According to the Organization for Economic Cooperation and Development (OECD), Korea became an aging society in 2000. An aging society is defined as one where the elderly account for at least 7% of the entire population. In 2019, Korea will emerge as an aged society, where the elderly make up at least 14%. The rapid aging of Korean society has been attended by a parallel rise in the prevalence of dementia. The ratio of senior citizens with dementia out of the entire population is expected to edge up from 1.1% (580,000) in 2013 to 5.6% (2.71 million) in 2050.
Since dementia requires long-term care, the aged with dementia and their family members must bear heavy costs for a substantial period of time. The Ministry of Health and Welfare and the National Institute of Dementia put the number of the elderly with dementia in Korea as of 2013 at about 570,000. The number of their family members including their spouses, children, and grandchildren is estimated at approximately 2.3 million. KRW 20.3 million was spent annually on the care of one senior citizen with dementia as of 2013. The social costs for dementia control nationwide were, accordingly, estimated at KRW 11.7 trillion as of 2013.
In a bid to curtail the various social costs associated with the rising incidence of dementia, the Korean government declared a ‘war on dementia’ in August 2008 and announced its comprehensive dementia management measures (2008~2014). In July 2012, it unveiled the second national comprehensive dementia management plan (2013~2015), and in July 2014, a ‘special dementia grade’ was included in the long-term elderly care insurance grades. The government also implemented the ‘vacation system for family members of dementia patients’ as part of its expansion of the dementia management program. Ahead of full-fledged expansion of the program, this report aims to evaluate presently ongoing dementia management projects, find ways to efficiently execute a budget for them, and improve their effectiveness.
Analysis findings suggest, more than anything else, that it is imperative to reduce the social costs arising from dementia by conducting checkups for more people to detect dementia earlier. The social costs attributable to dementia amounted to KRW 11.7 trillion (about 1.0% of GDP) in 2013 and are forecast to reach up to KRW 43.2 trillion (approximately 1.5% of GDP) by 2050. Early dementia screening and medication are expected to reduce the social costs by KRW 1.3 trillion to KRW 2.8 trillion per year. This points to the need for checkups for more people for early dementia detection. However, current dementia screening tests at community health centers and dementia counseling centers in cities, counties, and districts have recorded low rates of definite diagnosis. (Of a total of 1,593,598 persons tested in 2013, only 36,748 persons (2.31%) were confirmed as having dementia.) Possible inclusion of a dementia screening test in the National Health Insurance Service’s medical checkup and full coverage of dementia test subjects’ own medical expenses, regardless of their income levels, need to be considered. If persons aged 75 or older are rendered eligible for early dementia detection screening, KRW 48.8 billion will have to be spent over two years. If such minimum age requirement is lowered to 70 or 65, KRW 83.7 billion or KRW 124.5 billion in estimated expenses will, respectively, be incurred.
In addition, it is necessary to overhaul the dementia management service delivery system. In the six cities and provinces of Gwangju, Ulsan, Sejong, South Jeolla, South Gyeongsang, and Jeju, no metropolitan dementia center has yet been designated, and there are no legal grounds for its installation and operation. Metropolitan dementia centers need to be expanded in consideration of geographical proximity, number of dementia sufferers, and potential cessation of dementia diagnosis, including possible consolidation of metropolitan dementia centers in Gwangju and South Jeolla Province and in Ulsan and South Gyeongsang Province. Furthermore, related provisions must be inserted into the Dementia Management Act. Some cities and provinces, including South Jeolla, South Chungcheong, North Gyeongsang, and Jeju, took a passive stance toward securing necessary personnel for community health centers and dementia counseling centers at the city, county, and district level, despite their obligations to actively press ahead with dementia management projects, given the number of dementia sufferers and the vacuum in dementia diagnosis. Based on estimation of funding necessary to support dementia screening tests in each city, county, and district; provide cognitive training programs; and expand personnel dedicated to the dementia management project who handle such affairs as elderly dementia case management, costs are expected to run KRW 3.7 billion to 8.3 billion each year.
The Korean government introduced a special dementia grade in the long-term elderly care insurance scheme, and it is providing cognitive training to mild dementia sufferers using in-home services. However, its support for cognitive training programs available at elderly medical and welfare facilities remains insufficient. In a survey of dementia management service organizations (elderly medical and welfare facilities, convalescent hospitals, etc.) conducted by the National Assembly Budget Office, only 24.7% of all respondents (43 persons) said that they offer cognitive training programs by inviting instructors, while 60.9% (106 persons) replied that personnel at their institutions including social workers and care workers administer such programs. The government must develop programs suitable for varying degrees of severity, produce manuals for use by staff at individual institutions, and create a pool of professional cognitive rehabilitation instructors in each city and province for its utilization by dementia management service providers. To ensure better assessment of the quality of services rendered by dementia management service providers, it is necessary to cause a metropolitan dementia center in the location of a dementia management service provider to continuously monitor cognitive training programs which are offered to elderly dementia patients using such provider as well as deceleration, if any, of worsening of the disease.
Lastly, the government needs to establish a research institute that takes exclusive charge of studying aging and geriatric diseases and to reinforce coordination and connection among dementia-related research efforts. In other words, the government must set up an organization that oversees specialized dementia research centers including the National Institute of Dementia and the Korea Brain Research Institute and pursues coordination and connection among research institutes conducting studies on aging-related diseases. In addition, the government must cause metropolitan dementia centers to receive brain donations, collect clinical data on brain donors, and then submit related materials to control by the Korea Brain Research Institute’s national brain bank, while exploring a way for metropolitan dementia centers to coordinate clinical tests in the course of dementia research.
In the future, the government must proactively pursue early dementia detection by, for instance, including a dementia screening test in the National Health Insurance Service’s medical checkup. The government also has to ensure that professional staff of a metropolitan dementia center will support dementia management projects in each city, county, and district under its jurisdiction. In addition, the government must examine the possibility that indicators pertaining to the dementia management program will be reflected in joint assessment of local governments. It also needs to operate specialized long-term elderly care facilities by certifying institutions dedicated to dementia care services and controlling the quality of their services and set up an exclusive aging and geriatric disease research institute to render well-organized assistance for dementia research.
Since dementia requires long-term care, the aged with dementia and their family members must bear heavy costs for a substantial period of time. The Ministry of Health and Welfare and the National Institute of Dementia put the number of the elderly with dementia in Korea as of 2013 at about 570,000. The number of their family members including their spouses, children, and grandchildren is estimated at approximately 2.3 million. KRW 20.3 million was spent annually on the care of one senior citizen with dementia as of 2013. The social costs for dementia control nationwide were, accordingly, estimated at KRW 11.7 trillion as of 2013.
In a bid to curtail the various social costs associated with the rising incidence of dementia, the Korean government declared a ‘war on dementia’ in August 2008 and announced its comprehensive dementia management measures (2008~2014). In July 2012, it unveiled the second national comprehensive dementia management plan (2013~2015), and in July 2014, a ‘special dementia grade’ was included in the long-term elderly care insurance grades. The government also implemented the ‘vacation system for family members of dementia patients’ as part of its expansion of the dementia management program. Ahead of full-fledged expansion of the program, this report aims to evaluate presently ongoing dementia management projects, find ways to efficiently execute a budget for them, and improve their effectiveness.
Analysis findings suggest, more than anything else, that it is imperative to reduce the social costs arising from dementia by conducting checkups for more people to detect dementia earlier. The social costs attributable to dementia amounted to KRW 11.7 trillion (about 1.0% of GDP) in 2013 and are forecast to reach up to KRW 43.2 trillion (approximately 1.5% of GDP) by 2050. Early dementia screening and medication are expected to reduce the social costs by KRW 1.3 trillion to KRW 2.8 trillion per year. This points to the need for checkups for more people for early dementia detection. However, current dementia screening tests at community health centers and dementia counseling centers in cities, counties, and districts have recorded low rates of definite diagnosis. (Of a total of 1,593,598 persons tested in 2013, only 36,748 persons (2.31%) were confirmed as having dementia.) Possible inclusion of a dementia screening test in the National Health Insurance Service’s medical checkup and full coverage of dementia test subjects’ own medical expenses, regardless of their income levels, need to be considered. If persons aged 75 or older are rendered eligible for early dementia detection screening, KRW 48.8 billion will have to be spent over two years. If such minimum age requirement is lowered to 70 or 65, KRW 83.7 billion or KRW 124.5 billion in estimated expenses will, respectively, be incurred.
In addition, it is necessary to overhaul the dementia management service delivery system. In the six cities and provinces of Gwangju, Ulsan, Sejong, South Jeolla, South Gyeongsang, and Jeju, no metropolitan dementia center has yet been designated, and there are no legal grounds for its installation and operation. Metropolitan dementia centers need to be expanded in consideration of geographical proximity, number of dementia sufferers, and potential cessation of dementia diagnosis, including possible consolidation of metropolitan dementia centers in Gwangju and South Jeolla Province and in Ulsan and South Gyeongsang Province. Furthermore, related provisions must be inserted into the Dementia Management Act. Some cities and provinces, including South Jeolla, South Chungcheong, North Gyeongsang, and Jeju, took a passive stance toward securing necessary personnel for community health centers and dementia counseling centers at the city, county, and district level, despite their obligations to actively press ahead with dementia management projects, given the number of dementia sufferers and the vacuum in dementia diagnosis. Based on estimation of funding necessary to support dementia screening tests in each city, county, and district; provide cognitive training programs; and expand personnel dedicated to the dementia management project who handle such affairs as elderly dementia case management, costs are expected to run KRW 3.7 billion to 8.3 billion each year.
The Korean government introduced a special dementia grade in the long-term elderly care insurance scheme, and it is providing cognitive training to mild dementia sufferers using in-home services. However, its support for cognitive training programs available at elderly medical and welfare facilities remains insufficient. In a survey of dementia management service organizations (elderly medical and welfare facilities, convalescent hospitals, etc.) conducted by the National Assembly Budget Office, only 24.7% of all respondents (43 persons) said that they offer cognitive training programs by inviting instructors, while 60.9% (106 persons) replied that personnel at their institutions including social workers and care workers administer such programs. The government must develop programs suitable for varying degrees of severity, produce manuals for use by staff at individual institutions, and create a pool of professional cognitive rehabilitation instructors in each city and province for its utilization by dementia management service providers. To ensure better assessment of the quality of services rendered by dementia management service providers, it is necessary to cause a metropolitan dementia center in the location of a dementia management service provider to continuously monitor cognitive training programs which are offered to elderly dementia patients using such provider as well as deceleration, if any, of worsening of the disease.
Lastly, the government needs to establish a research institute that takes exclusive charge of studying aging and geriatric diseases and to reinforce coordination and connection among dementia-related research efforts. In other words, the government must set up an organization that oversees specialized dementia research centers including the National Institute of Dementia and the Korea Brain Research Institute and pursues coordination and connection among research institutes conducting studies on aging-related diseases. In addition, the government must cause metropolitan dementia centers to receive brain donations, collect clinical data on brain donors, and then submit related materials to control by the Korea Brain Research Institute’s national brain bank, while exploring a way for metropolitan dementia centers to coordinate clinical tests in the course of dementia research.
In the future, the government must proactively pursue early dementia detection by, for instance, including a dementia screening test in the National Health Insurance Service’s medical checkup. The government also has to ensure that professional staff of a metropolitan dementia center will support dementia management projects in each city, county, and district under its jurisdiction. In addition, the government must examine the possibility that indicators pertaining to the dementia management program will be reflected in joint assessment of local governments. It also needs to operate specialized long-term elderly care facilities by certifying institutions dedicated to dementia care services and controlling the quality of their services and set up an exclusive aging and geriatric disease research institute to render well-organized assistance for dementia research.