As South Korea enters a super-aged society, the government is considering raising the age standard for senior citizens from 65 to 70. A super-aged society is defined as a population where those aged 65 and over account for more than 20% of the total. Support for the livelihood and medical expenses of vulnerable groups will also be strengthened. To this end, livelihood benefits will be increased by 118,000 won per month for a four-person household, and the dependency ratio included in income assessments for medical aid recipients will be reduced from the current 15-30% to 10%. This marks a change after 16 years.
The government plans to resolve the tangled issues arising from the conflict between doctors and the government triggered by the increase in medical school admissions last year and to continue promoting medical reform to overcome the regional and essential medical crisis. To gain social acceptance of the supply and demand projections for medical personnel, a “supply and demand forecasting body by profession” will be established and operated. The projections will be conducted sequentially, starting with doctors and nurses, followed by dentists, oriental medicine practitioners, and pharmacists. This will serve as a basis for adjusting workforce numbers by profession, including university admissions quotas. There are plans to significantly expand national support for doctor training, such as increasing training allowances, and to accelerate improvements in working conditions for interns, including pilot projects to reduce working hours.
The Ministry of Health and Welfare announced its key business plan for the New Year on the 10th. This year, the ministry stated it will actively pursue four core tasks under the vision of “a welfare state where citizens are happy and healthy.”
◇ Breaking the long-held notion of '65 years = senior citizen'
On this day, the ministry stated that it intends to raise the age standard for seniors, which has been established at 65, to around 70. The notion that seniors start at 65 began with the Elderly Welfare Act enacted in 1981. Since then, the age criteria for major welfare systems have generally settled at 65 or older.
Lee Gi-il, Vice Minister of the Ministry of Health and Welfare, noted, “When the Elderly Welfare Law was enacted, life expectancy was 66 years, but by 2022, the life expectancy for seniors has increased to 82.7 years,” and “According to a survey on the elderly, seniors perceive the senior age as 71.6 years.”
The government's move to raise the senior age standard is aimed at responding to the sharply increasing elderly population in the future. On Dec. 23, South Korea entered a 'super-aged society,' where the population aged 65 and over accounts for more than 20% of the total. This is the fastest rate in the world, occurring only seven years after the entry into an aged society, surpassing Japan (10 years), which is known for its elderly population. By around 2050, domestic seniors are expected to account for 40% of the total population.
There are also concerns that the increasing elderly population will be difficult to support with the current national finances. Pension reform is a key example. The Vice Minister stated, “The current insurance premium rate of 9% and income replacement rate of 40% are not sustainable,” and “If we maintain the current system, a deficit is expected by 2041, and by around 2050, all funds are expected to be exhausted.” According to the ministry, citizens' burden is already increasing by 88.5 billion won daily. In response, the government plans to raise the insurance premium rate to 13% and the income replacement rate to 42%.
The Vice Minister stated, “We plan to focus on social discussions rather than amendments to laws and systems first,” and added, “We will work on how to make South Korea sustainable.”
◇ Reducing resident working hours from 80 to 72 hours a week… Transition of general hospitals
The ministry will also intensify efforts to improve the working conditions of residents who are training at university hospitals to become specialists. The government will expand the training allowances for residents and launch a pilot project to reduce working hours from 80 to 72 hours a week. A total of 41.5 billion won will be provided in training allowances for residents in eight medical specialties and two fields of fellowship. A budget of 233.2 billion won will also be established for innovation in the resident training environment.
The establishment of a specialized criminal system for medical accidents will also be promoted. There is a shortage of doctors in emergency, cardiology, obstetrics, and pediatric intensive care, and a major reason young doctors avoid specialties is the burden of disputes and lawsuits resulting from medical accidents. The government plans to establish a tentative “Patient Spokesperson System” to improve the medical accident dispute resolution system and strengthen patient rights. Plans were also announced to establish a tentative “Medical Accident Review Committee” to enhance the investigation process and shift to a prosecution system centered on gross negligence in essential medical care.
The restructuring of 47 national general hospitals will be intensified so they can focus on severe, emergency, and rare disease treatment. This is intended to establish a complete local healthcare delivery system. To this end, regional general hospitals will be supported, and specialized hospitals will be restructured focusing on essential medical areas such as burn and cerebrovascular treatments. A budget of 81.2 billion won will be invested to strengthen the role of regional essential healthcare hubs at national university hospitals and other designated healthcare institutions. The budget for expanding research infrastructure at national university hospitals is 11 billion won. Support will also be provided for operational costs, facilities, and equipment for essential healthcare in regional public hospitals.
A pilot program for a 'regional essential doctor system' will also be implemented to encourage capable specialists to work long-term in the regions. The government will support a monthly allowance of 4 million won for 96 regional essential doctors. Additionally, the allocation of residents to regions will be expanded, and plans are in place to establish a special accounts system for stable investment in regional and essential healthcare.
◇ Management of overuse and misuse of non-reimbursable expenses, measures to alleviate childbirth and childcare burdens
Essential non-reimbursable treatments will be converted to reimbursable services, and non-reimbursable services that are subject to overuse and misuse will be incorporated into a tentative 'managed service' for price and treatment standard management. A pilot project to shorten the health insurance registration period for severe and rare disease treatments from 210 days to 150 days will also be promoted. There are plans to expand the provision of home healthcare support for seriously ill children and assistive devices for people with disabilities.
Preventive health management will also be strengthened to reduce future healthcare expenses. The first out-of-pocket medical costs for major diseases that require timely treatment, such as hepatitis C, will be waived, and support for screening costs will be increased. Mobile health checkups will also be introduced for residents of social welfare facilities. A pilot project for primary healthcare innovation will be promoted so that outpatient medical institutions can provide continuous integrated health management.
Policies to alleviate the burden of childbirth and childcare will also be implemented. The ministry plans to provide support for essential fertility tests for all men and women aged 20 to 49, regardless of region or marital status. New support will also be established for freezing and preserving reproductive cells for those expected to experience permanent infertility. Women will receive 2 million won, while men will receive 300,000 won.
The costs for cesarean sections will be changed from the existing 5% out-of-pocket expense to 0%, treating them the same as natural births, and an obligation to evaluate and publish results aimed at improving the quality of postnatal care services will also be pursued. The number of psychological and emotional support centers for couples experiencing infertility and postpartum depression will increase from 10 to 12, and support will be strengthened for families dealing with such issues. Through senior jobs (5,000 positions), child care services will be provided, and the number of 'Together Care Centers' for elementary school children will be increased from 1,203 to 1,372.
Park Min-soo, the Second Vice Minister of Health and Welfare, stated, “We will create visible results from medical reforms that save lives.” He added, “To ensure that there are no disruptions in emergency care for severe and emergency patients, we will prepare special measures to maintain the emergency medical system for the lunar New Year holiday and concentrate our efforts on maintaining emergency and urgent medical systems,” and “We will also continue efforts for dialogue and persuasion within the healthcare community to normalize the system and resolve conflicts.”
◇ Investing 1 trillion won in health and medical research and development
The Ministry of Health and Welfare is investing approximately 1 trillion won in health and medical research and development (R&D), a 17% increase compared to the previous year. The health and medical R&D system will be restructured with a focus on mission-oriented, challenge-based and international collaborative research. Key regulations will also be innovated by industry. The certification standards for innovative pharmaceutical companies will be revised, and a system allowing immediate market entry for medical technologies will be implemented in September. To attract foreign patients, a survey of the actual routes for attracting patients will be institutionalized in the first half of the year, and a strategy for activating the overseas expansion of 'K-medical' will be established.
To create new added value, the activation of medical data and advanced regenerative medicine will also be pursued. The health information superhighway will be completed in connection with national general hospitals, and the scale of participant recruitment for the national integrated bio big data will be significantly expanded from the existing 19,000 to about 190,000. The establishment of a tentative “Digital Healthcare Law” to create added value based on safe utilization of healthcare data will also be pursued. Advanced regenerative medicine treatments for overcoming rare and intractable diseases are planned to be implemented in February, with management systems for prior reviews, expenses, and reporting of adverse reactions to be established.