical care costs:
The medical care costs for the elderly in Mitsugi were always above the average costs in the Hiroshima prefecture until 1987, for there were more bedridden elderly people in Mitsugi. Today, however, Mitsugi has lower medical care costs on average.
The Community-based Integrated Care System helped lower medical costs in Mitsugi by strengthening the link among health professionals and increasing the number of nursing facilities for the elderly. Such changes allowed elderly patients to discharge from hospitals earlier than expected.
Increased frequency of medical checkups:
The percentage of Mitsugi residents who receive medical checkups is currently higher than that of in the entire Hiroshima prefecture.
Another positive outcome is that public health nurses have connected with Mitsugi Hospital to conduct campaigns for public health promotion. Nurses in Mitsugi differ from nurses working in other municipalities; the latter work in the local government as government officials, while the former work in the hospital complex. As they actively interact with medical staff and patients in the hospital, nurses in Mitsugi can easily notice the weaknesses in the system and personalize prevention services. Healthcare workers, such as physicians and rehabilitation experts who work in the hospital, can also contribute to the betterment of preventive services and health promotion campaigns.
Medical checkups herald belonging and cohesion to societies through public health promotion classes and interaction with volunteers. Although the sense of community and medical checkups seem unrelated, the importance of public health improvement would spread more easily within the community where the residents are closer to each other. As a part of the Community-Based Integrated Care System, regular health promotion classes and volunteers in the hospital complex reinforce the connection between the residents while informing them of the importance of medical checkups. As a result, more people are likelier to receive medical checkups.
What are some challenges?
Shortage of Care Facilities:
Despite great demand for services, human and financial resources, and government regulations that restrict the building of new facilities, many potential residents have been waitlisted. Residents of the largest and most populated urban areas face the greatest shortage of care facilities due to the expected increase in older residents.
Shortage of Health Workers:
The Ministry of Health, Labor, and Welfare (MHLW) predicts that there will be a shortage of 300,000 healthcare workers by 2025. Low wages contribute to the small number of workers in this sector, and the MHLW has proposed various initiatives to address this situation.
Different Perspectives Towards Expansion of Labor Market:
As Japan has insufficient workers for a nationwide community-based integrated care system, it has agreed to accept workers from other Asian countries such as Indonesia, the Philippines, and Vietnam under official trade agreements.
The LTCI’s effect on the burden of the carer has yet to be extensively evaluated. Factors that may affect the carer’s burden could include service availability, community engagement, and emotional support.
Establishing a Community-Based Integrated Care in South Korea
The LTCI system in Korea was implemented in July 2008 using a social insurance framework as ﬁnancing for medical care using social insurance became more viable in the intervening years and therefore less politically problematic. The public showed positive attitudes towards LTCI. Many said that it improved the care environment for the elderly as it lessened financial burdens for the family of the aged.
Municipal & National Government’s responsibility for the aging population: Health-care professionals in countries that have not traditionally had to deal with aging will also need to change their perspectives so that doctors do not dismiss age-related disease as a normal and just part of life.
Doctors’ Active Encouragement of Using Hospice Care for Those Afflicted With Incurable Diseases:
Since Korean physicians are not actively encouraging such a system for the elderly like community-based integrated care, it would be important for doctors who earn trust from their patients to recommend it. Then, more people would be able to take advantage of it.