1.77 Million Use Integrated Nursing and Caregiving Services... "Urgent Need for Realistic Reimbursement and Expansion to All Wards"

Number of Users Surges by 39% in 10 Years, Saving 1.4 Trillion Won in Caregiving Costs

Bed Participation Rate Stuck at 34%... Securing Skilled Workforce Remains a Challenge

The number of patients using integrated nursing and caregiving services has surged at an average annual rate of 39% over the past decade, significantly alleviating the financial burden of private caregiving costs. However, experts pointed out that, in order to address the rising demand for caregiving services due to an aging population and the decreasing number of newly participating beds, it is urgent to expand the system and to establish a more realistic reimbursement structure that reflects labor costs.

On the 17th, at CJ Hall in Seoul National University Children's Hospital, Jongno-gu, Seoul, Jeong Hyunjin, Director of the Sustainable System Research Office at the National Health Insurance Service Health Insurance Research Institute, explained the current status and development directions of integrated nursing and caregiving services at the policy symposium titled "Caregiving Burdens, Expansion of Integrated Nursing and Caregiving Services is the Answer." Photo by The Korean Medical Bio Journalists Association

The Korea Medical Biotechnology Journalists Association and the Korean Hospital Nurses Association held a policy symposium titled "The Burden of Caregiving, Expansion of Integrated Nursing and Caregiving Services Is the Answer" at the CJ Hall of Seoul National University Children's Hospital on the 17th, where they discussed ways to advance the system.

According to data presented at the event, as of 2024, the number of patients using integrated nursing and caregiving services exceeded 1.77 million. The total private caregiving cost savings amounted to 1.4653 trillion won, with an average of about 800,000 won saved per person, while patient satisfaction reached 93.7%. The rate of private caregiving also dropped significantly from 73.1% in 2015 to 59.9% in 2023, demonstrating the positive impact of the system.

However, there were also clear limitations at the field level. As of June last year, 798 medical institutions nationwide (with 86,443 beds) were participating, but the overall bed participation rate remained at just 34.4%. In particular, only 118 institutions operated all wards under the integrated service model, and 85.6% of these were concentrated in small and medium-sized hospitals.

Jeong Hyunjin, Head of the Sustainable Systems Research Division at the National Health Insurance Service Health Insurance Research Institute, pointed out, "Although there was no case of excluding patients simply because of higher medical severity, patient groups requiring greater nursing management, such as those with dementia, delirium, or severe disabilities, had a 21% and 37% lower likelihood, respectively, of being admitted to integrated wards compared to general patients," highlighting the phenomenon of selection based on nursing difficulty.

As solutions, Jeong proposed the following: expanding the implementation to all wards; operating a flexible workforce according to patient composition; improving staffing standards; and establishing dedicated care teams for disabled patients. She emphasized that "the reimbursement system should be made more realistic, including compensation for the labor cost gap between integrated and general wards, and support for facility improvements." She also suggested changing the name of the system—which may be misunderstood as one-on-one caregiving—to "Comprehensive Nursing Service" or "Integrated Nursing Service."

Kim Jeongsuk, Deputy Director of Nursing at Bucheon Sejong Hospital, who presented a general hospital case study, shared the achievements and challenges of introducing dedicated wards for critical patients. Bucheon Sejong Hospital, selected as a panel hospital this year, has established an intensive nursing system by applying strict standards of one nurse per four patients and one nursing assistant per eight patients.

Deputy Director Kim stated, "Operating dedicated wards for critical patients has improved treatment capabilities and safety, but securing skilled nursing personnel remains the biggest challenge." She suggested that "strengthening competency training, developing a fall prevention system using risk prediction algorithms, and adjusting reimbursement to reflect actual costs are essential."

Social tragedies related to caregiving, such as sole caregiving and caregiving-related homicides, continue to occur. The average monthly cost of caregiving has soared from 2.06 million won in 2008 to 4.32 million won in 2024—more than doubling. Furthermore, the shortage of caregivers has led to the entrenchment of the "elderly caring for the elderly" structure.

Choo Youngsoo, Second Vice President of the Korean Hospital Nurses Association (Senior Nursing Director at Korea University Medical Center), stressed, "The standard for expanding the service should not be the number of beds, but patient safety and quality of nursing care." He emphasized the necessity of "improving the staffing calculation standards to reflect the actual number of patients per nurse per shift, and establishing a differentiated and regionalized reimbursement system."

Kim Sungjoo, President of the Korea Alliance for Patients with Severe Diseases, also agreed that "caregiving is a public issue that society as a whole must address," supporting the expansion to all wards. He further stressed, "Structural improvements—such as transparent disclosure of performance indicators and reimbursement usage, and the establishment of separate standards for vulnerable groups—are essential for the system to achieve its original purpose."

This content was produced with the assistance of AI translation services.