Lee Changyong: "Macroeconomic Issues from Life-Sustaining Medical Care Can No Longer Be Ignored"

Lee Changyong, Governor of the Bank of Korea, addressed the issue of "life-sustaining medical care" in his research on structural reform, emphasizing, "As the population ages rapidly, complex effects are emerging across society, including in labor, finance, healthcare, and caregiving." He added, "We cannot ignore the macroeconomic problems that may arise from issues surrounding life-sustaining medical care."

Lee Changyong, Governor of the Bank of Korea. Photo by Yonhap News

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Governor Lee made these remarks in his welcoming speech at the symposium jointly hosted by the National Health Insurance Service and the Bank of Korea, titled "How Should We Prepare for a Super-Aged Society? Focusing on End-of-Life Medical Care."

He explained that there was significant internal debate at the Bank of Korea about addressing the issue of life-sustaining medical care. Governor Lee said, "We have studied a variety of structural reform topics in the past, but this particular research faced several challenges during the preparation stage." He continued, "I was concerned that if the Bank of Korea approached such a sensitive topic as the dignity of life from an economic perspective-considering health insurance and fiscal issues-it could easily be misunderstood."

He further stated, "However, due to the aging population, our society can no longer avoid the issue of life-sustaining medical care. The complex problems arising from aging require institutions with strengths in different fields to collaborate in order to develop more effective policy alternatives. This joint research project also began with this awareness of the issue."

Governor Lee also became emotional as he shared that his mother, who passed away in August, did not receive life-sustaining treatment. He said, "At the time, my mother asked not to be given additional nutritional supplements and only to have her pain managed, which was a difficult decision for our family." He added, "Looking back after her passing, I believe it was the right choice for her." He went on to say, "This research is also deeply meaningful to me personally, and I dedicate it to my mother."

Internally, the Bank of Korea commented, "This research demonstrates that even in fields where the Bank does not have specialized expertise, collaborating with experts to collect new data and develop analytical frameworks can yield meaningful results." They added, "Among our structural reform studies, both the research on autonomous taxis and this study on life-sustaining medical care are sources of great pride." The statement continued, "We will continue to work closely with the National Health Insurance Service and other relevant agencies to deepen our research on structural issues such as aging, healthcare, and public finance."

Meanwhile, the joint symposium discussed topics including: ▲ End-of-life medical expenses for those who discontinue or forgo life-sustaining treatment ▲ Institutional improvements to bridge the gap between patient preferences and medical realities.

Im Minkyoung of the National Health Insurance Service’s Health Insurance Research Institute presented findings on "End-of-Life Medical Expenses of Those Who Discontinue or Forgo Life-Sustaining Treatment: Self-Determination and Resource Allocation." The research showed that the earlier a decision is made to discontinue or forgo life-sustaining treatment, the lower the medical costs, and that when patients make these decisions themselves rather than family members, it contributes to a dignified death.

According to Im’s analysis of end-of-life medical expenses using the National Health Information Database, the average medical cost (based on health insurance benefits) for those who decided to discontinue or forgo life-sustaining treatment one month before death was 4.6 million won, about half that of the general deceased population (average 9.1 million won). In contrast, for those who made the decision just before death, the average medical cost ranged from 10 million to 18 million won, which was even higher than that of the general deceased group.

Both end-of-life (final month) medical expenses and treatment intensity were lower when patients themselves decided to discontinue or forgo life-sustaining treatment. The rate of intensive care unit use was 24.2% when patients made the decision themselves, compared to 36% when family members decided. The hospice utilization rate was also higher when patients (44.5%) made the decision themselves, compared to when family members decided (9.1%).

Currently, decisions to discontinue or forgo life-sustaining treatment are made by family members in 59.1% of cases, higher than the 40.9% made by patients themselves. The proportion of family decisions was higher among those aged 80 and older (58.4%), while the proportion of patient decisions was higher among those with higher incomes (41.7%).

Im concluded, "This research empirically demonstrates that patients’ self-determination plays an important role in improving the quality of life at the end of life and contributes to the efficiency of medical resource use." She suggested, "The advance directive for life-sustaining treatment should be managed as a process of reflection and choice about the end of life, and institutional design should be improved so that the right to self-determination is not subject to discrimination based on region or income level."

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