Convalescent hospital group head calls for covering fees based on patients, not hospitals

The government is pushing to implement a policy to reimburse nursing care costs at select healthcare-focused nursing hospitals. In response, the nursing hospital sector emphasized that reimbursement should be applied based on the patient, not the hospital.

Lim Seon-jae, president of the Korean Convalescent Hospital Association (KCHA), said so during a telephone interview with Korea Biomedical Review on Monday.

Lim was referring to the Ministry of Health and Welfare’s plan to implement health insurance coverage for nursing care costs at nursing hospitals. The ministry unveiled the plan on Aug. 18 in its “Status of Major Task Implementation” report presented at the National Assembly’s Health and Welfare Committee plenary session.

The ministry aims to cover nursing care costs under health insurance, considering that the lack of such support exacerbates the burden of caring for severely ill patients. It plans to pursue both the coverage of nursing care costs and the “innovation of healthcare-oriented nursing hospitals.”

Accordingly, it plans to establish 200 medical-centered nursing hospitals by the second half of 2026, 350 by 2028, and 500 by 2030, and apply nursing care cost coverage to these facilities. The target nursing hospitals will be selected by the first half of 2026, with nursing care cost coverage implemented in the second half of that year.

The ministry's strategy is to apply nursing care cost coverage to medical-focused nursing hospitals, which will not only resolve financial issues but also consolidate patients with high medical needs from existing nursing hospitals into these facilities, thereby addressing the social hospitalization problem in nursing hospitals.

However, the nursing care hospital sector is already expressing significant dissatisfaction with the ministry's plan.

In particular, the Emergency Countermeasure Committee for Small- and Medium-sized Nursing Hospitals, which represents small- and medium-sized facilities, is strongly protesting, stating, “This is an attempt to eliminate about 800 small- and medium-sized long-term care hospitals within five years, leaving only 500 large ones.”

“Although the emergency committee claims the ministry will divide medical-focused nursing hospitals based on a 200-bed standard, we have not yet received any official communication from the ministry regarding the criteria for this classification,” Lim said. “We understand the relevant details will be disclosed at the public hearing on nursing care fee reimbursement scheduled for next Monday.”

He continued, “While I understand members' significant concerns regarding the coverage of nursing care costs, it's unwise to jump to conclusions. The association is officially continuing discussions with the ministry on this matter.”

During discussions with the ministry, the association conveyed its opposition to limiting the number of hospitals eligible for nursing care fee coverage. Its position is that criteria should be established for patients requiring nursing care support, and nursing care fees should be covered regardless of which hospital meets those criteria, he added.

“We will proceed with future discussions with the ministry based on the plan they will announce at the public hearing next Monday,” he said. “It is not desirable for the nursing care hospital sector to become divided or for the long-term care hospital infrastructure to be damaged during the discussions on covering nursing care costs.”

However, Chairman Lim stressed that strengthening the medical functions of nursing hospitals is necessary, separate from the coverage of nursing care costs, to prepare for the nationwide implementation of the “Integrated Care Support Act” in March 2026.

“Once integrated care is established in 2026, nursing hospitals with weak medical capabilities will inevitably suffer. Since taking office as the KCHA president, I have advocated for strengthening the medical capabilities of nursing hospitals. This is actually necessary not for the coverage of nursing care costs, but to respond to integrated care,” Lim said.

When integrated care begins, home-based medical care will become more active, and nursing homes are likely to be excluded from the policy design process, he noted. Currently, nursing homes are excluded from integrated care services that are delivered at home. Nursing hospitals must play a role in bridging the gap between acute-care facilities and home-based medical care, Lim emphasized.

To achieve this, providing care for patients requiring respiratory therapy, severe rehabilitation, or those with terminal cancer and other end-of-life conditions is the path to survival for nursing homes. In this context, strengthening the medical capabilities of nursing hospitals is an undeniable reality, he added.

“While some patients prefer home medical care through integrated care, convalescent hospitals have a reason to exist in a super-aged society,” Lim said. “Through systemic changes, the convalescent hospital infrastructure could collapse in an instant, but rebuilding it when needed would be extremely difficult.”