Panel proposes maternal registry, mandatory integrated nursing care at non-capital public hospitals

A proposal has been put forward to introduce a maternal registry that would assess and manage prenatal risk levels for all pregnant women.

Separate recommendations call for creating a hospital-wide model for integrated nursing and caregiving services — to be mandated first at public hospitals outside Greater Seoul — and for extending national health insurance coverage for caregiving at long-term care hospitals with strong capacity to treat severely ill patients.

The Medical Innovation Committee, an advisory body under the prime minister, adopted the recommendations Thursday at its 7th meeting in Jung-gu, Seoul, chaired by committee head Jeong Ki-hyeon. The two packages — "Government Recommendations for Improving Care for High-Risk Mothers and Newborns" and "Government Recommendations for Improving Nursing and Caregiving" — were released following the session.

The committee said the burden of high-risk obstetric care is growing as the proportion of older mothers and multiple pregnancies rises, while the medical workforce and the number of delivery facilities continue to shrink. It proposed restructuring the system into a regionally integrated maternal and neonatal care network.

Under the recommendations, prenatal clinics would act as primary physicians, periodically reassessing each patient's risk level throughout pregnancy and logging the results in a shared system.

Delivery hospitals would be designated in advance so that prenatal clinics and delivery facilities can coordinate care before birth. High-risk mothers would be assigned to dedicated maternal-fetal care centers responsible for managing deliveries and emergencies.

To strengthen emergency response, the centers would maintain standby beds at all times, and delivery hospitals would provide 24-hour telephone consultations. When an obstetric emergency arises, the patient's delivery or prenatal clinic would contact a dedicated transfer coordination team at the National Medical Center to arrange rapid transport.

On staffing, the committee said specialized personnel should be concentrated at maternal-fetal care centers to build clinical capacity, and that incentives — including allowances and training opportunities — are needed to draw specialists back from private practice.

It also proposed allowing physicians to work across multiple institutions and expanding rotational on-call arrangements between hospitals.

Over the medium to long term, the committee recommended restructuring residency training to prevent excessive subspecialization and strengthening the roles of physician assistants and midwives.

The committee also called for a comprehensive institutional reimbursement model under which the government takes responsibility for funding medical infrastructure, while imposing public obligations on facilities — such as maintaining emergency standby beds.

To raise fertility rates while reducing high-risk multiple pregnancies, the committee proposed developing clinical standards for single-embryo transfer in infertility treatment and adjusting the current national health insurance support criteria, which are based on the number of treatment cycles.

The committee also recommended creating a hospital-wide model for integrated nursing and caregiving services — currently operated at the ward level — and making it mandatory starting with public hospitals outside Greater Seoul.

Although the integrated nursing and caregiving service pilot has been running for more than a decade, it still caters mainly to patients with mild conditions, and supply remains particularly inadequate outside Greater Seoul.

Other problems cited include wide variation in caregiving quality at long-term care hospitals, the absence of a workforce management and qualification framework, and the financial burden on patients who must hire private caregivers.

In response, the committee proposed setting staffing standards at the hospital level rather than the ward level, giving hospitals the flexibility to deploy ward staff according to patient needs.

It also called for unifying the job title of ward support staff — whose roles currently vary by hospital — under a single "caregiver" designation with clearly defined responsibilities.

Alongside this, the committee proposed classifying long-term care hospitals by their capacity to treat patients and extending national health insurance coverage for caregiving to those with the highest capacity for severe cases.

However, it said a caregiving workforce management framework covering all long-term care hospitals must also be established to ensure patients at facilities not covered by the benefit scheme are not left behind.

On community-based home nursing, the committee recommended consolidating fragmented services — including home nursing and visiting nursing — into a unified home nursing system and expanding its coverage.

It further called for developing a nursing workforce supply plan, improving conditions to encourage nurses to settle in regional areas, and laying the broader groundwork for nursing and caregiving reform.