A Qualitative Exploratory Study on the Service Delivery System for the New Long-Term Care Insurance System in Korea

ABSTRACT

To cope with the rapid growth in its aging population, the Korean government introduced a new social long-term care insurance (LTCI) system for elderly people beginning in July 2008. This study aims to understand how National Health Insurance Corporation (NHIC) staff and home-visiting service providers experienced and evaluated the new service delivery system. A total of 26 semistructured in-depth interviews were conducted with NHIC staff primarily responsible for the functional assessment of the elderly and the home-visiting service providers responsible for providing direct services to elderly clients. In summary, interviewees had negative experiences with the new service delivery system such as difficulties in carrying out their roles. The findings suggest that Korea's new LTCI service delivery system faces challenges and that a more active role for the Korean government, especially regarding the introduction of a proper care management system, is needed to address the issues. Future research with larger sample sizes is needed to examine and understand the issues in detail.     

The Effects of Marketization of Long-term Care Services for Older Adults in Korea

To cope with the rapid increase in aging population, the South Korean government introduced new long-term care insurance in 2008 by using the market forces and mechanisms of competition and choice. The study explored the effect of the marketization of long-term care (LTC) services on the provision of services under the Korean long-term care insurance (LTCI) system. By adopting qualitative semi-structured in-depth interview methods, the experiences of 17 home visiting service provider managers were examined. The study results suggest that the marketization of LTC services faces several challenges. Some of the stakeholders in the field, such as home visiting service providers, care workers, and older clients, appear to employ unlawful activities or unprincipled behaviors to maximize their individual interests. The results also suggest that the unprincipled behavior, unlawful activities, and financial problems that service providers face contribute to low quality care services. Future studies should explore these issues using larger samples of service users and providers.     

Social Policies for the Elderly in the Republic of Korea and Japan: A Comparative Perspective*

The Republic of Korea (South Korea) and Japan are highly industrialized and modern nations which are both influenced by the Confucian tradition of respect for the elderly and family responsibility for the care of aging parents. In both countries the proportion of the elderly population is increasing. Japan, since the end of World War II, has utilized its government bureaucracy to help develop the social welfare system and to formulate social policies and programs for the elderly. Japan's tradition of samurai Confucianism is congruent with the commitment of the Japanese government to such social development as a matter of national policy. The Republic of Korea has not assigned a comprehensive planning role to its government bureaucracy. Lacking the mix of industrial/post-industrial infrastructure of Japan and not yet faced with the immediacy of a very large elderly population, the Republic of Korea's government has developed its social policies for the elderly in a more incremental manner, usually emphasizing small scale and piecemeal initiatives. With respect to social support, it has emphasized voluntary family efforts as congruent with the Korean (and Chinese) variant of Confucianism. This paper will compare and contrast these different approaches.     

Long-term care reform in Korea: lessons from the introduction of Asia's second long-term care insurance system

Korea was the second Asian country to introduce universal long-term care insurance in an attempt to meet the challenges posed by its ageing population. This article presents an overview of the key issues that were involved in designing and implementing the new Korean system and the lessons that have been learned. Although the government reformed the long-term care system, a number of new challenges have emerged, such as its limited coverage and the unethical behavior of service providers. These problems appear to be closely associated with the scheme's initial design flaws and the government's passive responses to these problems.     

"Many Helping Hands": A Review and Analysis of Long-term Care Policies, Programs, and Practices in Singapore

Using the political economy perspective to examine key long-term care policies and provisions, we uncover some ideological underpinnings of policy-making in Singapore. Family involvement, an inherent part of the long-term care system, is overtly reinforced by legislations and policy imperatives. Further, the government encourages and expects the participation of nonstate actors in the provision of services as part of its Many Helping Hands approach to welfare provision. In our analysis, we argue that the government's emphasis of certain ideology, such as self-reliance and cultural exceptionalism, allows it to adopt a residual and philanthropic approach in support of its macro-economic and legitimacy concerns.     

Older People's Family Contacts and Long-term Care Expenditure in OECD Countries: A Comparative Approach Using Qualitative Comparative Analysis

In recent decades there has been a suggestion that public and private long-term care (LTC) expenditure might be replacing traditional family care for older people. The decline of family contact is known to be more advanced in some OECD countries than others, with southern Europe identified as where family contact is still strong. This article explores at a country level whether there is an association between levels of expenditure on long-term care and the availability of family contacts. Qualitative Comparative Analysis is used as a comparative method, so as to use national quantitative indicators with a small sample of countries. An association between higher levels of family contact and lower levels of expenditure on LTC is suggested, but it is weakened by a number of untypical cases. Countries that defy this relationship have government care policies that seek to promote informal social care through the family contact that continues to be available. Austria, Canada, Great Britain and Japan are discussed in this context.     

Analysis and Advocacy in Home- and Community-Based Care: An Approach in Three Parts

A new chapter in health policy presents both challenges and opportunities for aging policy analysts and advocates concerned with long-term care. Millions of long-term care recipients and providers live today in a pubic policy netherworld, one principally associated with Medicaid. I suggest here that moving policy forward will entail three key steps: (a) to overcome structural lag in key home and community-based care (HCBC) policy arenas; (b) to reverse a contemporary pattern of risk-shifting from institutions to individuals; and (c) to inform and empower caregivers to have their own pressing needs recognized. Recent developments in Washington provide new optimism on these fronts. Voluntary long-term care and community-based care (LTC/HCBC) proposals are on the table within the broad context of health care reform. Whether they remain will be, in large, part a function of how far we have moved along the fronts described: modernizing policies, recognizing risks, and activating neglected policy constituencies.     

A Confucian War over Childcare? Practice and Policy in Childcare and Their Implications for Understanding the Korean Gender Regime

We ask about the development of childcare policies in Korea and what these mean for our understanding of the gender assumptions of Korean governments. Women's labour market participation has been increasing rapidly, with married women now much more likely to be in the labour market. The provision and regulation around support for women's employment, and especially for mothers’ employment, is a key issue and problem for Korean women and for governments. A number of policies give the impression that the Korean government is moving rapidly towards a policy for reconciling work and family based on a dual‐earner model of the family. But we argue that a close inspection of these policies suggests that the state is still playing a residual role, legislation is not effectively implemented, and government is giving way to the private sector and to the family in responsibility for childcare. Mothers’ accounts of their lives centre on a childcare war played out beneath the apparently harmonious Confucian surface, with resisting husbands supported by powerful mothers‐in‐law, and daily struggles over the management of services. The Korean government and its policy‐makers, far from moving rapidly towards a dual‐earner model of the family, are still rooted in Confucian ideals.     

Ageing Society Issues in Korea*

Korean society is facing unprecedentedly higher population ageing, particularly in the first half of the 21st century. The implications of population ageing have a much wider effect than the welfare of the elderly. From a broader and long‐term perspective, understanding population ageing may require a new paradigm. Korea has attempted to model its policies for ageing society on those of advanced welfare states, but as these no longer seem viable, Korean policy‐makers are searching for more effective and efficient measures to deal with its rapid ageing population. Reflecting a broader and long‐term perspective, the Korean government recently produced a comprehensive national policy plan to deal with the consequences of rapid population ageing. This article outlines the phenomenon of population ageing in Korea and the recent development of national policies for population ageing, describing the Korean comprehensive national policy plan for responding to it and examining major issues and problems related to developing and implementing the plan. This article finally suggests a new, age‐integrated social system approach to an ageing society.     

Home care development in Korea and Germany: The interplay of long-term care and professionalization policies

The aim of the study was to compare the effects of long-term care and professionalization policies on the development of home care infrastructure and the care workforce in reference to long-term care insurance systems adopted in Germany and Korea. A comparative analysis of the effects of the two policy systems allowed us to examine distinct forms of marketized home care service expansion. In both countries, the opening-up of care markets has brought about a significant expansion of home care services through the active participation of mainly for-profit providers. However, a trade-off between the rate of expansion, the quality of care services, and the stability of care infrastructure has emerged. The market-based expansion of home care services has resulted in difficult employment and working conditions for care workers in both countries. The country-specific organization of home care and related professionalization approaches has led to the development of a well-trained care workforce with less precarious conditions in Germany but not in Korea. Despite this difference, less well-trained care workers experience precarious employment in both countries.     

略论医疗保险政策的公平性选择

在现阶段经济转型时期,卫生事业的公平性是和谐社会建设的重要基础之一。而目前,我国医疗保险政策存在公平性缺失的问题,医疗保险政策的公平性选择就是建立强制性城乡一体化的医疗保险体制;在加大政府投入的同时,建立收支两条线的资金控制系统;建立医疗保险再分配机制和医疗救助体系。     

Child welfare policy and services in Korea

Over the past 20 years, the Korean government has developed child welfare laws to respond to an increasing number of child maltreatment cases and create a centralized child welfare delivery system. However, the system remains fragmented and under-developed due to a lack of understanding of child maltreatment and limited government support. Further, few studies have comprehensively reviewed the system. This study examines the Korean child welfare system, identifies challenges for child welfare policies and services, and discusses the implications for future policy; the results can be used to improve the safety, permanency, and well-being of children and families in Korea. The analysis shows that the government has prioritized family preservation over removal from families, even in substantiated cases of abuse. However, ensuring the safety of children in Korea will require not only working to preserve families but also developing and implementing better options for in-home services and out-of-home placement.     

The Relationship between Public Long-Term Care Insurance Awareness and Preparation for Later Life in South Korea

An increased focus on individual preparation for later life paired with a shift in family support within South Korea makes it necessary to study factors that influence preparation for later life among South Korean adults. This study examined whether the awareness of public long-term care insurance (LTCI) was related to South Koreans' financial, psychosocial, and physical preparations for later life. Data from the third wave (2009) and third supplement wave (2010) of the Korean Retirement and Income Study (KReIS) yielded a sample of 2,487 middle-aged adults. Multiple regression analyses were used to compare the influence of the awareness of public LTCI on financial, psychosocial, and physical preparation by dividing the sample into negative status and positive status groups based on subjective perceptions of current economic, relationship, and health conditions. The results showed that being aware of public LTCI increased preparation for later life in financial, psychosocial, and physical domains. In addition, participants in the negative status group had higher scores for psychosocial and physical preparation than individuals who perceived themselves as being in relatively better situations. These findings suggest that the policy makers and practitioners should include education on LTCI and the risks it targets across various preparation domains as well as account for differences in perception and preparation among sub-populations of middle-aged adults in order to ensure effective social policies for the elderly population.     

Chapter 18. The Aging Network and the Future of Long-Term Care

SUMMARY

Federal and state governments face a significant challenge in meeting the long-term care needs of an older population that will double in size between 2000 and 2020 and continue to increase through 2050. States have made significant improvements in their long-term care systems for the elderly. However, they are still spending a significant proportion of their long-term care funds on nursing homes. Any effort to improve long-term care for the elderly qualitatively, and not just on the margins, must be focused on developing a more flexible and balanced long-term care system that is responsive to consumer choice.

The Aging Services Network is poised to play a significant role in this transformation process. The strengths of the Network include the ability to develop and manage consumer-driven community-based programs; to assess the needs and resources of individual older persons and provide cost-effective community supports; to operate within fixed, capped budgets; and to identify and maintain roles for informal caregivers. Now is the time for national aging organizations, state units on aging, and area agencies on aging to use existing opportunities to move towards the establishment of a balanced system of long-term care.     

Partnership Working and Eligibility Criteria: What Can We Learn from the Implementation of Guidance on Continuing Health Care?

Current government policy places great importance both on clinical governance and on partnership working between health and social services. Separately and together, these policy emphases require greater clarity in and between organizations about who should provide what care where than has often been achieved in the past. A study of the implementation of continuing health care policies suggests that clarity about appropriate long–term health and social care provision was difficult to achieve in the 1990s quasi–markets, because there were too few financial and structural incentives for agencies to cooperate in developing and implementing precise and comprehensive eligibility criteria. This problematic interplay between financial and structural factors is being addressed by a number of government initiatives designed to stimulate joint working, although the difficulty of drawing a clear boundary between health care (free at the point of delivery) and social care (which can be means–tested) remains.     

Health Care in Asia and the Pacific: Increasing the focus on social health insurance

This paper focuses on health insurance reform within the broader frameworks of both social security and health services system development. In most countries in Asia and the Pacific, it is indeed the reform of the health services system, through policy changes in health care financing, that has led to an increased focus on health insurance. The underlying issue in this reform is the shift in responsibility that has taken place in most countries in the region over recent years. In the past, governments were responsible for financing health care for their populations. This shifted to defining, legislating and implementing an appropriate health care financing mechanism, presenting several challenges: to reach universal health insurance coverage through new initiatives for new populations, mainly the informal sector accounting for the majority of the population in almost all these countries; to apply provider payment systems that enable control over costs and the volume of utilization; and to strengthen primary health care as a foundation for rational utilization and more resources for prevention, including prevention of chronic diseases among the ageing population. This approach will require an active partnership between health insurance schemes and government that should reflect the new division of responsibilities to guarantee access to high-quality health care for all.     

完善养老服务体系的构想

我国目前养老基础设施还比较薄弱,体系不甚健全。为破解养老难题,需要不断完善涵盖养老服务机构、服务制度、供养服务、医疗服务、人力资源开发等内容的服务体系。笔者试就此作相关阐述。     

Long-Term Care Policy for Functionally Dependent Older People in the Republic of Korea

In the Republic of Korea, the construction of a long-term care system for frail older persons has become an issue of great concern in the twenty-first century, as the population is ageing rapidly. Functionally dependent older people aged 65 and over (excluding those who have difficulty performing so-called instrumental activities of daily living) are estimated to make up 15 per cent of the total population, but only about 1 per cent of older people can afford to use formal services. In response to the increasing burden of supporting frail older persons, a long-term care model is being prepared with the establishment in March 2003 of the Planning Committee for Developing a Public Long-Term Care Security System for the Elderly. This paper analyses the sociodemographic background to the introduction of a long-term care system, as well as the content and problems of the current system, and suggests the fundamental policy areas to be improved on the basis of these results. Policy issues are as follows: expansion of infrastructures for providing long-term care services, transforming small and medium-sized acute hospitals into long-term care hospitals, continuum of health and long-term care services, construction of a system to support informal caregivers, and development of a funding system for long-term care service costs.     

完善养老服务体系的构想

我国目前养老基础设施还比较薄弱,体系不甚健全。为破解养老难题,需要不断完善涵盖养老服务机构、服务制度、供养服务、医疗服务、人力资源开发等内容的服务体系。笔者试就此作相关阐述。     

Client Experiences of Trauma-Informed Care in Social Service Agencies

This paper describes a qualitative study of individual client interviews (n?=?26) from four social service agencies to understand how clients experience trauma-informed care services and implementation challenges. We used the Fallot and Harris framework to explore client experiences of the five core concepts of trauma-informed care (safety, trustworthiness, choice, collaboration, and empowerment) using semi-structured interview questions with each client. The four agencies consisted of: refugees (n?=?4), substance abuse (n?=?8), older adults (n?=?12), and maternal/child health (n?=?2), and the agencies varied in size, service goals, and clientele. The results of the study suggest that clients’ experience of these concepts was shaped by the actions of other clients, and these experiences were either mitigated or hindered by actions of the agency employees. Agency policies either supported or enhanced their experiences as well. The results also suggest that it was challenging for agencies to provide for all of the trauma-informed care (TIC) concepts at the same time. We discuss the implications of these findings for social service delivery in a range of agency types. Future research should examine the effects of trauma-informed policies on client experiences of each TIC domain.