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[Column] Preparing for old agePark Jae-young’s Monotasking
  • By Park Jae-young Executive editor
  • Published 2017.02.23 12:00
  • Updated 2017.02.24 09:06
  • comments 0

Taiwan has recently enacted a law prohibiting inheritance to children who neglect their duty of supporting aged parents. To resolve conflicts arising from parents who are dependent on their children, Singapore appointed a commissioner and established the Tribunal for the Maintenance of Parents. India, France, Germany and China have also specified the obligation of children to support their elderly parents. South Korea has imposed no such legal requirements yet.

In the town of Weesp, the Netherlands, there is a “dementia village” called De Hogeweyk. More than 150 dementia patients live in 20 houses, each of which accommodates six to eight residents. Patients share some of the housework and have resident staffs to help them.

There are restaurants, pubs, and theaters nearby for the inhabitants to use as well. In Boston, there is an active adult community called Beacon Hill Village where elderly residents and volunteers live together in the same neighborhood and help one another. This arrangement is cheaper than regular retirement communities because there are few paid workers. Korea has yet to embark on residential experiments of this type.

Countries like the United Kingdom, the United States, and Singapore are trying to reduce hospital admission by organizing a “caring continuum” that links clinics, hospitals, general hospitals, nursing homes, emergency rooms, and keeps the family at the center. The goal is to deliver as much medical care as possible at home, including advanced acute care. Korea still has a long way to go before reaching that stage.

In Hawaii, local governments, medical institutions and insurance companies are collaborating to conduct video-based training for people to establish a “pre-treatment plan.” The program allows people to decide in advance what level of treatment they want to receive when they arrive at a hospital in a terminal condition. The three options are maximum, limited, and palliative care. Once they make a decision, people tell their wishes to their friends, families, and doctors. This sort of preparation reduces unwanted life-prolonging treatment and medical costs. Many countries are pushing for a variety of policies that allow for a comfortable and dignified death. Expansion of hospices is just one example. Korea is only in the formative stages of a healthcare consent law.

Like health management organizations (HMOs) in the United States, insurers and providers are experimenting with disease prevention and early diagnosis to limit a surge in medical costs for the elderly. They are also exploring the use of smartphones, wearable technology, and robots. The same goes for other countries where the government plays even bigger roles. Korea has been debating the introduction of telemedicine for years.

Korea leads the world in population aging. Over the next decade, the share of people 65 or older will exceed 20 percent of the population, making Korea a "super-aged society." This aging problem is already severe but is likely to worsen because the elderly population will be 50 percent bigger than now. Just look at the number of working people, aged 15-64, who support those 65 or older. Globally, there were 12 people for every senior citizen in 1950. Today the average is eight. In 2050, it will be four to one. The figure here goes down to five as early as in 2018. If the low fertility rate continues, it will soon be just two or three. Cost is one thing, but generational conflicts, serious as they are now, are likely to aggravate.

Everyone knows that population aging is a serious issue, but policies that help us prepare for it are virtually nonexistent. It’s not that we are unaware of its seriousness; rather, the problem is so momentous that it’s hard to know where to begin. In some ways, aging society is a future problem, and we are so busy fixing current issues that we tend to put it off. Even so, we should start to plan for the future.

No policy can perfectly prepare us for population aging. We have to take many problems _ housing, food, finance, transportation, education, and medical care _ into account. There is no question that medical care is the most urgent issue that we need to prepare for, however. Korea’s medical care has made remarkable progress so far, but many difficulties lie ahead. Squeezing more out of providers and a fee-for-service payment model will not cut it as the solution.

The time has long past we try something new. Desperate times call for desperate measures.


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Park Jae-young is Executive Editor of 〈The Korean Doctors‘ Weekly〉. Author, Novelist, MD PhD (health law & medical ethics)

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