Korea moves to expand home healthcare, as study shows pilot programs are effective

The government has included “revitalizing home healthcare” in a list of major supportive projects to facilitate the restructuring of tertiary general hospitals.

According to the Health Insurance Review and Assessment Service (HIRA), all of the ongoing home healthcare pilot projects have been effective. However, transitioning the project to a full-scale implementation requires setting a co-payment rate and establishing criteria for selecting target diseases.

HIRA recently released the results of the pilot project's effectiveness analysis. Yonsei University’s University-Industry Foundation conducted the study, which was led by Professor Jang Suk-yong of the Graduate School of Public Health.

The study analyzed the effectiveness of home healthcare pilot projects conducted from December 2019 to June 2020, covering peritoneal dialysis, type 1 diabetes, home ventilators, and cancer patients with urinary fistulas (a program launched in December 2022). It also highlighted the potential for integrating these services.

Results showed that the peritoneal dialysis home management pilot program provided treatment to 7,849 patients across 79 registered medical institutions. Many tertiary general hospitals enrolled only a few patients, indicating the need for active promotion of the project to medical professionals of the involved hospitals.

The study also said that medical institutions with single-digit patient enrollment must be monitored for service quality.

The analysis found that patients enrolled in the home management pilot project used fewer medical services and incurred lower medical expenses than those who were not enrolled.

The evaluation of clinical effects by enrollment status showed that the enrolled group was more closely monitored by medical staff to detect complications, including peritonitis and prolapse, earlier.

The type 1 diabetes program enrolled 6,215 people in 54 registries. Like peritoneal dialysis, it was primarily enrolled in large, university hospital-level institutions.

It was also found that the enrolled patients used less medical care and incurred fewer medical expenses than the unenrolled group. Hospitalizations and emergency room visits due to hypoglycemic coma and ketoacidosis were lower in the enrolled group, confirming the effectiveness of preventing complications.

The clinical effectiveness evaluation showed similar trends for both adults and pediatric patients, though the benefits were more pronounced in pediatric cases.

The home ventilator patient program showed 1,167 patients enrolled in 21 centers, but a small number of centers tended to enroll many patients, with three centers enrolling 953 patients.

In terms of outcomes, the enrolled group used less healthcare and incurred lower healthcare costs than the unenrolled group, but they used more outpatient visits.

he researchers attributed this to regular face-to-face visits with healthcare providers, which led to a significantly lower risk of death in the enrolled group compared to the unenrolled group.

The cancer patient (urostomy) program has 246 patients enrolled in 18 institutions, and three institutions have enrolled 156 patients, showing that a small number of institutions have enrolled a large number of patients. Clinically, the results showed a significant reduction in the likelihood of reoperation, one of the most essential complications in cancer patients (urinary incontinence).

Based on their findings, the researchers pointed out several things to consider when transitioning to the main home healthcare project.

First, the researchers believe setting the co-payment rate will be problematic when transitioning to the main project.

In the pilot project stage, educational counseling fees 1 and 2 were set at a 10 percent co-payment rate and patient management fees at 0-5 percent. However, in the patient survey, less than 5 percent of patients were willing to pay more than 3,000 won ($2) in additional fees, so patients will likely psychologically reject the program if the co-payment exceeds 10,000 won when it is converted to the main project.

In response, the research team said that patients' willingness to pay could be higher if the project strengthens the “two-way” communication channel with doctors when needed, which is the service patients want the most. However, legal issues surrounding remote consultation and resistance from existing neighborhood clinics must be overcome in this case.

The researchers also noted that selecting disease groups for the shift would be difficult, stressing the need for its criteria. They suggested that type 1 diabetes should be a prioritized criterion for limiting the program's scope to moderate and severe conditions.

The research team recommended implementing differential payments based on risk while ensuring uniform compensation within each risk category, regardless of service type or frequency, to enhance the effectiveness of risk classification.

They also pointed out that the current pilot project only provides remote counseling services, different from the name of home healthcare, and suggested that it should be integrated with home visits in the future.

“As the role of home healthcare will be discussed in line with the government's reorganization of the healthcare delivery system, it is necessary to design home healthcare services that go beyond non-face-to-face services to include home visits,” the research team said.