[The Era of 10 Million Elderly](16) "Doctors Visit Seniors' Homes"... NHIS Home Medical Care Service

"Medical and Nursing Services at Home Without Hospital Visits"
'Fulfilling the Wish to Stay at Home, Not in Care Facilities, Even When Health Declines'
High Satisfaction... Nationwide Expansion of Long-term Care Home Medical Center Pilot Project

As the elderly population in South Korea surpasses 10 million, the demand for integrated services for elderly medical care and caregiving is increasing. Among seniors who have difficulty moving independently and cannot have a caregiver constantly present, those with high medical and nursing care needs often rely on nursing hospitals, while those with lower medical but higher nursing care needs depend on nursing homes. However, it is best for a stable old age to receive care while staying in their own homes whenever possible. Accordingly, the government has decided to expand projects that support medical care, health management, and caregiving services for the elderly. To this end, the Ministry of Health and Welfare and the National Health Insurance Service have begun expanding the pilot project for the 'Long-term Care Home Medical Center,' where doctors visit homes to provide linked medical and nursing care services.

Photo by National Health Insurance Service

Long-term care recipients receive doctor consultations without hospital visits... "Comfortably at home"

The Long-term Care Home Medical Center pilot project is a program where a multidisciplinary management team composed of doctors, nurses, and social workers visits individuals requiring home medical care to provide consultations. Since its launch in December 2022, as of the end of March this year, 3,986 long-term care recipients have been receiving regular home medical services. Among them, 2,015 are aged 85 or older.

The target group includes home-based long-term care recipients (priority given to grades 1 and 2) who have mobility difficulties and are judged by a doctor to require home medical care. This includes those with physical paralysis, post-surgery recovery, terminal illnesses, medical device attachment, neurodegenerative diseases, pressure sores and ulcers, psychiatric disorders, and cognitive impairments. The demand for home medical care is confirmed by government surveys. According to the Ministry of Health and Welfare's 2022 Long-term Care Status Survey, 53.5% of home-based recipients expressed a desire to continue living in their own homes even if their health deteriorates.

The government is strengthening elderly medical and caregiving policies while expanding home medical services. Although there are existing programs such as home nursing, pilot projects for primary care home visits, pilot projects for disabled patients' primary doctors, and long-term care home nursing that provide medical services by visiting homes, there have been criticisms that these are insufficient to meet the medical needs of home-based long-term care recipients with mobility difficulties.

The Long-term Care Home Medical Center pilot project targets medical institutions participating in the existing primary care home visit pilot project. It expands services to long-term care recipients, broadening the scope, and distinguishes itself by having not only doctors but also nurses and social workers visit together. A National Health Insurance Service official explained, "In addition to medical services, visiting social workers connect elderly individuals who need nursing services with community resources."

Regular visits 'at least once a month'... including nutrition and caregiving management

When applying for the home medical pilot project, a social worker first verifies eligibility, and the multidisciplinary team visits the recipient's home to assess the overall situation and develop a management plan. Depending on the recipient's condition, the frequency of doctor visits and the scope, frequency, and number of nursing services are determined, and services such as housing, nutrition, and caregiving are linked with community resources. Regular management of recipients is conducted monthly. Doctors visit once a month, nurses at least twice a month, and social workers visit or provide caregiving and support via phone consultations at least once a month. A comprehensive evaluation is conducted annually to revise the management plan, considering the patient's health status, willingness to treat diseases, and living conditions.

The doctor, as the leader of the multidisciplinary team, oversees not only medical consultations but also the review and establishment of future management plans. Nurses assist with medical care, perform nursing treatments as directed by doctors, report changes in diseases and symptoms, and manage medication and nutrition. Social workers connect recipients with caregiving and welfare services provided by local governments, welfare centers, and home long-term care institutions. These services include meals (lunch boxes), transportation support, medical expense assistance, laundry, home modifications, and home visits for nursing and day/night care provided by long-term care institutions.

Home medical care at 'around 40,000 won'

The government plans to reduce the financial burden of home medical care to enable more people to use these services. Costs related to home medical care are shared between long-term care insurance and the National Health Insurance.

The 'basic home medical care fee,' which covers one doctor visit per month and two nurse visits per month, costs 140,000 won per patient per month and is paid by long-term care insurance. There is no out-of-pocket expense for the patient. If care continues for more than six months, a 'continuous monitoring fee' of 60,000 won every six months is also paid, again with no patient co-payment.

However, if the number of nursing visits exceeds the basic two visits per month, patients incur co-payments. Long-term care insurance pays medical institutions 51,110 won per additional visit, with patients paying up to 15% of this cost, approximately 7,600 won. Additional nursing visits are allowed up to three times per month. Summing this up, if patients use doctor and nurse visits plus the maximum three additional nursing visits, their out-of-pocket cost is in the 70,000 won range.

When a doctor visits a long-term care home medical pilot project recipient, the home visit fee is paid by health insurance and amounts to 128,960 won per visit. If a nurse accompanies the doctor, the cost is 161,790 won. The patient co-payment is 30%. Since doctors and nurses usually visit together, the patient pays about 48,000 won each time the medical team visits their home.

A National Health Insurance Service official added, "Even those who are not long-term care recipients but have difficulty visiting hospitals due to surgery, injury, or childbirth can use the one-time home visit service under the 'Primary Care Home Visit Pilot Project' operated by the Health Insurance Review and Assessment Service."

94% of recipients satisfied... Home Medical Centers to expand to 250 by 2027

Overall satisfaction with home medical care is high. According to the '2023 Long-term Care Home Medical Center Pilot Project Evaluation Study' released by the Health Insurance Research Institute in April, 94% of recipients in the first pilot project (December 2022 to November 2023) were satisfied. Satisfaction was also high among participating service providers: doctors (76.4%), nurses (87.1%), and social workers (72.9%).

The main reason for recipient satisfaction was "being able to receive medical and nursing services at home without going to the hospital" (59.9%). After participating in the home medical center pilot project, the rate of proxy prescriptions decreased from 32.4% before participation to 26.5%, indicating improved access to face-to-face consultations.

The home medical care project is establishing itself as a program that genuinely helps recipients rather than just a 'showcase' policy. Analysis of the average number of visits per recipient showed an average of 1.05 doctor visits, 2.2 nurse visits, and 0.75 social worker visits per month. A Health Insurance Research Institute official commented, "Considering that the minimum requirement for basic home medical care fee payment is one doctor visit and two nursing visits per month, both doctors and nurses have exceeded the basic visit requirements. Including initial consultations and comprehensive evaluations by the multidisciplinary team, actual activity levels are even higher." Reflecting these results, the government plans to expand the Long-term Care Home Medical Centers currently operating in 95 locations across 15 cities and counties to at least one center in every city and county nationwide by 2027, increasing the total to 250 centers.