Structural alignment of Korea’s Integrated Care Support Act with the World Health Organization’s Integrated Care for Older People framework, including Singapore case: a narrative review

Background

As global population aging accelerates, existing fragmented medical and care systems are increasingly unable to respond effectively to the complex and interdependent needs of older adults. Recognizing these limitations, the World Health Organization (WHO) proposed Integrated Care for Older People (ICOPE), a community-based integrated care model designed to maintain and promote the intrinsic capacity of older adults, as a key policy alternative [1]. Grounded in its policy structure and implementation model, ICOPE has been adopted in several countries, including France, China, and Singapore, where it serves as a central strategy for improving older adults’ health and ensuring the sustainability of healthcare financing [2–6].

In 2018, Korea introduced the Community Care Basic Plan under the Ministry of Health and Welfare and launched community care pilot projects. Various service models were developed by local governments, and integrated health, welfare, and housing services were piloted for older adults, people with disabilities, and those with mental illnesses. However, the results of these pilots highlighted the need to secure an appropriate workforce in both the public and private sectors, as well as the need to strengthen professional expertise through continuous training. In addition, establishing an information and communications technology-based information system to support multi-professional collaboration was emphasized as a critical requirement [7,8]. More specifically, the lack of an institutional foundation, such as dedicated coordinating bodies and information-sharing systems, hindered effective service linkage across agencies. The unclear delineation of functions and roles within the pilot project’s promotion system was also identified as a key limitation [8].

To overcome these shortcomings and strengthen the institutional basis for integrated care, the Act on Integrated Support for Community Care, Including Medical and Nursing Care (hereinafter the Integrated Care Support Act) was enacted in 2024 [9]. Although the act outwardly mirrors the WHO ICOPE framework—addressing elements such as regional plans, integrated support councils, and information system development—legislation alone cannot ensure effective implementation. A robust operational foundation and a carefully managed transition to the implementation phase are necessary. In particular, while the WHO’s “Ready–Set–Go” phases indicate that Korea has reached the “Ready” phase through enactment of the law, the conditions for achieving the “Set” (operational foundation design) and “Go” (field implementation) phases now require systematic assessment [10].

WHO reports characterize Singapore as having a well-established governance structure encompassing Ministry of Health (MOH), Agency for Integrated Care (AIC), and Geriatric Education and Research Institute (GERI), and highlight its integration of medical and social care services as well as its adoption of digital ICOPE screening tools. These descriptions support the use of Singapore as a relevant comparative case for evaluating Korea’s readiness.

Objectives

Therefore, this study aims to systematically examine the structural consistency of Korea’s Integrated Care Support Act enacted in 2024 and its subordinate legislation using the WHO ICOPE framework. Based on the analytical results, it seeks to inform the successful establishment of the Korean integrated care model by identifying policy design elements that should be strengthened during the implementation process. Consistent with this objective, the study focuses exclusively on Korea’s legal and institutional alignment with the WHO ICOPE Ready phase. Because the nationwide system has not yet entered implementation, performance or outcome evaluations related to the Set (operational design) and Go (field implementation) phases were not available and were therefore excluded from this analysis.

Theoretical framework

Analytical methods

We adopted WHO’s ICOPE implementation framework as the central analytical lens, using the 19 service-level action items and 4 system-level enablers as assessment criteria. Each ICOPE item was mapped to the relevant provisions of the Integrated Care Support Act and its subordinate legislation to evaluate legal and institutional consistency.

Prior to the analysis, classification criteria were predefined to ensure consistency and reproducibility. Results were categorized as: (1) Direct reflection (✓): a legal provision explicitly stipulating operational procedures or responsibilities aligned with the WHO-defined action item; (2) Indirect reflection (△): a provision delegating or implying responsibilities without specifying operational standards, including borderline cases requiring further administrative interpretation; and (3) Absence (✗): no corresponding legal basis identified.

These predefined criteria were applied throughout the mapping process, and all coding decisions underwent iterative review to ensure internal consistency.

For the system-level enablers, Singapore was selected as the benchmarking country because WHO’s Ready phase report identifies it as having a well-established governance structure and early development of integrated medical–social care pathways. Accordingly, institutional arrangements in Singapore were compared to derive implications for Korea’s policy design (Table 1) [1,10].

Table 1.

Classification for World Health Organization’s Integrated Care for Older People 19 action items and 4 policy strategies (Ready phase)

Analysis results by 19 practical items

Table 2 maps the 19 ICOPE action items to the Act and its subordinate legislation. Among the 19 items, 7 were explicitly reflected (✓), 9 were indirectly reflected (△), and 3 were not reflected (✗) [9].

Table 2.

Comparison of the Korean Act according to World Health Organization’s Integrated Care for Older People 19 practical action items

Items classified as explicit (✓) include legal provisions and procedures that clearly articulate required actions—for example, proactive case finding (Act Art. 10), comprehensive needs assessment (Act Art. 12; Enforcement Decree Art. 5), individualized plans (Act Art. 13; Rules Art. 13), and integrated information systems (Act Art. 22). These provisions indicate that many core processes are now legally institutionalized.

Numerous operational elements, however, were only indirectly reflected (△). For instance, the multidisciplinary team approach (Rules Art. 12), personnel training (Act Art. 24), and finance and incentives (Act Art. 28) articulate guiding principles or delegate specifics, but they do not establish concrete standards. This pattern underscores the need for further operationalization. Some items (self-management support, human resources processes, and regular equity checks) had no identifiable legal basis (✗), highlighting gaps in the user-centered and qualitative dimensions emphasized by ICOPE.

Conclusion: The Act represents a major step toward legalizing the core framework of integrated care, yet follow-up implementation plans and detailed guidelines are essential for translating statutory language into routine field operations.

Analysis by 4 major policy implementation elements: comparison with Singapore

Table 3 compares the institutional alignment of Korea and Singapore across the 4 system-level enablers, revealing clear differences in approach [12–15].

Table 3.

Coherence of integrated care policies in Korea and Singapore: a comparison based on the WHO ICOPE framework

Singapore advances ICOPE through strong policy alignment with White Paper on Healthier SG (hereinafter the Healthier SG) and Age Well SG rather than through new standalone legislation. Regional Health Systems clusters and Geriatric Service Hubs (GSH) operationalize ICOPE elements; Individual Care Plans are continuously updated based on functional change; the National Electronic Health Record standardizes data linkage across providers; and multidisciplinary personnel roles and training requirements are clearly specified. Collectively, these features illustrate a strategy-led, top-down model that minimizes the gap between policy design and everyday practice.

Korea, in contrast, has pursued a bottom-up legal strategy through enactment of the new Act, thereby establishing a legal basis for individualized care plans and governance structures (e.g., integrated support councils). However, operational specificity remains limited. Roles and qualifications for multidisciplinary teams, referral and transfer pathways, meeting frequency, and decision-making procedures are described only in principle. Moreover, although an information-system foundation exists, standard operating procedures for workforce use remain insufficient, weakening the linkage between system structures and personnel.

In sum, Singapore began by establishing national strategies and aligning existing programs, thereby clarifying organizational roles. Korea has created the legal base but must now develop concrete operational components to initiate full implementation.

Key results

Korea's Integrated Care Support Act aligns with the WHO ICOPE framework's Ready phase by establishing the legal foundations for case finding and care planning. However, it lacks operational mechanisms for the Set phase, such as multidisciplinary workforce standards, performance-based incentives, and function-oriented data systems. A comparison with Singapore emphasizes Korea's governance gap: unlike Singapore's Agency for Integrated Care (AIC), Korea lacks a national coordinating authority.

Interpretation/comparison with previous researches

The above findings indicate substantial progress in establishing an institutional architecture corresponding to WHO’s Ready phase. However, several key implementation elements remain underdeveloped. Although procedural requirements are stipulated, legislative provisions alone will not ensure actual delivery. Many operationally essential items are only indirectly reflected, meaning they state principles without detailed standards, and some core ICOPE values (e.g., self-management support) are not addressed at all. These gaps point to deficiencies in the workforce, information infrastructure, and governance arrangements needed for transition to the Set phase.

Comparison with Singapore, a front-runner in integrated care (Suppl. 1), further clarifies these gaps. Rather than creating a new law, Singapore adopted a strategy-centric approach that aligns national initiatives, including the National Frailty Strategy Policy Report, with existing organizational platforms. ICOPE screening is embedded within Communities of Care and Regional Health Systems [16]. The AIC and GERI coordinate standardized multidisciplinary teams at the community-cluster level to deliver the full care pathway—from functional assessment (clinical frailty scale, ICOPE screening tool) to Personalized Care Planning and continuous follow-up—supported by the HealthHub national information platform, which enables dynamic adjustment to functional change. Evidence from Singapore and other countries associates this approach with reduced functional decline, lower rehospitalization, and more efficient resource use [10,16]. Recent international research also reports significant effects of ICOPE-based interventions on functional trajectories [17].

In sum, Korea has secured a legal starting point through a law-centered strategy, whereas Singapore has progressed to the Set phase through a strategy-led system linkage model with mature operational structures. Korea’s primary gap is governance, especially the absence of a national control tower capable of coordinating fragmented programs and supporting frontline practice, in contrast to Singapore’s AIC (implementation) and GERI (education and research). Establishing such governance, together with concrete standards for workforce, financing, and information systems, is essential for converting the legal framework into routine integrated care [3].

Policy recommendations

Based on the analysis, we propose 4 directions for establishing Korea’s integrated care model.

First, the establishment of a National Integrated Care Implementation Support Agency (AIC-like) under the Ministry of Health and Welfare would provide a more coherent alternative to the current Integrated Support Council and fragmented roles. As a national control tower, such an agency could (1) issue and disseminate standard implementation protocols so that individual support plans become operational, including standardized screening, assessment, linkage, and readjustment processes and the systematization of existing guidelines and directives (cf. Singapore’s frailty strategy; including the Korean WHO ICOPE translation [18]); (2) assume responsibility for competency models and certification for multidisciplinary teams, quality management of care plans, and payment innovation; and (3) coordinate regional delivery systems (e.g., GSH) while strengthening frontline partners [19].

Second, greater specification of multi-professional standards and training would enhance implementation capacity. Within the scope of Article 24 delegations, roles, qualifications, and team-based collaboration models for physicians, nurses, social workers, and rehabilitation therapists could be articulated through Ministry of Health and Welfare Notices. Specialized education and research institutions—analogous to GERI—could serve as designated platforms for standardized curricula and workforce upskilling. Flexible, hub-based teams (GSH) and community resources (e.g., volunteers) may also be incorporated to meet field needs without requiring statutory amendment.

Third, advancement of the function-based information system would further align Korea’s model with ICOPE principles. A standardized ICOPE-domain assessment dataset could be defined and incorporated into the Article 22 platform, with longitudinal tracking and shared access across medical, long-term care, and welfare sectors. Such enhancements would support dynamic and function-responsive case management rather than the current emphasis on administrative processing.

Fourth, performance-based financing mechanisms require further operational development. Although Article 28 establishes a foundational principle, specific mechanisms remain limited. Near-term add-on payments for functional assessments and multidisciplinary meetings within fee-for-service could serve as an initial step, accompanied by a phased roadmap—aligned with health and long-term care insurance—toward P4P or bundled payments linked to functional outcomes. These financing reforms, long discussed in Korea, could play a central role in translating the Act into routine practice.

Limitations and significance of the study

This study relied on pre-implementation text analysis; thus, it did not address the actual enforcement process or outcomes and does not incorporate subordinate administrative rules that had not yet been promulgated at the time of analysis. Care is also warranted when interpreting Singapore’s experience in relation to the Korean context, given differences in institutional settings. In addition, alignment ratings between legal provisions and ICOPE items (explicit/indirect/not reflected) were conducted by a single researcher, meaning that some degree of subjective interpretation cannot be fully excluded. Future research may strengthen objectivity and reliability through expert Delphi surveys and cross-validation by multiple analysts.

Despite these limitations, this study constitutes the first effort in Korea to evaluate a new law using an international standard (ICOPE), thereby offering an important academic foundation and comparative benchmark for future assessments of policy effectiveness. As Korea progresses beyond the Ready phase toward effective Set and Go phases, periodic review and reinforcement of alignment between the Act and ICOPE will be important, with iterative refinement of governance, workforce, financing, and information-system components as implementation advances.

Conclusion

This study has pioneering significance as the first attempt to systematically assess the ‘Integrated Community Care Support Act,’ scheduled for implementation in 2026, using the international standard of WHO ICOPE. The analysis shows that Korea’s integrated care system is currently in the Ready phase, with a foundational legal framework in place, and that designing concrete implementation structures aligned with the Set phase is an urgent priority for establishing a practical, function-centered care system.

Importantly, this study is limited to examining Korea’s legal and institutional readiness corresponding to the WHO ICOPE Ready phase. Because the system has not yet been implemented, evaluations related to the Set (operational design) and Go (field implementation) phases were not included.