Institutional Fragmentation and Care Access Disparities in the Korean Long-Term Care System

South Korea’s long-term care (LTC) system has expanded rapidly in both expenditure and coverage over the past two decades, but this growth has not translated into equitable access to care. This chapter examines disparities in care access in the Korean LTC system through four dimensions—availability, accessibility, appropriateness, and affordability—with particular attention to the system’s strong reliance on institutional, especially hospital-based, care. Drawing on academic literature, official documents, and statistical data, the chapter argues that institutional fragmentation between long-term care insurance, long-term care hospitals, and local authority services has produced persistent mismatches between older people’s needs and the services they receive. Private-sector-led expansion has increased the overall supply of services, but it has also reinforced rural—urban disparities, limited the diversity of community-based care, and encouraged provider behavior shaped by profitability rather than need. Weak gatekeeping for long-term care hospital admission and insufficient local coordination further undermine appropriate care, while high out-of-pocket payments for social care in hospitals create substantial financial burdens for older adults and their families. The chapter concludes that meaningful reform requires stronger integration between health and social care, clearer institutional roles, expanded community-based services, and improved public steering to ensure more equitable access for older people in South Korea.