제1차 심뇌혈관질환관리 종합계획

Objectives

The First Comprehensive Plan for Cardiovascular and Cerebrovascular Disease Management covers 2018–2022 and is the first statutory plan under the Prevention and Management of Cardiovascular and Cerebrovascular Diseases Act. It aims to reduce disease incidence, mortality and socioeconomic burden; improve survival and quality of life after acute events; narrow regional disparities; and respond to the growing needs associated with ageing, recurrent disease and disability.[1][2][3][4][5]

• Improve public awareness of cardiovascular and cerebrovascular risk factors, healthy living, and the symptoms and urgent response required for acute myocardial infarction and stroke.[6][7][8][9]
• Strengthen identification and management of high-risk groups and precursor conditions, particularly hypertension and diabetes, through prevention, self-management and primary care.[1][6][10][11]
• Enhance community emergency response, specialist treatment capacity, referral systems and equitable access to care across regions.[1][5][6][12]
• Establish continuous patient management spanning acute treatment, early rehabilitation, post-discharge follow-up, long-term rehabilitation and reintegration into community life.[1][6][13][14][15]
• Strengthen legal, organisational, statistical, research and workforce foundations for disease management.[1][16][17][18][19]

Quantified targets include increasing recognition of acute myocardial infarction symptoms from 45.5% to 55% and stroke symptoms from 51.2% to 61% by 2022; improving hypertension control from 46.2% to 50.0% and diabetes control from 26.6% to 35.0%; reducing 30-day fatality for acute myocardial infarction from 8.1% to 7.5% and for haemorrhagic stroke from 7.5% to 6.6%; and expanding early rehabilitation to at least 50% of acute myocardial infarction patients and 80% of stroke patients.[20]

Priority action also includes producing nationally approved statistics, addressing current gaps in representative incidence, prevalence, pre-hospital, post-acute and long-term outcome data.[21][3][20]

Implementation

The plan adopts an integrated safety-net model that links central coordination, regional cardiovascular and cerebrovascular disease centres, local primary centres, public health centres, primary-care clinics, hospitals, emergency services and community resources. It combines nationwide prevention with local delivery, specialist acute care, rehabilitation, post-discharge support, patient registration and evidence generation.[22][23][12][14][24]

• Coordinate policy through a Central Cardiovascular and Cerebrovascular Disease Centre acting as a national control tower for policy support, evaluation, patient registration and management, foundational data, and national statistics.[25][23]
• Require metropolitan and provincial governments to prepare annual locally tailored action plans and incorporate them into regional health and medical plans.[2]
• Engage the Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention, professional societies, researchers, regional centres and external experts through subcommittees, consultations, hearings, workshops and forums.[26]
• Deliver prevention through public communications, Cardiovascular and Cerebrovascular Disease Prevention and Management Week, the Red Circle campaign, school and workplace education, public health centres, and an integrated information portal.[7][8][9][27]
• Provide chronic-disease services through collaboration between public health centres and local clinics, including screening, monitoring, counselling, medication and appointment support, lifestyle assistance and navigation to community resources.[11][28]
• Operate regional centres with 24-hour specialist teams, emergency transfer and referral arrangements, rapid stroke treatment, early rehabilitation links, clinical pathways, and support to local hospitals and clinics.[29][12]
• Develop post-discharge services offering self-management and provider information, telephone and online counselling, rehabilitation referral, links to medical and community services, and stroke advice connected to regional centres.[13][14][15]
• Standardise rehabilitation through surveys of practice, clinical guidance, protocols, workforce training and referral pathways covering early, subacute and chronic rehabilitation.[14][15]
• Develop high-risk screening tools and management guidance using epidemiological research, clinical research, economic evaluation and national health-screening data.[10]
• Build national statistical and registration systems by expanding regional-centre data, following mortality, incidence, rehabilitation and long-term outcomes, and publishing a national statistical yearbook.[17][24]
• Implement a five-year research and development plan, supported by a research advisory group, roadmap, performance-management arrangements and shared research resources.[18][30]
• Assess workforce requirements, establish consultation with professional societies, and strengthen competencies among specialists, intensive-care physicians, nurses, therapists and provincial-hospital doctors.[19]

Monitoring will track symptom recognition, hypertension and diabetes control, acute-event fatality, early rehabilitation, regional disparities and production of national statistics. Annual Community Health Survey measurement of symptom awareness and response capability is undertaken by the Korea Centers for Disease Control and Prevention from 2017 onwards.[20][9]

The plan assigns the central centre a technical-support and policy-evaluation role and calls for monitoring systems, registration, surveys and research-performance management; however, a consolidated reporting cycle, formal public accountability framework and independent evaluation body are not specified.[11][23][14][18]

No overall programme budget or financing gap is specified. National Health Insurance reimbursement supports some community-management pilots, while research and development funding is identified as relatively limited; the 2016 budget for cardiovascular risk-factor identification and the related hub field was 1.98 billion Korean won.[29][3]

Monitoring & Evaluation

Monitoring and evaluation centre on developing nationally representative cardiovascular and cerebrovascular disease statistics, strengthening patient registration and follow-up, and tracking prevention, emergency care, rehabilitation and regional equity. Existing data are constrained by fragmented coverage and the limited national representativeness of registration data from regional centres.[3][17][24]

• Revise performance indicators and detailed tasks through expert consultation, stakeholder feedback, public hearings, workshops and forums undertaken during plan development.[26]
• Monitor public-awareness campaigns for changes in healthy-living behaviour as well as awareness, and measure symptom recognition and response capability annually through the Community Health Survey from 2017 onwards.[7][8][9]
• Track stated national targets for symptom recognition, hypertension and diabetes control, 30-day fatality following acute myocardial infarction and haemorrhagic stroke, early rehabilitation, and production of approved national statistics.[20]
• Monitor regional inequalities in cardiovascular and cerebrovascular mortality, cardiac-arrest survival, availability of percutaneous coronary intervention, and emergency-department arrival times.[5]
• Develop community high-risk-group monitoring systems, supported by defined target groups, allocated responsibilities for medical institutions and public health centres, operational guidance, health-screening data and risk-identification algorithms.[10][11]
• Use epidemiological, clinical and economic evidence to develop high-risk-group recommendations and assess regional centre operations and the policy-control role of the central centre.[10][25]
• Assign the proposed Central Cardiovascular and Cerebrovascular Disease Centre responsibility for technical support and evaluation of policies and programmes, patient registration and management, foundational data, and national statistics.[25][23]
• Survey early rehabilitation for acute myocardial infarction and stroke from 2019, including treatment timing, duration, intervals, criteria and content, and assess post-acute rehabilitation use and referral pathways.[14][15]
• Expand registration and follow-up data to cover mortality, incidence, recurrence, rehabilitation and long-term outcomes, including cooperation between regional centres and large local hospitals to secure follow-up information.[24]
• Define epidemiological and policy-performance indicators, establish methods for approved national statistics, expand data collection, and publish a national statistical yearbook.[17][24]
• Establish research-performance management and shared research-resource systems from 2020 onwards, while assessing professional workforce needs and strengthening capacity.[6][13][18]

Reported progress includes improved risk-factor and acute-care performance: hypertension awareness increased from 23.5% in 1998 to 67.3% in 2015 and treatment from 20.4% to 63.6%; diabetes awareness increased from 44.2% to 70.5% and treatment from 29.8% to 63.3%.[29]Male current smoking declined from 66.3% in 1998 to 40.7% in 2016, while bystander cardiopulmonary resuscitation increased from 1.9% in 2008 to 16.8% in 2016.[31]In regional centres, arrival-to-intervention time for acute myocardial infarction declined from 69.3 minutes in 2008 to 53.3 minutes in 2017, and arrival-to-medicine time for cerebral infarction declined from 65.6 to 28.8 minutes.[16]

Important remaining performance gaps include early arrival in 2016 of 36.6% for acute myocardial infarction and 42.9% for stroke, and early-rehabilitation rates in 2017 of 40.0% and 75.4% respectively.[32]The plan identifies insufficient incidence and prevalence statistics, weak pre-hospital and post-acute outcome information, and fragmented information provision as evidence gaps.[21][32]Formal reporting cycles, public accountability arrangements, independent evaluation, named monitoring bodies and a consolidated accountability framework are not specified.[3][5][23][17]

Costing & Financing

Cardiovascular and cerebrovascular disease creates a substantial economic burden, but the supplied material does not provide a consolidated budget or financing plan for implementing the national plan. In 2016, medical expenditure for cardiovascular and cerebrovascular disease was approximately 9.6 trillion Korean won.[33]The wider socioeconomic cost reached 19.6 trillion Korean won in 2015, following an average annual increase of 6.5% between 2006 and 2015.[33]

• Record medical expenditure of 8.8 trillion Korean won in 2015 and 9.6 trillion Korean won in 2016, an annual increase of 9.1%.[33]
• Recognise that socioeconomic costs include direct medical, transport and care costs and indirect losses of future income and productivity.[33]
• Identify essential hypertension, cerebral infarction, type 2 diabetes and angina among the highest-cost diseases in 2016, with essential hypertension ranking second among the ten highest-cost diseases.[4]
• Note that investment in cardiovascular and cerebrovascular research and development was assessed as low relative to disease importance and effects on health and medical expenditure.[3]
• Allocate 1.98 billion Korean won in 2016 for research on cardiovascular disease risk factors and the related hub field.[3]
• Use National Health Insurance reimbursement to support pilot community chronic-disease-management models, and provide medical-cost support for registered hypertension and diabetes patients aged 65 years or over without a stated amount.[31][29]
• Consider government budget support or National Health Insurance reimbursement rates to compensate appropriately for complex treatment and rehabilitation, support safety-net and centre cooperation, and reduce patients’ medical costs.[34]
• Link early-stage research to existing government research and development and grant-funded programmes, while seeking a separate budget for later implementation research.[30]

No overall programme budget, activity-level costings, funding allocations, resource-mobilisation targets, quantified funding gap or economic assumptions are specified for prevention campaigns, high-risk management, centre development, rehabilitation, statistics, workforce measures or the information portal.[6][10][23][17][19]The stated separate implementation-research budget is presented in units of 100 million Korean won, without a basis for converting it into Korean won.[30]