By 2028, the number of hospice specialized institutions will be doubled and the utilization rate will be expanded to 50%.

The government will expand the number of hospice specialized institutions from 188 last year to 360 by 2028, and will also increase the utilization rate of patients with hospice diseases to 50% by 2028.

In order to strengthen the construction of the hospice and life-sustaining medical information system, we plan to establish a hospice comprehensive information system to manage the data of patients applying for hospice use and check whether services are available.

In particular, we will revamp the curriculum of hospice professional institutions and develop and expand various programs for essential personnel to strengthen the capabilities of workers.

The Ministry of Health and Welfare announced that it held the National Hospice and Life-Sustaining Treatment Committee on the 2nd and deliberated and decided on the ‘2nd Hospice and Life-Sustaining Treatment Comprehensive Plan (draft)’ containing these contents.

This plan will continue to supplement insufficient infrastructure based on the institutional foundation such as service expansion and base (infrastructure) expansion promoted in accordance with the first comprehensive plan.

In addition, by increasing the people’s accessibility to services, we have improved the system and supplemented blind spots to ensure that people are better able to make choices about ending their lives.

Meanwhile, a comprehensive plan for hospice and life-sustaining care is established every five years to establish an institutional system for decisions on hospice, palliative care and life-sustaining treatment in accordance with Article 7 of the ‘Act on Hospice, Palliative Care and Decisions on Life-Sustaining Treatment for Patients in the Dying Process’. I’m doing it.

◆ Expanding user choice guarantees

Improve accessibility to hospice and life-sustaining treatment decision systems and expand end-of-life support infrastructure.

Accordingly, we plan to expand the target and scope of hospice service provision, adjust targets for life-sustaining treatment, and strengthen management of advance directives for life-sustaining treatment.

In addition, the scope of the current five target diseases will be gradually expanded to reflect the demand for hospice services, and services such as spiritual care and bereavement family programs for patients and families will be developed.

The period for writing life-sustaining treatment plans will also be expanded so that communication regarding life-sustaining treatment with medical staff can begin early.

Currently, a life-sustaining treatment plan can be written after receiving a terminal diagnosis of the disease, but the system is planned to be supplemented so that it can be written even before the terminal stage.

In addition, if the patient’s will is unknown and there is no family member who can make the decision, the decision to discontinue life-sustaining treatment was not possible. However, the system will be improved to allow for discontinuation of life-sustaining treatment.

Advance directives for life-sustaining treatment are efficiently managed and operated with a focus on the consumer, and customized counseling support tools for vulnerable populations registered with the directive are additionally developed and distributed.

In cases where there is a demand for registration of a letter of intent but registration is not easy, we provide guidance on the system and provide consultation by linking related businesses such as home medical care, home hospice, and long-term care institutions.

Management before and after writing a letter of intent will be strengthened, and a periodic alarm system for registered information will also be introduced.

Accordingly, we provide prior training to increase understanding of the system before writing a letter of intent, and strengthen the guidance system to enable communication with the family after writing the letter of intent.

In particular, the end-of-life support infrastructure will be expanded by expanding hospice providers and life-sustaining treatment decision-making institutions and strengthening information system construction.

Hospice specialized institutions are scheduled to expand from 188 in 2023 to 360 in 2028, and the utilization rate of patients with hospice diseases will increase from 33% in 2023 to 50% by 2028.

Meanwhile, the current hospice specialty institutions are divided into inpatient, home, and advisory types. By 2028, the inpatient type will increase by 15 locations to 109, the home type will increase by 41 to 80, and the advisory type will increase by 116 to 154. Expand to

In the case of the life-sustaining treatment decision system, the medical institution ethics committee (medical institutions capable of discontinuing life-sustaining treatment) will be expanded from 430 in 2023 to 650 in 2028.

By 2028, general hospitals plan to expand the establishment of medical institution ethics committees to 250 locations (75% of all general hospitals), an increase of 43 places, and nursing hospitals plan to expand the establishment of medical institution ethics committees to 280 locations, an increase of 144 places (20% of all nursing hospitals).

In addition, in order to expand the establishment of ethics committees in small and medium-sized hospitals, the number of public ethics committees will be increased from 12 in 2023 to 20 in 2028.

The registration agency for advance directives for life-sustaining treatment seeks balanced expansion, focusing on local health care institutions and medical institutions. In the case of local health care institutions, the number of locations will increase by 45 to 155 by 2028.

Among medical institutions with ethics committees, the number of registration institutions in tertiary and general hospitals will be expanded to 200 by installing 86 additional institutions by 2028.

In addition, the life-sustaining medical information system is upgrading the system by strengthening personal information protection according to the designation of the personal information intensive management system, and improving user-centered convenience by introducing an electronic registration certificate issuance system and an integrated civil complaint management system.

◆ Strengthening the foundation for system implementation

We will enhance the effectiveness of system implementation by upgrading the evaluation and management system of the providing organizations, strengthening the capabilities of the providing organizations and personnel, including strengthening the capabilities of the employees of the providing organizations, and strengthening on-site support.

Accordingly, the system-centered hospice professional organization evaluation indicators, such as compliance with current legal standards, will be improved to include user-centered quality evaluation indicators such as satisfaction of medical staff, patients, and guardians.

In addition, the human resources standards (doctors, nurses) of hospice specialized organizations will be changed from the number of beds to the number of patients, and the quality of service will be improved through efficient ward operation.

We will also strengthen the inspection, investigation, and feedback system for institutions implementing the life-sustaining treatment decision system, and expand exchange and cooperation through networks among participating organizations, such as providing information and consultation support, mentoring of new entrants, and sharing field cases.

In particular, to increase the capabilities of hospice workers, we will develop non-face-to-face training programs and strengthen education on non-cancerous diseases such as cancer, chronic liver cirrhosis, and chronic obstructive respiratory disease.

In addition, we develop and standardize in-depth courses for each service area, such as spiritual care, end-of-life care, and bereavement family care.

Implementing the decision to disqualify life-sustaining treatment, differentiated educational strategies are established and implemented for medical personnel and counselors, and the curriculum is developed by subdividing the medical personnel in the field according to their level of involvement in the system.

Meanwhile, hospice and life-sustaining treatment information data will be activated to improve the effectiveness of system implementation.

Accordingly, a cooperation system will be established by linking and utilizing related data from hospice, National Cancer Center, National Health Insurance Corporation, Health Insurance Review and Assessment Service, and Cancer Data Center, and the advancement of the data system will be promoted.

The life-sustaining treatment decision system also plans to promote evidence-based policies through data linkage with the National Health Insurance Corporation and others.

We will strengthen on-site support by realisticizing the cost of home hospice manpower, promoting improvements in manpower standards for auxiliary activities, and reviewing compensation plans for end-of-life services for patients and their families after discontinuation of life-sustaining treatment.

◆ Promoting awareness improvement and expansion

We will revitalize research on hospice and life-sustaining treatment decision systems, increase policy awareness through public promotion, and strengthen local community connections.

Accordingly, we will strengthen research support, including cost analysis studies, such as the economic effects of expanding hospice infrastructure in the community, developing the appropriate number of hospice services that can be introduced, diagnosing and analyzing the cost of life-sustaining treatment, and developing services after discontinuation.

In order to effectively increase public awareness of the system, differentiated promotions will be conducted by dividing the hospice service into high-interest and low-interest groups depending on their level of interest.

We plan to spread practical messages that can positively perceive the dying process and disseminate examples of prepared end-of-life plans and implementation.

In addition, we create and distribute communication tools to plan for end-of-life decisions and communicate with family members.

In particular, it provides opportunities to think in advance about self-determination at the end of life by opening and disseminating curricula for each age group, such as school age, adulthood, and middle-aged as well as old age.

In order to strengthen community connection and governance, we provide current hospice services in connection with community visit medical services and explore new service types.

We plan to strengthen end-of-life care capabilities through hospice training for medical staff, including a pilot project for home medical care.

Focusing on hospice centers in each region, we will promote human resource training and link services to provide care for terminally ill patients at home, discover additional recipients of care, and continue to supplement the types of services and required personnel.

Strengthen the governance of hospice and life-sustaining treatment decision systems.

First, we will form and operate our own consultative body to discuss related social issues, and strengthen support for sharing results between central and regional hospice centers and promoting on-site training for hospice centers in each region.

Furthermore, we plan to expand the functions and organization of the National Life Sustaining Medical Management Agency and re-establish the business management system.

Jeon Byeong-wang, Director of Health and Medical Policy at the Ministry of Health and Welfare, said, “Social interest in ending one’s life with dignity and comfort, as much as living a healthy and happy life, is growing.” “We will proceed with the plan without disruption,” he said.

Inquiries: Ministry of Health and Welfare Disease Policy Division (044-202-2517), Bioethics Policy Division (044-202-2615)