A study on equity promotion in the National Dementia Services

Abstract

An increasing number of elderly Koreans are suffering from cognitive decline and dementia. Given the disease impacts to the affected individuals, families, and the national healthcare systems, many policies have been applied to provide healthcare and community services to those with dementia and the family caregivers. However, little is known about whether such social and healthcare services have been provided equally and equitably to those in need. This research focuses on the service equity by cognitive decline progress, geographical area, and one’s socioeconomic characteristics. First, this study aims to define the equity in services for dementia/cognitive health and to explain the importance of equity promotion in dementia services. The second aim of this study is to describe the service availability and utilization for the people with a broad spectrum of cognitive declines, including those with subjective cognitive declines. Third, this study examines the adequacy of dementia services by geographical area (si-gun-gu or si-do level). Based on the descriptive analyses of the 2019 Community Health Survey, we found that the elderly people with cognitive declines, especially those in need of help in daily activities, were more likely to report unmet needs of general medical services than their counterparts without such impairment. Among those with cognitive declines and in need of help in everyday life, about 21.2% were experiencing a lack of necessary (formal and informal) support. When we examined the support for those with cognitive declines by socioeconomic status, those living with families, those without physical limitations, and those aged younger (<70 or <65) were more likely to report unmet needs than their counterparts. Similarly, the proportion of dementia screening and cognitive health counseling recipients was also lower among those aged younger (<65) and those without physical limitations. We also found geographical variations in community services, including community dementia centers, daycare centers, and home visit care agencies. Community dementia centers – regional centers (at si-gun-gu level) mandated by the Dementia Law - showed higher adequacy rates in the provinces of Gangwon, Jeonnam, and Gyeongbuk where the proportion of elderly population was relatively high and other health and social care resources were limited. On the other hand, home care services and daycare centers mostly operated by private agencies were less available in Gangwon and Chungbuk provinces. Chungbuk was also lack of dementia-specialized daycare centers. The result of this study suggests several important policy implications. First, accommodations are needed for those with cognitive impairment as many of them report the unmet need in medical care services. Expansion of home-care medical services should also be considered for those with functional limitations. Second, the elderly people in the community with cognitive declines should be systematically monitored by the governments to check whether their needs of support are adequately met and to provide necessary services if needed. Third, dementia and cognitive health programs should embrace and target the diverse populations regardless of individual characteristics such as age, living arrangement, and physical abilities, to prevent service gaps in particular groups and to promote equity of dementia/cognitive health services. Finally, local governments should pay attention to the demand and supply of dementia/cognitive health services and strategically expand available services in their geographic area.