Bridging the Gap: Addressing the Need for Home Healthcare in South Korea’s Aging Population
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South Korea is at a critical juncture as it prepares for the rapid acceleration of its aging population. By 2050, more than 40% of the population will be 65 years or older, pushing the nation into rapidly aging society.1) Currently, an estimated 1.4 million older individuals are homebound due to severe mobility impairments, which represents approximately 15% of the older population.2) Despite these alarming numbers, South Korea has yet to develop an effective, wide-reaching home health system, putting its older adults at risk of poor health outcomes, hospitalizations, and premature death.
South Korea’s current healthcare model is heavily centered around hospital-based care, offering limited support for homebound older patients. Of the 1.4 million homebound older adults, nearly 60% rely on assistance to move or must use wheelchairs, and another 17% are entirely bedridden.1) As a result, a significant proportion of these older adults rely on family members to manage chronic illnesses via proxy prescriptions—a practice that can delay critical treatments. Pneumonia, one of the leading causes of death in South Korea, is a perfect example. With limited mobility, homebound senior patients often cannot access timely care, which exacerbates their conditions and leads to higher hospital admissions and mortality rates.3) This is compounded by the fact that South Korea’s current long-term care insurance system largely neglects medical home visits, focusing primarily on nursing care but failing to provide comprehensive medical support.
Furthermore, one of the stark realities of South Korea’s healthcare system is the growing rural-urban divide. While the majority of medical institutions in South Korea are private, rural physicians often operate small private clinics with limited resources, which can make participation in home visit services more challenging.4) Rural areas also face significant shortages in healthcare professionals, making it nearly impossible for older residents to receive timely medical care without traveling long distances. This disparity leaves rural older adults vulnerable, with many forced to rely on family caregivers or relocate to urban areas for better access to healthcare services, putting additional financial burden to those very people.
In 2018, the South Korean government introduced its “Community Care Plan,” designed to integrate health and welfare services and promote Aging-In-Place, a provision for older individuals to remain in their homes while receiving adequate care.5) While this plan included a pilot program for home health visits, its reach has been limited and public awareness remains low. Legal constraints further stymie efforts to expand home visits by physicians. South Korea’s medical law requires that healthcare services be provided primarily in medical facilities, with few exceptions made for home-based services.5)
Beyond financial disincentives, several structural and logistical challenges also hinder the expansion of home-based medical care. One key barrier is the lack of a standardized infrastructure for coordinating home health services, resulting in fragmented care delivery and inefficiencies in scheduling physician visits.6) Additionally, workforce shortages, particularly among home health nurses and caregivers, further limit the feasibility of large-scale home care implementation.6) Many healthcare providers also lack formal training in home-based care, making it difficult to ensure the quality and consistency of services.6)
The benefits of home healthcare are well-documented. Studies from the United States, Canada, and Japan have shown that home-based care reduces hospital admissions, lower healthcare costs, and improves patient outcomes.7-9) Home visits allow physicians to provide personalized care in a patient’s familiar environment, leading to better chronic disease management and increased patient satisfaction.10)
Similar results have shown in Korea as well. Recent pilot programs have demonstrated promising results. A study conducted by Bang et al.11) evaluated an integrated care model, which a home-based care was part of, and found a 12% reduction in hospital admissions among older adults. Despite these successes, these programs remain small in scale, and their long-term sustainability is uncertain without stronger governmental support.
To effectively address the gaps in South Korea’s home healthcare system, a multi-pronged policy approach is essential. This must prioritize not only financial and legal reforms, but also the development of an integrated care network that bridges the current divide between hospitals and home-based services.
1) Increase financial incentives for home visits: To expand home health services, the National Health Insurance Service (NHIS) must revise its reimbursement policies to adequately compensate physicians for home visits. This should include higher payments for rural visits to address the rural-urban disparity and encourage great physician participation in underserved areas.
2) Strengthen legal frameworks: Amendments to existing medical laws are necessary to facilitate the provision of home-based care. By removing legal barriers that restrict home visits and creating clear guidelines for their implementation, South Korea can expand access to care for its homebound older adults.
3) Expand pilot programs and collect data: The government needs to expand its current home health pilot programs and collect comprehensive data on their outcomes. This will allow policymakers to make evidence-based decisions about the best ways to scale home health services nationwide.
4) Address patient recruitment and awareness: A key challenge in home health expansion is ensuring that eligible patients are aware of and enrolled in these services. Public education campaigns and streamlined referral pathways through primary care providers can help improve patient recruitment. Additionally, partnerships with community organizations can enhance outreach efforts, ensuring that vulnerable populations, particularly those in rural areas, are not overlooked.
5) Reduce out-of-pocket costs for patients: Many older adults may be hesitant to utilize home health services due to financial concerns. Policymakers should explore subsidies or cost-sharing models to make home-based care more affordable. Expanding coverage under the NHIS for home visits and chronic disease management could alleviate financial burdens and encourage greater utilization of these services.
6) Invest in workforce development: Healthcare professionals, particularly in rural areas, need training in delivering home-based care, which is significantly different from traditional in-office care delivery model. Specialized training programs for doctors and nurses, along with incentives for new graduates to enter the home care field, are essential for scaling home health services. South Korea should also explore telemedicine solutions to complement physical home visits, particularly in remote areas where access to healthcare is limited.
7) Develop integrated care models: South Korea needs to move away from its fragmented care approach and develop an integrated model that connects home health services with hospitals and community care centers. By building a comprehensive care network, the government can ensure that older individuals receive continuous and coordinated care, whether in their homes or at local healthcare facilities.
With the country facing a major standoff in its medical sector with a large number of medical residents and interns refusing to work in protest against the government’s plan to increase the number of medical school seats, South Korea is on the brink of a healthcare emergency if it does not act swiftly to address the needs of its again population. The lack of a comprehensive home health program leaves millions of older individuals at risk of poor health outcomes, hospitalizations, and premature death. As the population continues to age, the demand for home-based care will only increase, placing further strain on an already overstretched healthcare system.
To avoid a crisis, the government must take immediate steps to reform its healthcare policies, develop integrated care models, and invest in workforce development. A robust home healthcare system is not only a necessity but an urgent imperative for ensuring that South Korea’s older population can age with dignity, health, and security in their own homes.
Notes
CONFLICT OF INTEREST
The authors claim no conflicts of interest.
FUNDING
None.
AUTHOR CONTRIBUTIONS
Conceptualization, DHK, JHK; Data curation, DHK, JHK; Investigation, DHK, JHK; Methodology, DHK; Project Administration, DHK; Supervision, DHK; Writing-Original Draft, DHK; Writing-Review & Editing, DHK, JHK.