Health care strategy for ensuring work ability in an aging Korea

The current health care system for employees in South Korea

The government’s comprehensive plan, ‘The Second Plan for Aging Society and Population (2011-2015)’, lacked life-cycle-specific health care measures (i.e. measures for young and middle-aged workers) in the ‘proactive health care system’ section [7]. It also placed the public health center for the community population at the center of most activities, including improvements in health screening and follow-up systems, establishment of a community-based integrated health care system, institutionalization of health care services, and introduction of chronic degenerative diseases management programs. Even though the Framework Act on Health and Medical Services Article 36 (Occupational Health Care) states that the government should take measures to protect and promote employees’ health [8], almost none of these activities have been carried out for the employees, the most important target for management of chronic degenerative diseases.

Based on the current Occupational Safety and Health Act, workers' medical examinations are to be carried out regularly in all workplaces, regardless of business size. However, workplaces with fewer than 50 workers do not have professional personnel to perform follow-up measures after medical examinations, and this is a significant problem in the current workers’ health care policy. In addition, workplaces with fewer than 2000 workers (or fewer than 3000 or 5000 workers in some sectors) are not required to appoint a doctor or nurse according to the Occupational Safety and Health Act [9]. Thus, a number of workplaces rely on external expertise for workers’ health care services, such as follow-up measures of periodic medical examinations. Follow-up measures for general medical examinations tend to be neglected compared to occupational medical examinations, although employers are required to perform these follow-ups. In addition, workplaces and external professional organizations for occupational health programs lack specialized personnel, facilities, and equipment for health promotion and health promotion programs. Thus, establishment of a linkage with health promotion resources in the community is urgently needed.

Benchmark: strategies to promote work ability in aging Japan

Japan has guidelines on cooperation between community health and occupational health activities for workers’ health promotion at the level of the local community, and has performed cooperative activities since 2005 [10]. The implications of these policies and guidelines is as follows. First, the law should have a provision for harmonization and collaboration of existing health services that were previously carried out independently in different department of one ministry. Second, it is necessary to have common recognition of the collaborative activities. Each agency holds the value of the existing independent business, so it is necessary to share the recognition of the need and significance of collaborative activities for the community’s health problems through the exchange of information between institutions regarding health information and services. Third, it is important to establish guidelines for collaborative activities so there is a clear and mutual understanding and a systematic project plan based on the consensus. Lastly, it is crucial to establish a local council to promote these collaborative activities.

Recommendation for policy

We described in detail a process leading to a recommendation for promoting work ability in an aging society in a Table, which shows a logic for solution containing current status and problem identification, counter-measures for the problem, obstacles, and solution (Table 1).

Table 1

Process leading to a recommendation for promoting work ability in an aging society

The policy for promotion of work ability in a low-birth rate and aging society must be included in the 4^th Five-Year Plan for Industrial Accident Prevention (2015–2019) [11]. The principle to implement this policy is as follows: First, prevention programs should be tailored to the age of the workers (adolescence, middle age, seniors, etc.). Second, there should be prevention programs through collaboration among the relevant ministries (Ministry of Employment and Labor/Ministry of Health and Welfare/Ministry of Culture, Sports and Tourism, etc.). Third, prevention programs should be linked to community resources. The management of chronic degenerative diseases, using follow-up measure in general medical examinations, should be placed at the center of these principles.

The principles and strategies to promote work ability through the collaboration of relevant agencies at the central and local level is as follows. A common goal–the reinforcement of follow-up measures of general medical examinations and the promotion of healthy lifestyles for workers–must be set up by signing a memorandum of understanding between the Ministry of Employment and Labor and the Department of Health and Welfare. In addition, the Ministry of Employment and Labor should inform all employers of the significance of follow-up measures of general medical examinations. Once this basic governmental policy is announced, workers’ health promotion activities by employers will gain momentum, conditions for collaboration will be established, and an environment for collaboration will be created that naturally leads to collaboration.

In order to promote cooperation between community health and occupational health activities for health promotion in workers in Korea, several points should be addressed (Fig. 1). First, workers’ health information should be shared between the National Health Insurance Corporation and the Korea Occupational Safety and Health Agency. Second, a standard code should be presented to share data by linking the websites that each agency operates to provide integrated information. Third, when setting up the cooperation, the target institutions should be the Korea Occupational Safety and Health Agency, the National Health Insurance Corporation, and the local government at the administrative agency level. The active organizations should be the Worker’s Health Center, the Health Promotion Center, and the community health centers, respectively, at the local activity level. Finally, there should be a steering team to promote employees’ work ability in the Ministry of Employment and Labor. Under the leadership of the Ministry of Employment and Labor, it will play the role of a “control tower” to promote collaboration, and form a group consisting of about 10 individuals below the vice Minister who operate together. This should include all institutions participating in the collaboration, and should hold periodical conferences to monitor the process and results.

Fig. 1

Reinforcement of workplace health promotion activities through the collaboration of central and local agencies in Korea