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A primary doctor system can improve elderly health care

Published: 27 Feb. 2025, 00:02

Lim Jae-jun

The author is a professor of internal medicine at the Seoul National University College of Medicine and Seoul National University Hospital.

Korea takes pride in its remarkable economic transformation, often referred to as the “Miracle on the Han River.” Despite ongoing economic challenges, the country’s growth has been extraordinary.

As the economy advanced, so did Korea’s medical capabilities. Cancer survival rates, a crucial indicator of health care effectiveness, highlight this progress. Between 2010 and 2014, Korean patients diagnosed with gastric cancer had a five-year survival rate of 69 percent, the highest in the world. This figure surpassed Japan at 61 percent and far outstripped Germany's 34 percent, 33 percent in the United States, and Italy with 31 percent.

Yet, national health is not determined by medical expertise or health care systems alone. Social and economic factors play a critical role—commonly referred to as the “social determinants of health.” The U.S. Centers for Disease Control and Prevention identifies five key determinants: income level, quality of education, health care accessibility, living environment and community support. These factors significantly shape individual health outcomes.

As Korea developed, improvements in nutrition and medical infrastructure, coupled with better living conditions, led to a substantial increase in life expectancy. In 1970, the average Korean could expect to live an average of 62.3 years — 58.7 for men and 65.8 for women. By 2023, life expectancy had surged to an average of 83.5 years — 80.6 for men and 86.4 for women, exceeding the Organisation for Economic Cooperation and Development (OECD) average and approaching Japan, the world’s longest-living nation at 81.1 for men and 87.1 for women.

Senior citizens wait to receive food at the Wongaksa soup kitchen near Tapgol Park in Jongno District, central Seoul, on December last year. Korea became a ″super-aged society,″ classified by the United Nations as when the population aged 65 years or older account for more than 20 percent of the total population, as of Dec. 23, 2024. [YONHAP]

On Dec. 23, 2024, Korea officially became a “super-aged society” with the proportion of people aged 65 and older surpassing 20 percent. The transition from an aging to a super-aged society took only seven years and four months—faster than Japan, which took 11 years. However, rapid aging comes with an alarming increase in health vulnerabilities among the elderly.

Dementia remains one of the most pressing concerns. The Ministry of Health and Welfare and the National Institute of Dementia estimate that the number of dementia patients aged 65 and older rose from approximately 750,000 in 2018 to 940,000 in 2022.

Currently, 10.4 percent of seniors suffer from the disease. By 2030, the number is projected to reach 1.42 million. Although some experts argue these projections may be overstated, the overall trend is undeniable — more seniors mean more dementia cases.

An older adult looks at a job information bulletin in Mapo District, western Seoul on Oct. 22, 2024. [NEWS1]

Elderly suicide rates are another troubling issue. In 2023, Korea recorded 13,978 suicides, with an overall rate of 27 per 100,000 people — far exceeding Japan at 16 and the United States at 15. Among seniors, the crisis is even more severe: The suicide rate was 39 per 100,000 for those in their 70s and 59 per 100,000 for those in their 80s — more than double the national average.

Why are so many Korean seniors taking their own lives? Data from the Korea Suicide Prevention Center provides insight. In 2022, the most common reasons for elderly suicide were mental distress and financial hardship. Depression is widespread among Korea’s elderly population, and the country’s elderly poverty rate is three times the OECD average. These factors are inextricably linked to the soaring suicide rates.

Tuberculosis, a disease commonly associated with poverty, remains prevalent among Korea’s elderly. According to the World Health Organization, the country's tuberculosis incidence rate in 2023 stood at 38 per 100,000 — more than ten times higher than the United States and Japan. This paradoxical trend is largely due to wartime generations who contracted latent tuberculosis and are now developing active cases due to weakened immunity in old age.

Income levels significantly impact health outcomes. Lower-income individuals face a higher prevalence of chronic illnesses and severe conditions. The Korea Institute for Health and Social Affairs’ 2024 Welfare Panel Survey reveals stark disparities: 76 percent of low-income households have family members with chronic diseases, compared to 37 percent for general households. Consequently, low-income individuals visit outpatient clinics more than twice as often and are hospitalized more frequently.

This disparity translates to life expectancy gaps. A recent study by Prof. Seok-jun Yoon of Korea University's College of Medicine analyzed life expectancy across income quintiles, revealing a striking difference. In 2020, men and women in the highest income bracket had life expectancies of 85.1 and 89.3 years, respectively. Meanwhile, their counterparts in the lowest income bracket had significantly shorter life expectancies of 75.5 and 83.9 years.

Addressing these health disparities requires more than just increasing the number of doctors. A systematic, long-term approach is needed — one that ensures continuous, individualized health care. One of the most effective solutions is the implementation of a primary care physician system.

A primary care physician system allows individuals to establish ongoing relationships with trusted doctors at nearby clinics or hospitals, ensuring timely and consistent care. Unlike a reactive model that treats illnesses as they arise, primary care physicians provide proactive, preventive care. They manage chronic conditions, monitor mental health, and oversee vaccinations, ensuring that aging individuals receive comprehensive medical attention. This system is especially beneficial for elderly patients with hypertension, diabetes, dementia, or depression.

Primary care physicians also serve as coordinators, referring patients to appropriate specialists when necessary. They facilitate home health care services for dementia patients, connect critically ill individuals with at-home medical services and ensure seamless access to various medical resources. With a trusted primary care doctor, patients are less likely to rely on unproven health supplements or unnecessary treatments. Additionally, reducing redundant hospital visits can significantly lower national health care expenditures.

Many advanced nations have already adopted primary care systems. In Britain, all citizens must register with a general practitioner. France requires individuals to designate a primary physician to receive full insurance benefits. Germany operates a family doctor system, while Canada and the United States provide ongoing health care through family physicians.

Korea has made impressive strides in health care, emerging as a model for longevity. However, its elderly population faces severe health challenges. As the country navigates this super-aged era, ensuring universal access to primary care is no longer optional — it is imperative.

Translated using generative AI and edited by Korea JoongAng Daily staff.