[Inside Chodong] Why Promises to Support Caregiving Costs Are Emptily Made

One of the main issues in the second televised debate for the 21st presidential election candidates, held on the 23rd, was "state support for caregiving costs." With the election just ten days away, the candidates brought up an issue that is among the most sensitive for the public. Both of the leading candidates have pledged to reduce the financial burden on citizens by applying national health insurance to caregiving costs at long-term care hospitals, which are currently paid entirely out-of-pocket.

Lee Jaemyung, the presidential candidate of the Democratic Party of Korea, had already proposed making caregiving costs eligible for insurance coverage during last year’s general election. In this presidential race as well, he emphasized, "The burden of caregiving costs should be shared by society, not individuals," and pledged, "The public sector will share the burden to relieve people’s worries about bankruptcy due to caregiving costs." He also promised to expand the integrated nursing-caregiving service, where a nursing team provides comprehensive professional care so that guardians or caregivers do not need to stay in the hospital room.

Kim Moonsoo, the presidential candidate of the People Power Party, also stated, "The state will take care of the health of our seniors so that they do not have to worry about being a burden to their children," and said, "We will support caregiving costs for inpatients at long-term care hospitals." He also announced plans to provide at least 500,000 won per month for family caregivers and 1 million won per month for spouses aged 65 or older.

Currently, when a patient is admitted to a long-term care hospital, they must pay for caregiving, hospitalization, and medical treatment. Among these, caregiving costs are not covered by health insurance, so patients must pay 100% out of pocket. The average daily caregiving cost is about 120,000 to 150,000 won, amounting to at least 3.6 million to 4.5 million won per month. According to a report from the National Assembly Research Service, the amount spent by patients and their families on caregiving costs increased from about 3.6 trillion won in 2008 to 8 trillion won in 2018, and is expected to exceed 10 trillion won this year. The Health Insurance Research Institute of the National Health Insurance Service estimates that even if health insurance is applied only to patients with higher severity levels (levels 1 to 3 out of 5), 15 trillion won per year would be needed.

The problem is that the health insurance fund is rapidly being depleted, leaving no money to support caregiving costs. Due to indiscriminate policies to expand health insurance coverage and the medical service gap that has continued since last year, the health insurance fund is expected to run a deficit starting this year, with accumulated reserves projected to be exhausted by 2028. For the first time ever, health insurance premiums have been frozen for two consecutive years, meaning that the premiums citizens will have to pay are expected to rise even more steeply in the future.

However, neither candidate has presented detailed implementation plans, financial requirements, or funding sources for making caregiving costs eligible for insurance coverage, instead offering only vague answers. Candidate Lee said, "The scope of caregiving cost coverage should be expanded according to what medical finances allow and as circumstances permit." Candidate Kim said, "We will reduce waste by reviewing excessive or duplicate treatments and areas where coverage is too leniently granted to foreigners, one by one." In contrast, Lee Junseok, the presidential candidate of the Reform New Party, presented a relatively concrete alternative two days after the debate: to reduce health insurance spending by expanding the "differentiated co-payment system," under which patients, except those with serious illnesses, would have to pay a higher proportion of medical costs if they use outpatient services excessively (more than 120 visits per year).

In our society, which has already entered a super-aged phase with more than 20% of the population aged 65 or older, caregiving costs are the biggest unavoidable problem in old age. Policies to relieve individuals and families of the burden of caregiving costs by shifting it to the state are also essential. However, if there is no plan or solution for how to secure the enormous funds required, such pledges will only become a source of frustrating false hope for citizens who may have briefly expected real change. Empty promises are ultimately just evidence of a lack of willingness to take responsibility.