[Development in the National Hospice Care Service in Korea]

The urgent needs to establish hospice care systems in Korea arise from the following reasons: (1) a drastic increase in chronically ill patients with the increase of aged population: (2) rapid changes in living environment from the traditional habitation (e.g., Many Koreans living in apartment complexes, which is the most popular form of modern residence in recent years, prefer to die in the hospital.): the overall increase in patients with advanced cancer: (4) recent trends in early discharge of terminally ill patients from the limited hospital facilities to accommodate other medical insurance beneficiaries: (5) easy acceptance of euthanasia owing to the recent social atmosphere that belittles the dignity of human life: (6) medical and nursing care of AIDS patient in terminal stage: (7) and the problem associated with inhumane medical care system, overtreatment, and groundless fears against narcotics. Terminally ill patients were used to be treated in the hospital in the past. In these days, however, they are forced to have home cares with little assistance from the qualified medical personnel because of insufficient hospital facilities, which are even short for the need of emergency patients and provide priority cares to medical insurance beneficiaries with other acute problems. And yet, neither are there any administrative organizations nor systematic medical studies that deal with the level of terminally ill patient's need, their family's problems and resources of hospice care systems in Korea. Thus, most patients are not able to get appropriate medical care at the terminal stage of their lives. The objective of this study is to make comprehensive database for various hospice care organization currently in operation, link them through medical information system, and develop an easily accessible hospice care model that meets the need of most Korean people. Our survey results may be summarized as follows: Nationally there are 40 organizations that provide partial or full hospice care. However, these organizations are not linked to any formal medical service network. Furthermore, the objective of hospice care, care principles, personnel with appropriate training, educational programs, standard for care, costs, consulting service to patients' family members, the extent of medical care from professional staff members, status of hospice facility, and management of those institutions are neither clearly defined nor organized compared to the international hospice care standards. The surveys on patients of terminal stage, grouped in hospice and non-hospice care patients, reveal what they want visiting nursing care to help their pain control, psychological, social and spiritual demands. While the more than 90% of hospice care patients want to reduce their pains, the non-hospice care patients, in addition to their desire for pain control, demanded more psychological, social and spiritual helps as well. The results of this research could be utilized to (1) define the standard of hospice care, (2) provide the guidance for hospice medical care costs, (3) establish the database of hospice care systems, (4) develop softwares, (5) build communication network through Medinet, and (6) provide an organized visiting home nursing care system. These information should be a valuable resource to many medical staffs who are involved in cancer therapy, nursing care, and social welfare programs.