Questions/Answers

- Under the provisions of the Regional Health Act in South Korea, Bucheon City has established and operated three public health centers, one in each of the three districts of Wonmi-gu, Sosa-gu, and Ojeong-gu. - However, in Bucheon, a metropolitan city with an area of 53.4㎢ and a population of more than 800,000, three public health centers are not enough to meet the citizens’ needs for health and medical services in terms of quantity and quality. - To solve this problem, as a first among the local governments in South Korea, Bucheon City reorganized its administrative systems by restructuring the three districts into ten provincial districts on July 4, 2016. - As a result, the health and medical services mainly provided by the three public centers are now expanded to ten administrative welfare centers, allowing them to provide numerous services with high quality. - With the motif of “small health centers at administrative welfare centers,” the health center for 100-year-old has become a citizen-centered health and medical center which is “closer, more convenient, and more in number.” - Besides only one-time services like health checkups and counseling, not only does the health center for 100-year-old refer residents to the local health programs by considering individuals’ health conditions but also plans and provides specialized regional projects that meet the needs of residents. In this way, the center has established itself as a “tailored and continuous health care center” and a “one-stop health and medical service provider.”

- Field of application: Achieving Efficiency of Public Institutions for Sustainable Development - Consistency with the project: Main service contributes to the prevention, early detection, and management of disease. Checkups and dementia and depression tests detect diseases that occur in old age early and refer high-risk groups to examinations, reducing medical costs, promoting national health, and increasing efficiency of public institutions. The hub function of various medical projects is implemented by improving residents’ accessibility. Existing health centers with accessibility problems limit citizens’ participation, but health centers for 100-year-old, closer and more in number, help everyone participate in health projects.

- The health center for 100-year-old not only carries out preventive management of chronic diseases such as blood pressure, blood sugar, and cholesterol, and conducts body composition tests as its main services but also contributes to improving mental health and well-being by entrusting a precision inspection agency to detect and treat diseases early through dementia and depression tests. - This is closely related to the realization of the sustainable development goals’(SDGs) main goal No.3(Ensure healthy lives and promote well-being for all ages) and detailed goal nos.3–4(By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being).

- Citizen centered: For sustainability of chronic disease prevention management, carry out citizen-centered projects that citizens can participate in, such as communicating with citizens about the plan and implementation of service, conducting cause analysis on people who discontinue services, as well as satisfaction surveys. - Leakage prevention: For more citizens to benefit from limited resources, details of services should be managed to prevent duplication and omission of health and welfare services. In addition, the services should be diversified for each target. - Partnership: Not limiting medical services in the public sector and promoting sustainability through public–private partnership(PPP).

- Improving accessibility: In order to overcome the limited use of public medical services at 3district public health centers, the number of health centers for 100-year-old was expanded to 14, situated at 10 administrative welfare centers and community support centers, thereby greatly improving accessibility. - Qualitative adequacy improvement: Quality health and medical services are provided to prevent chronic diseases and metabolic syndrome, including blood pressure and blood sugar management, healthy diet management such as controlling cholesterol, body composition analysis, salinity lending, nutrition counseling, and operation of specialized health programs for each health center for 100-year-old. - Utilization of digital innovation: At the health center, a remote video counseling system is established and operated so that no one is alienated and civil petitioners can consult with doctors anytime, anywhere.

- The survey(2018) shows that the life expectancy of males is 79.7 years, while that of females is 85.7 years. The incidence of dementia differs between men(28.7%) and women(71.3%). - Women have longer life expectancy, but are more exposed to health problems. - Main users of health centers for 100-year-old are old women. High utilization rate of bone density tests for osteoporosis in women after menopause shows that the health center is trying to resolve gender inequality through health care for women. - Health centers for 100-year-old enhance accessibility of public medical services and solve health and gender inequalities.

- The health center for 100-year-old provides equal and fair health management services to every Bucheon citizen. All citizens, including lower-class citizens, seniors, children, and women benefit from them. - Chronic disease prevention management service of the health center is free and provided with the help of the latest medical equipment by professional nursing staff. When registered, a health notebook is issued and a user gets regular checkups and is subject to management. When abnormalities are found after examination, one-stop and non-stop health and medical services are provided, from examination to management, such as linking them with various health care programs and precision inspection institutions in Bucheon. - In addition, in the case of an economically vulnerable class, the health center is linked to support medical costs such as artificial knee joint surgery and eye surgery. Since opening in 2016, a total of 316 people have benefited from artificial joints and eye care.

Plan: A task force team(T/F) was organized in 2010 for health center for 100-year-old. Staff and tasks were confirmed through in-depth meetings of the T/F team, which included domestic and foreign cases and experts. Manuals and public forms were created and distributed. Pre-preparation was completed by conducting briefings and training for staff capacity building(e.g., cardiopulmonary resuscitation), and on-site simulation. Implementation: In 2016, the first year of opening, the center focused on a wide range of services such as management of chronic diseases and metabolic syndrome for various classes in several ways. After that, actual usage status and residents’ needs were reflected, and service items were adjusted for efficient workforce operation. Currently, the center implements a healthy life encouragement project through the management of chronic diseases and metabolic syndrome, senior health care(dementia and depression tests), and so forth. High-risk group link(e.g., High blood pressure and diabetes management center) and integrated care services in local community are implemented. Each health center for 100-year-old plans and operates specialized health programs according to characteristics of health conditions of residents and needs of users. It functions as a hub for various health projects for local groups. Inspection: Through inspection of monthly operation performance of each health center for 100-year-old, the number of users and status of service use are identified. In addition, the cause of poor service use and solutions to the problem are checked. Evaluation: At the beginning, the satisfaction survey was conducted every 30 days, 100 days, and 6 months. Citizens’ responses were immediately recorded. Now, it is conducted twice a year on 1,000 citizens. Continuous efforts to expand: Thanks to citizens’ interests and satisfaction, the project, which started with 10 centers in 2016, was expanded to 12 in 2017 and 14 in 2019. It will be expanded to 16 in 2021.

The center carries out its work as an intensive body of health projects in an administrative welfare center such as a remote video counseling system and smoking cessation service. These efforts, however, led to excessive distribution of the workforce, resulting in less efficiency in civil affairs. Therefore, the work details were adjusted to focus on services related to chronic diseases and to link sectors that require expertise. By commissioning specialized institutions such as centers for high blood pressure, diabetes, and dementia, it was possible to increase the level of expertise in health management and the satisfaction of citizens.

- One-stop, non-stop services: The health center for 100-year-old provides various one-stop and non-stop services, from examinations to management by linking them with health management programs and precision inspection institutions. - Linkage with multiple sectors: The health centers for 100-year-old are in administrative welfare centers, and various health information is shared through computers. - Breaking stereotype: The green signboard and interior design of the health center gives a friendly image. Until now, public medical services held the stigma that only economically vulnerable people use them, but through the new health center, it has become a public medical services institution for all.

- Health center for 100-year-old is a specialized project in Bucheon city. According to the Regional Health Act, South Korea can establish a health center in a city or district. Through administrative reforms, Bucheon city reorganized the existing three “gu” districts into ten “dong” districts, systemizing Bucheon City’s specialized public medical services delivery system. This made it possible to use the health center for 100-year-old anywhere in the 10 administrative welfare centers so that citizens can easily visit and receive consistent services. It also spreads its excellence to other regions and communities.

- Remote video counseling system: In this ubiquitous era, to apply remote medical systems, the health center for a 100-year-old planned remote video consultation before its opening and established the system. In just 100 days after the opening, there were 54 cases of video consultation. - With the consent of sharing personal information from patients, health information from health centers, administrative welfare centers, and relevant institutions is shared through computer systems such as the PHIS(regional health and medical information system). This prevents the loss of information and simplifies referral steps to provide target-centered convenience by immediately linking high-risk groups.

No

- Most local governments provide health and medical services with the standards of setting up one health center in each city or district. This means there are no local governments that systematically serve as a hub of local health care through 14 health centers for 100-year-old in administrative regions such as Bucheon City. - If Bucheon’s systematic and successful operating system is implemented in other local governments or countries, it is expected to solve the accessibility problem, which is the most significant problem in existing Korean health centers. - The utilization rate of preventative health management will increase. In addition, the increase in citizens’ health, life expectancy, and the decrease in costs of national health care will be a great benefit to national finances. Considering the effectiveness of equipment and experts at the health center for 100-year-old, it is a very efficient project and the possibility of spread and implementation is high.

- Financial resources: The initial budget for the health center for 100-year-old is about 250 million won, including expenses for 9 types of medical equipment(e.g., BMI meter, blood pressure, blood sugar meter, cholesterol meter, etc.), interior design, and office management. - Human resources: Staff are 44, including 9 civil officers in charge of nurses, medical technology, and medical care, and 35 time-selective workers. Since the new health center integrates projects from other departments of existing health centers, existing staff could be placed without the need to hire additional staff, which saved 1.2 billion won in labor expenses.

- Financial aspect: Regular equipment management and professional staff training should be conducted to reduce costs and increase efficiency. As mentioned above, existing staff were hired, which saved 1.2 billion won in labor costs. Through system design that minimizes financial expenses and improves citizens’ satisfaction, a sustainable model is built. - Institutional aspect: The role of a health center for 100-year-old is important for the success of the community care system. The health center manages the health of people commissioned by administrative welfare centers or links the users of the health center with required welfare and living support.

Yes

- Internal assessment: A satisfaction survey is conducted every year on users of the health center for 100-year-old. ⇨ More than 95% of citizen satisfaction is found every year. - External assessment: ① 2016.11, “3rd Government 3.0 National Experience Center” is selected as an excellent case of local governments in the medical support service sector; selected as “Top 7 of popular booth.” ② 2017, from ”Government 3.0 Best Practices Contest,” organized by Gyeonggi-do, it won the grand prize for the nation’s first local health organization-health center for 100-year-old.

- Internal assessment: Multiple choice questions and descriptive questions asking about the usage route of the health center, the most useful part among services, the degree to which health care and practices are helpful, sufficiency of explanation, overall satisfaction, and improvements. - External assessment: Evaluation of whether it provides demand-oriented and nation-customized services to the people by realizing the core value of Government 3.0(open-minded, share, communication, and cooperation)

- The contents of the satisfaction survey are the usage route of the health center, the most useful part among services, the degree to which health care and practices are helpful, sufficiency of explanation, and overall satisfaction. The results were maintained at over 95% every year. - The results of the survey are utilized as basic data to decide the promotion of the health center for 100-year-old and the direction of services to focus on. - For example, high preferences for bone densitometry tests, which are difficult to measure due to the lack of medical equipment in other health centers, are shown every year. Cholesterol tests, which are expensive but free at the new health center, are found to be highly satisfactory every year. - These are evaluated as appropriate service items for actively promoting the health center for 100-year-old and differentiating them from other centers’ examination services.

- Main services of health centers for 100-year-old are not only medical treatment but also medical checkups, consultation, and referrals. This enabled the workforce to be expanded to nurses and nutritionists, not just doctors. - Citizens show high satisfaction for the kindness of workers and professional counseling. The local community’s plan to utilize a highly efficient workforce for the prevention management of diseases turned to a successful institutional mechanism. - In addition, Bucheon City was selected as Korea’s first leading local government in community care. To successfully provide community care, it requires specialized delivery systems such as the health center for 100-year-old in Bucheon City. - For community care’s success, health, welfare, nursing, housing, and living support services should be provided as a one-stop service through multi-sector linkages, and the health center for 100-year-old plays this role. - If Bucheon City’s community care successfully develops into a Korean model, most local governments are expected to model the health center for 100-year-old.

- The health center for 100-year-old has established a cooperative system since the beginning with relevant institutions. The high-risk groups that are found in basic health checkups are referred to local hospitals and blood pressure or diabetes centers in Bucheon city. High-risk groups of depression are referred to mental health promotion centers in Bucheon. - In addition, to promote the use of the health center for 100-year-old, a cooperative system with related institutions such as senior centers and associations has been established. The health center manages the health of people commissioned by the administrative welfare center community care team and links the users to required welfare and living support. - Other efforts are made for sustainable development of the project through a close relationship with administrative welfare centers and local health centers by operating a health center for 100-year-old booth during events or local festivals, allowing users of the health center for 100-year-old to participate in health classes at a local health center.

The results of the satisfaction survey in 2019 on 1,500 users of health centers for 100-year-old show that satisfaction with the kindness of workers(42.3%), professional counseling(32%), and accessibility(22.3%) was high. As for the most helpful services, high satisfaction was recorded for chronic diseases prevention management services such as blood pressure tests, blood sugar tests, body composition tests, and bone density tests. In conclusion, through the placement of trained experts, the provision of health management could be implemented for free. This plays a role in prevention and management of chronic diseases. However, the satisfaction with accessibility compared to the kindness of workers is relatively low. Continuous efforts are needed to expand health center for 100-year-old to improve citizens’ satisfaction. The results of the satisfaction survey in 2018 showed that the need for additional health centers was the highest for better operation of the center. Bucheon City has expanded its health center for 100-year-old to 14 when it started with 10 in 2016, and is providing financial and administrative support to build 2 more by 2021. Bucheon will continue to respond to citizens’ requests for health care services through health centers for 100-year-old and make continuous efforts to improve citizens’ health.