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Analysis Area: Busan Metropolitan City

Core Area: 16 districts and counties in Busan, including Yeongdo-gu and Busanjin-gu

Agenda: Alignment between the growth rate of the elderly population and integrated operational capabilities for medical, nursing, and care services

Golden Time Type: Critical Demand Growth + Fragmented Care Risk

Reference Date: 2026.08.28

Version: Regional AX Golden Time Intelligence v3.2 Enhancement Standard
 

In 2025, the proportion of the population aged 65 and over in Busan was 24.5%, 4.2 percentage points higher than the national average of 20.3%, and the elderly population based on resident registration in April 2025 was 794,050, accounting for 24.4% of the total population. Busan's demographic structure has shifted from a stage of responding to an aging society to a structure of constant demand for medical and care services, where one in four citizens is elderly. However, a public runtime linking the number of the elderly population with actual demand for chronic diseases, frailty, long-term care, hospitalization, discharge, and home care at the individual and community level has not been confirmed. If the elderly population and the late-aging population increase simultaneously between 2026 and 2028, a structure will become entrenched where increased demand is identified only after shortages of facilities and personnel have occurred. Although  Busan has completed its entry into a super-aged society, it is judged to be a city where the completion of a demand-forecast-based medical and care operational system has not been confirmed.

Nationwide, per capita medical expenses for those aged 65 and older were 5,306,000 won and out-of-pocket expenses were 1,252,000 won in 2023, while Busan's proportion of the elderly population was projected to be the highest among metropolitan cities in 2025. Population aging has shifted from an increase in welfare recipients to urban operational risks involving overlapping issues such as multiple diseases, repeated hospitalizations, long-term care, and family care. However, there is no publicly available evidence linking the diseases, hospitalizations, emergency services, long-term care grades, home care services, and housing conditions of Busan's elderly along a single timeline. If medical and care costs increase over the next two to three years due to separate accounting and systems, it will be difficult to simultaneously identify overlapping services and care gaps.  Busan's burden is assessed to be structured such that demand accumulates while medical and care services remain separated, rather than being driven by the total volume of the elderly population.

On March 27, 2026, the "Act on Integrated Support for Community Care, Including Medical and Long-term Care" came into effect, and Busan fully launched its Busan-style integrated care system with dedicated organizations in 16 districts and counties. The unit of service provision for medical care, long-term care, housing, and health management shifted from individual services to integrated community support. However, publicly available outcomes tracking the entire process—from application to integrated assessment, service combination, re-hospitalization, facility admission, and recovery to daily life—based on the same individual have not yet been verified. If performance metrics during the initial implementation period of 2026–2028 become fixed around the number of applicants and referrals, actual changes in health and independent living will remain outside the scope of measurement.  It is determined that while Busan's integrated care system has reached the implementation stage, it has not yet reached the outcome verification stage.

Busan City projected that the proportion of the elderly population would reach 30.1% by 2030. The speed at which the aging rate shifts from the 23% range in 2024 to the 30% range by 2030 indicates a direction in which the demand for medical and care services will structurally expand within six years. However, public forecasts combining the supply of care personnel with the late-stage elderly, those living alone, those with chronic diseases, housing insecurity, and time to access medical care by district and county have not been confirmed. The period from 2026 to 2028 is the final early stage where the intersection point of the demand and supply curves can be identified in advance.  Currently, the "Golden Time" is not the point to expand projects responding to the aging population, but rather the point to determine where unmanageable demand will first arise.

Golden Time Thesis — The medical and care risks in Busan lie not in the fact that the elderly population is large, but in the fact that the era of 30% elderly population will arrive in 2030 with a person's illness, hospitalization, discharge, nursing care, and home life separated into records of different institutions.

In 2024, Busan’s population was 3,329,888, the elderly population was 783,663, and the aging rate was 23.53%; by April 2025, the elderly population had increased to 794,050. As a decrease in the total population and an increase in the elderly population occurred simultaneously, a structure was formed in which both the absolute volume and density of demand for medical and care services relative to the population rose together. However, it is not disclosed in the same time series whether the increase in the elderly population consists of healthy individuals aged 65 to 74 or those aged 75 or older who are at high risk of multiple diseases and frailty. If the increase in the late-stage elderly population between 2026 and 2028 is obscured by the total elderly population statistics, the actual speed of demand growth will be confirmed belatedly.  Busan’s scale risk is assessed as a dual structure in which the aging rate rises and the total population decreases simultaneously.

According to Busan City's projections, the proportion of the elderly population will rise from the 23% range in 2024 to 30.1% in 2030. This represents a structural shift where the demand for medical, nursing, and care services increases, while the working-age population supporting each elderly person decreases. However, no publicly available data has been found comparing the projections of the elderly population by district with the supply projections for care workers, visiting medical services, and home care benefits using the same base year. If workforce attrition and increased demand intersect within two to three years, service waiting lists and the burden of family care will expand simultaneously.  It is assessed that Busan's capacity is structured to be determined by the difference between the rate of demand growth and the rate of supply decline, rather than the total capacity of facilities.

Nationwide per capita medical expenditure for those aged 65 and older was 5,306,000 won in 2023, and the proportion of the elderly population in Busan in 2025 was 4.2 percentage points higher than the national average. While the national average medical expenditure cannot be directly applied to Busan's aging population, it is confirmed that a high proportion of the elderly population is amplifying pressure on healthcare finances. The latest regional baseline combining per capita medical expenditure, recurring hospitalizations, emergency room use, and long-term care expenditures for the elderly in Busan is not available in publicly available evidence. If the regional cost structure remains isolated from 2026 to 2028, it is difficult to determine whether the increase in medical costs is a result of prevention failures or increased life expectancy.  Currently, while the direction of medical cost risks in Busan is confirmed, the decomposition of causes by region is deemed incomplete.

Busan-style integrated care was fully implemented with a structure that links medical, nursing, housing, health management, and daily support services across 16 districts and counties. The service delivery system has shifted from applications by individual project to integrated assessment and linked support. However, data disclosed on the same district or county regarding the number of beneficiaries, service combinations, waiting periods, service providers, and reductions in readmissions and facility admissions is still limited. If only the number of linked cases accumulates over the two to three years following implementation, it cannot be determined whether the total supply in Busan is meeting actual demand.  The system's scope of application covers the entire region, yet its actual capacity is assessed as unmeasured.

In Busan, university hospitals, general hospitals, nursing hospitals, long-term care facilities, public health centers, welfare centers, and home care service agencies are all in operation. While the number of medical and care providers exists, the continuous ecosystem where changes in an elderly person's condition lead to movement between institutions is a separate issue. There is no confirmed public disclosure system linking hospital discharge information, long-term care eligibility, case management at the Eup, Myeon, and Dong levels, and home care service provision records based on the same individual patient. If the increase in demand projected for 2026–2028 is recorded solely as performance data by individual institutions, care gaps may not be reduced even with an abundance of services.  Busan lacks the evidence to determine that the concentration of providers aligns with a continuous care ecosystem.

In 2022, Busan promoted the demonstration of smart care services and the development of an integrated dashboard in Seo-gu, Dong-gu, Yeongdo-gu, and Busanjin-gu. Responses utilizing sensor, health, and care data shifted from simple visiting services to risk signal-based management. However, the publicly available data does not confirm how actual readmissions, emergency transports, facility admissions, and care hours changed after the demonstration, nor the extent of expansion across the 16 districts and counties. If the past demonstration is not linked to the full implementation of integrated care scheduled for 2026–2028, the demonstration data will not be carried over as the baseline for the main project.  While the input of smart care is verified, the city-wide outcome and expansion are deemed unconfirmed.

Busan-style integrated care includes reassuring care for discharged patients, end-of-life care, hospital accompaniment, and support for meals, housekeeping, and daily living. The scope of services has expanded from a single welfare benefit to a structure that addresses both health status and living conditions. However, there is no publicly available comparative data confirming which service combinations were provided to the same recipient and how outcomes varied by status. If only the types of services and usage volume increase over two to three years, combinations with low effectiveness accumulate as identical performance figures.  The current ecosystem is in the stage of service diversification, not yet at the stage of verifying optimal combinations for each individual.

With the implementation of the National Integrated Support Act, local governments and the National Health Insurance Service participate in determining eligibility and linking services. While the intersection between administration and insurance has expanded, the data generation cycles and responsible entities of medical institutions, long-term care facilities, public health centers, and welfare departments differ. A public timeline connecting an individual's condition from deterioration to service intervention and recovery has not been verified. If the individual systems of each institution are expanded as they are between 2026 and 2028, there is a high likelihood that integrated care will remain a multi-agency referral system rather than a unified assessment system.  Currently, Busan's level of integration is assessed as having institutional linkage ahead of the integration of the data ecosystem.

In 2025, 65.9% of the elderly nationwide engaged in social activities, and ICT usage time increased compared to five years prior, with an internet usage rate of 76.9%. The elderly population has diversified from a single type of non-digital user group into multiple groups with differing usage capabilities and health statuses. Publicly available detailed data classifying the elderly in Busan based on digital accessibility, health risk, living alone, and care resources is unavailable. If all elderly individuals are treated as the same target for digital services from 2026 to 2028, high-risk non-users and healthy users will be simultaneously misclassified.  The digital care risk in Busan is assessed as having a structure that fails to distinguish disparities between groups, unlike the non-use status of the elderly.

Medical demand for the elderly is shifting from the treatment of single diseases to long-term care that combines multiple diseases, medication, rehabilitation, nutrition, cognitive function, and residential safety. The structure makes it difficult to explain daily functioning after discharge and the risk of readmission based solely on hospital-centered care. In Busan, no open risk model combining medical records with living functions, residential environment, and family care has been identified. If disease-unit management persists for two to three years, it becomes increasingly difficult to assess the overall condition of high-risk groups utilizing multiple institutions. It is  determined that while the structural changes in Busan's medical and care services have shifted from disease treatment to the management of living functions, the data remains limited to usage records by institution.

The implementation of the Integrated Support Act in 2026 shifted the operational unit from hospital and facility-centered services to place-of-residence-centered support. The criteria for service outcomes also shifted from the number of services provided to factors such as readmission, delays in facility admission, and the maintenance of daily living. However, common outcomes measuring the duration of in-home living maintenance and functional changes before and after care intervention in Busan are not disclosed. If the initial indicators for the 2026–2028 period remain fixed on the volume of supply, the final outcome of in-home living will be left outside the scope of evaluation.  While the system structure has shifted to a community-centered approach, structural changes in the outcomes data have not yet been confirmed.

Generative AI, predictive models, and IoT have created a technological environment capable of rapidly analyzing consultation records, medication adherence, activity levels, and emergency signals. This has secured the conditions for care operations to shift from a focus on regular visits to one that adjusts priorities based on risk signals. However, the runtime across Busan—where sensor alerts are linked to on-site visits, medical treatment, and emergency transport, while verifying false positives and missed detections—has not been confirmed. If equipment is merely expanded within two to three years, the increase in alerts could only raise the workload of field personnel.  While technical readiness has improved, the combined readiness of risk detection and on-site response remains unconfirmed.

Busan developed an integrated dashboard for the Smart Care demonstration in 2022 and expanded the Busan-style Integrated Care to all districts and counties in 2026. A change is confirmed in which the technical approach of a limited demonstration area extends to the operation of the system throughout the entire city. However, the health outcomes of demonstration participants, model accuracy, reduction of field work, and the succession rate to the main project are not verified in the publicly available evidence. If the demonstration and full-scale implementation from 2026 to 2028 are operated with different data structures, learning effects will not accumulate.  It is determined that while Busan's response involves both demonstration and system expansion, they are not connected to a single learning runtime.

Dedicated integrated care organizations and communication systems have been established in 16 districts and counties, and Busan-style specialized and common services are currently in operation. Administrative points of contact have been reorganized from fragmented welfare windows to integrated support windows in the districts and counties. However, publicly available data comparing dedicated personnel, the number of cases handled, integrated assessment times, service waiting times, and case closure criteria by district and county is unavailable. If regional differences in workload accumulate within two to three years, accessibility and assessment speeds will vary even under the same system.  While the formal expansion of organizations is confirmed, the equitable distribution of operational capabilities is deemed unconfirmed.

Busan City has presented services tailored to different stages of life, including discharged patients, end-of-life care, hospital accompaniment, household chores, and meals. While the scope of integration between medical and welfare services has expanded, record-keeping methods vary among service providers. Public information linking the actual service arrival time after a referral, dropouts, re-applications, and the causes of condition deterioration is not available. As service volume increases between 2026 and 2028, connection failures are also expected to rise, yet the causes of these failures remain scattered across the records of individual institutions.  The current response is in the phase of expanding service scope, and a system for learning from service failures has not been identified.

By 2026, the integrated support cooperation system between public and private partner organizations was strengthened, and community-centered preventive care programs were expanded. Service providers shifted from a public-only model to a network combining hospitals, insurance companies, and private care institutions. However, no public registry comparing costs, quality, waiting times, staffing, and outcomes across institutions using the same criteria has been identified. As provider networks expand over the next two to three years, quality disparities and boundaries of responsibility also increase. While  Busan's cooperation foundation has expanded, its provider quality intelligence is assessed as being in an early stage.

In 2025, the proportion of the elderly population in Busan was projected at 24.5%, which was 4.2 percentage points higher than the national average of 20.3% and also higher than Gyeongnam (22.2%) and Daegu (21.2%). Busan is structured to experience demand for the super-aged population—which is ahead of the national average—within its metropolitan medical and care systems. However, there are no standardized indicators that simultaneously compare regional differences in aging rates with medical and care capacity. If the national average supply standards are applied directly to Busan for the 2026–2028 period, the gap between actual demand and supply could widen.  Busan is classified as a leading region in terms of the speed of aging, but as a "Data GAP" region when comparing capacity.

In 2023, the life expectancy for Koreans aged 65 was 21.5 years, which was 0.7 years longer for men and 1.9 years longer for women than the OECD average. An increase in survival time creates a structure that expands the demand for long-term healthcare and care following treatment. Recent publicly available data comparing the healthy life expectancy, duration of disability, and duration of in-home living of the elderly in Busan with international and domestic cities is limited. If only life expectancy rises for two to three years without measuring the healthy life expectancy gap, the point at which the burden of medical and care increases is determined late.  The comparative risk for Busan lies in the fact that the difference between the period of living a long life and the period of living without care is not measured at the regional level.

In 2023, per capita medical expenses for the elderly nationwide amounted to 5,306,000 won, an increase of 77,000 won from the previous year. In Busan, which has a high aging rate, even the same increase in unit costs places greater pressure on total medical expenses. However, no publicly available comparative data linking medical expenses and long-term care costs for the elderly in Busan by disease, district, county, and institution has been found. If the cost increase projected for 2026–2028 is separated into hospital, insurance, local finance, and family burdens, the total burden on the city is underestimated.  Busan's relative risk is assessed not by the level of costs, but by a structure that fails to view the total burden as a single account.

Busan possesses both the implementation of integrated care across all 16 districts and counties and past smart care pilot projects. Its systemic scope and experience in digital experimentation are assets comparable to those of other regions. However, publicly available long-term follow-up data linking pilot projects, full-scale implementation, and health outcomes is not available. Without the accumulation of results over two to three years, prior experience remains merely a history of repetitive projects.  Busan's current position is assessed as "Mixed Readiness," characterized by the simultaneous existence of policy leadership and delayed outcome verification.

The elderly population in Busan increased from 783,663 in 2024 to 794,050 in April 2025, while the total population continued to decline during the same period. Connecting the absolute increase in the elderly population with the decrease in the total population reveals a structure in which the density of demand for medical and care services in the city rises rapidly. However, the distribution of age, disease, long-term care, and single-person households within the increased elderly population is not linked within the same data. If supply is allocated based solely on the total volume for 2026–2028, shortages in areas where high-risk groups are concentrated are obscured by the average.  Busan's demand risk is determined by the invisibility of the distribution of high-risk groups rather than the growth rate of the elderly population.

Connecting the projected proportion of the elderly population of 24.5% in 2025 with the 2030 forecast of 30.1% reveals a path of increase of more than 5 percentage points over approximately five years. While the medical and care systems respond through annual project adjustments, the population structure changes cumulatively. Annual forecasts for demand, manpower, hospital beds, and home care services based on the same criteria are not disclosed. If the mid-term supply plan for 2026–2028 is not aligned with the demographic trajectory, shortages in 2030 will manifest first in manpower and visiting hours, rather than in facilities.  Busan's temporal risk lies not in the sudden emergence of demand, but in the fact that predictable growth is disconnected from operational plans.

Mechanically multiplying the national average medical expenditure per elderly person of 5,306,000 won by Busan's elderly population of around 790,000 results in errors in estimating regional medical costs. This is because there is no evidence that Busan's disease structure, medical supply, income, out-of-pocket expenses, and long-term care utilization are identical to the national average. A formulaic baseline that decomposes regional unit costs and utilization volumes has not been confirmed. If national average estimates replace policy decisions for two to three years, both the causes of cost increases and the effects of interventions become distorted.  The total volume of medical costs in Busan is currently determined to be a data gap that should not be estimated without official regional evidence.

The actual effectiveness of integrated care services can only be revealed by linking the number of service requests and referrals with periods of re-hospitalization, institutionalization, and in-home living. While currently available information confirms the types of services available and the application system, it does not verify long-term outcomes for individual recipients. The structure lacks a connection between input and outcome. If the number of referrals for 2026–2028 becomes the fixed performance indicator, it will be impossible to distinguish between service growth and health improvement.  The largest numerical gap in Busan's integrated care system is determined to exist between service utilization and recovery of daily living.

The first gap is the discontinuity in the timeline of medical, nursing, and care recipients . Hospital treatment, admission and discharge, long-term care certification, welfare counseling, and home-based services are recorded separately. However, a public runtime connecting the entire process—from deterioration of condition to intervention, recovery, and re-deterioration—based on the same recipient is not verified. As the number of service providers increases between 2026 and 2028, the overall trajectory of high-risk recipients becomes more opaque.  Busan's greatest readiness gap is determined to be the discontinuity in the recipient's trajectory, rather than a shortage of services.

The second gap is the separation between demand forecasting and field personnel . Although the elderly population is increasing, the available hours for visiting medical care, nursing, long-term care, social welfare, and meal support personnel by district and county are not disclosed together. The structure operates with population forecasting based on long-term projects and personnel deployment based on short-term project units. If demand from the late elderly increases over the next two to three years, actual available visiting hours may decrease even if the number of institutions is maintained.  Supply Readiness is judged as unconfirmed based on available personnel hours rather than the number of facilities or institutions.

The third gap is the absence of risk maps by district and county . While the average aging rate in Busan is confirmed, a public map combining factors such as living alone, multiple diseases, frailty, housing vulnerability, slope, public transportation, and medical access time is not available. The structure in which the difficulty of care varies by region, even within the same elderly population, is obscured by the average value. If equal distribution is repeated between 2026 and 2028, waiting times and emergency utilization in high-risk living areas will increase first.  Spatial Readiness is assessed to have remained at the average management stage.

The fourth gap is the separation of outcomes and costs . Medical expenses, long-term care costs, local care budgets, and family time costs remain in separate accounts. A joint cost-outcome account, which determines whether integrated care reduced costs in one area and increased costs in another, is not verified. If total costs are separated over a period of two to three years, cost savings and cost transfers may be recorded as the same outcome.  Financial Readiness is determined to have been achieved in project-specific execution but not in the determination of the burden on the entire city.

The fifth gap is the time lag between danger signals and on-site response . While smart sensors, health data, and consultation records generate early signals, the processing time linked to actual visits, treatments, and transport is not disclosed. This creates a structure where the speed of detection technology differs from that of field personnel. As the volume of alerts increases between 2026 and 2028, unresponded alerts accumulate into new blind spots. AX Readiness is assessed as being lower in signal termination than in signal generation.

In 2026, dedicated integrated care organizations and reception systems were established in 16 districts and counties in Busan. Administrative infrastructure expanded from a focus on pilot districts to application across the entire region. However, dedicated personnel, case volume, assessment periods, and service waiting times by district and county are not disclosed using the same standards. If demand increases between 2026 and 2028, the number of unclosed cases per staff member will reveal operational limitations before the establishment of organizations.  Administrative infrastructure is assessed as fully deployed, while processing capacity is deemed unconfirmed.

Medical institutions, long-term care facilities, and home care service agencies are distributed throughout Busan, and the public-private cooperation system was strengthened by 2026. The supply chain has expanded from individual agency operations to multi-agency cooperation. However, public supply indicators linking available visiting hours, response times for nights and holidays, and the time of arrival for the first service after discharge are not verified. Even if the number of institutions is maintained over the next two to three years, perceived supply will decrease if actual response times increase. While service infrastructure exists, time-based availability is determined to be unmeasured.

The 2022 smart care demonstration and integrated dashboard development left behind a data-driven care experience. The technical infrastructure is not entirely non-existent; it has undergone limited-area demonstration. However, the standardization of the demonstration data, its transfer to 16 districts and counties, and the linkage of health insurance, medical institution, and long-term care data remain unconfirmed. If the initial demonstration is not connected to the main project data within two to three years, it will be excluded from long-term learning.  The data infrastructure is judged to be partially established, and the urban runtime is deemed unconfirmed.

The Integrated Support Act, along with Busan City ordinances and dedicated organizations, have established the legal and administrative foundations. The system has shifted from service-specific applications to integrated support targets. However, the level of disclosure regarding data liability, explainability of algorithm judgments, objections, inter-agency error correction, and long-term retention standards remains limited. As the scope of automation expands between 2026 and 2028, liability for misclassification and correction time will remain as new institutional risks.  It is determined that institutional readiness has reached the implementation of integrated support but has not yet reached the AX liability framework.

Starting in March 2026, Busan citizens will be able to apply for integrated care through their local administrative welfare centers or National Health Insurance Service branch offices. Access to the system has been expanded from specific pilot areas to all residents of Busan. However, the eligibility determination rate relative to applications, service arrival rates, dropout rates, and unmet needs are not disclosed. If only the number of applications increases over a period of two to three years, residents who did not actually receive services are excluded from performance statistics.  While the expansion of system access is confirmed, the expansion of service reach is deemed unconfirmed.

Customized Elderly Care targets elderly individuals at risk of care among recipients of basic livelihood support, the near-poverty group, and basic pension recipients, while Integrated Care has expanded its scope to include medical, nursing, housing, and daily support. The eligibility criteria have expanded from an income-centric approach to one that considers both health and functional living skills. However, it remains unclear how many individuals outside the income criteria—specifically those at risk of care and those experiencing family care burnout—are being identified. If the gap between eligibility assessment criteria persists between 2026 and 2028, blind spots will remain even if support programs increase.  The gap in resident coverage is identified more by the capture rate of at-risk individuals than by the types of services provided.

Reassuring care for discharged patients and hospital escort services expand the scope of services to life outside the hospital. This structure transforms the termination of service at a medical institution into the starting point of community care. However, public outcomes linking the time to the first visit after discharge, readmissions after 30 or 90 days, and repeat emergency room visits are not verified. If only the number of discharge referrals is managed over a period of two to three years, the actual failure of continuous care remains between the hospital and community services.  The expansion of medical-care services is currently in the stage of establishing points of contact, not the stage of verifying continuity.

Care companies, social service agencies, and nursing facilities are the actual providers of Busan-style integrated care. Public policy has shifted from direct administrative provision to network operations involving multiple private and non-profit providers. However, publicly available data comparing staff turnover rates, service cancellations, travel times, quality, and recipient outcomes by provider is unavailable. If the supply volume expands between 2026 and 2028, low wages and high turnover could spread to lead to service disruptions.  While the proliferation of companies and institutions is confirmed, the stability of the supply chain is deemed unconfirmed.

While Busan's average aging rate is projected to reach the 24% range by 2025, the age structure, housing types, and mobility conditions differ between the original city center and hillside areas and new towns and outlying regions. Demand for medical and care services is shifting from a focus on population size to a differentiation based on living difficulty, which combines factors such as slope, elevators, public transportation, single-person households, and housing deterioration. No publicly available data is available that combines aging rates by district and county with travel times for visiting services. If the population-proportional distribution continues from 2026 to 2028, shortages will intensify in high-difficulty areas where the same workforce must visit fewer households. It is assessed that  internal disparities within Busan are likely to manifest more significantly in the time required per care session than in the proportion of the elderly population.

While large hospitals and medical institutions are relatively concentrated in the city center, the elderly face limitations in residential mobility, walking, and transfers. This structure means that even if the distance to a hospital bed is short, the actual time to access medical treatment can be long. Medical access times for the elderly, reflecting factors such as public transportation, walking, and gradients, are not verified through publicly available common indicators. If facility evaluations based on straight-line distance are maintained for two to three years, the actual accessibility gap between the original city center and the outskirts accumulates.  The medical disparity in Busan is determined by the discrepancy between the existence of facilities and their availability.

The operating conditions for visiting care differ between large areas like Gijang-gun and Gangseo-gu and areas with high-density, sloping housing like Jung-gu, Dong-gu, and Yeongdo-gu. In the former, long-distance travel, while in the latter, difficulties with walking and access to residences, extend service hours. However, data comparing travel, waiting, and service provision times for a single identical service case by region is unavailable. If identical unit prices and staffing standards are maintained from 2026 to 2028, differences in spatial conditions could lead to providers avoiding services or resulting in waiting times.  Busan's spatial readiness is assessed as being at a stage where it cannot distinguish between care costs and service provision times by region.

The distribution of the elderly population capable of using digital devices and those facing difficulties with non-face-to-face services due to cognitive, visual, auditory, or economic limitations varies by region. The 76.9% internet usage rate among the elderly nationwide indicates that approximately one-quarter remain non-users. No publicly available data linking digital literacy with health risks has been found across the districts and counties of Busan. If non-face-to-face care services expand uniformly over the next two to three years, the most vulnerable non-users will be left outside the service.  Within Busan, the digital divide is determined to be unidentifiable based on the spatial distribution of high-risk non-users rather than simple access rates.

The proportion of the elderly population in Busan was 24.5% in 2025 and is projected to reach 30.1% in 2030. The period from 2026 to 2028 marks an intermediate phase of transition, moving from a structure where one in four people is elderly to one in three. However, the annual demand curves for the late elderly, frailty, long-term care, and single-person households are not publicly disclosed. If demand forecasts are not established during this period, the shortages expected in 2030 will manifest as accumulated labor, housing, and financial structures.  Busan's "Golden Time" is assessed not as the period prior to entering a super-aged society, but rather as the two to three years before demand density rises to the 30% range.

The Integrated Support Act came into effect in March 2026, and the Busan-style Integrated Care system was fully launched. Structural changes have begun in which data items and performance indicators from the initial launch of the system are fixed as future operational standards. Currently, publicly available outcomes have not yet reached the long-term health status following application and referral. If the initial indicators solidify into supply performance between 2026 and 2028, the cost of subsequently shifting to an evaluation centered on readmission and independent living will increase.  The system's "Golden Time" is determined to be before the initial data structure becomes entrenched, rather than during service expansion.

Approximately four years of policy experience have been accumulated leading up to the full implementation of integrated care in 2026, following the smart care pilot project in 2022. Busan is at a stage where it can connect the pilot project with the implementation of the system, rather than launching a completely new business. However, it is unclear whether the pilot participants, models, dashboards, and the current integrated care runtime will be carried over. If the connection is delayed between 2026 and 2028, the initial evidence will be difficult to reuse due to technological and organizational changes. The AX Golden Time is determined to be before the existing pilot evidence disappears, rather than at the time of technology introduction.

Caregiving duties involve face-to-face visits, mobility, and physical support, making it difficult to replace them with automation in the short term. As demand from the elderly increases and the working-age population declines simultaneously, the labor shortage shifts from a simple hiring issue to a problem of the city's overall service capacity. Forecasts for demand, turnover, and available hours by occupation in Busan are not publicly disclosed. If the workforce gap widens within two to three years, the burden of service waiting times and family caregiving will be difficult to resolve solely through facility expansion. The  "Golden Time" for manpower is determined not after a shortage is confirmed, but before the supply curve falls below the demand curve.

12-1. Golden Time Application Case in Basic Local Governments ① — Yeongdo-gu

Yeongdo-gu was included in the Busan Smart Care demonstration area in 2022, and a dedicated system comprising an integrated care division and a care policy team is confirmed for 2026. This structure allows for the continuity of the demonstration project and statutory integrated care within the same region. However, it is not confirmed whether the health status, alerts, on-site interventions, readmissions, and current integrated care cases  of the demonstration subjects have been carried over. If the past demonstration and the current system are not connected between 2026 and 2028, Yeongdo-gu will have to re-investigate the same subjects and risks. Yeongdo-gu is determined to be a region where AX experience exists, but the institutional succession of training data remains unconfirmed.

Yeongdo-gu’s sloping terrain, aging housing, and mobility limitations create conditions that require longer travel times for home care and hospital transfers, even with the same elderly population size. The structure of demand for medical and care services is shifting from population ratios to one that incorporates spatial accessibility difficulties. However, publicly available operational indicators combining travel time per visit, stairs, slopes, residential safety, and emergency transport times are not verified. If personnel deployment based on population size is maintained for two to three years, actual on-site capacity will decline faster than the statistical supply.  Yeongdo-gu’s "Golden Time" is assessed as a risk where spatial difficulties encroach upon service capacity, rather than the increase in the elderly population.

12-2. Golden Time Application Cases in Basic Local Governments ② — Busanjin-gu

Busanjin-gu was also included in the 2022 Smart Care demonstration area and possesses a living zone densely populated with urban medical, transportation, and welfare institutions. However, the superiority of institutional accessibility is not the same as continuous care for individual elderly people, and utilizing multiple institutions may actually exacerbate record fragmentation. Public outcomes linking medical, welfare, long-term care, and emergency services for each recipient have not been confirmed. If the level of readiness is assessed solely based on the number of institutions for 2026–2028, repeated use and service duplication are misinterpreted as sufficient supply.  Although Busanjin-gu is a supply-intensive area, it is determined to be a region where integrated outcomes have not been confirmed.

In urban integrated care, operational bottlenecks shift from a shortage of service providers to patient classification, referral, duplication coordination, and case closure. Busanjin-gu's pilot experience serves as historical evidence to verify these bottlenecks. However, publicly available data does not confirm that the dashboard used during the pilot was linked to the current dedicated organizations within the districts and counties. If the number of patients continues to increase over the next two to three years, data duplication and unclosed cases could slow down processing speeds even before field personnel can handle them.  Busanjin-gu's "Golden Time" is assessed as the time required to determine whether supply concentration translates into actual continuous care, rather than simply expanding facilities.

If subject IDs and outcome criteria are separated during the initial 2 to 3 years of integrated care, past pathways are omitted when linking medical, nursing, and welfare data thereafter. The implementation of the system in 2026 marks the starting point for the anew accumulation of cases across Busan. Currently, with long-term tracking not being verified, if initial records remain by project, it is difficult to retrospectively reconstruct the causes of re-hospitalization and institutionalization.  The first loss is determined by continuous data from the early stages of the transition to the super-aged, rather than by the budget.

If the turnover, aging, and travel time of care workers are not measured, actual service hours decrease even while the number of institutions remains constant. While increased demand is reflected in elderly population statistics, the decrease in supply is dispersed through service cancellations, waiting lists, and family burdens. The public runtime connecting these factors is not verified. If the workforce shortage becomes structural between 2026 and 2028, it will take longer to train new personnel and restore tenure.  The second loss is determined not by the number of service providers, but by the hours of skilled field personnel.

If the gap between hospital discharge and the start of community care persists, repeat hospitalizations, emergency room visits, and institutionalization may increase. Although Busan operates a "Safe Care" program for discharged patients, 30-day and 90-day outcomes are not disclosed. This creates a structure where coordination failures remain between medical institutions and community services. If this gap repeats for two to three years, unnecessary hospitalizations and family care burnout become entrenched as normal patterns.  The third loss is determined by the duration of time one can live in their hometown, rather than opportunities to utilize individual services.

If spatial conditions and the distribution of high-risk groups by district and county are not reflected, average distribution exacerbates regional disparities. Sloping terrain in the old city center and vast outskirts require more travel time for the same service. Regional care costs and waiting times are not publicly compared. If the gap accumulates between 2026 and 2028, a structure will become fixed where one's address determines service arrival times and the possibility of in-home living.  The fourth loss is determined to be the inter-regional care equity that disappears when the average service volume in Busan falls below that level.

Busan possesses continuous evidence, including smart care pilot projects in 2022, the full implementation of statutory integrated care in 2026, and dedicated organizations across 16 districts and counties. It represents a rare structure where experimentation, institutionalization, and city-wide application all exist. However, data succession and outcome comparisons across these three stages have not been confirmed. If this connection is not established between 2026 and 2028, the accumulated experience will be fragmented into a separate project history.  Currently, the opportunity is assessed as the time available to solidify the existing four years of experience into a single learning curve, rather than through new pilot projects.

Busan possesses hospitals, long-term care facilities, home care services, welfare centers, public health centers, and private service providers. The current gap lies in the disconnection of service pathways between institutions rather than the complete absence of a supply base. If the service order and outcomes for the same recipient are aligned, there is room to identify duplication, gaps, and delays without the need for new facilities. However, if demand increases within two to three years, this potential for operational improvement will be absorbed by waiting lists and staffing shortages.  Currently, the "Opportunity" is assessed as a phase where the actual availability of existing supplies is evaluated prior to expanding the total supply volume.

With the implementation of the system in 2026, an official administrative channel has been established for the integrated assessment and linkage of medical, nursing, and care services. This represents a structural shift from past autonomous cooperation between institutions to a statutory operational system. However, there is a lack of public evidence confirming that the initial performance indicators have been finalized as reduced home living, functional recovery, and re-hospitalization. If supply-based indicators become entrenched between 2026 and 2028, subsequent outcome-based evaluations will begin without a baseline.  Currently, Opportunity is determined based on the initial data definition of the system up until the long-term evaluation structure is decided.

The 76.9% internet usage rate among the elderly nationwide and the smart care experience in Busan demonstrate that digital touchpoints are not non-existent. While the potential to combine digital services with face-to-face care exists, the classification of high-risk non-users has not been confirmed. If technology diffusion is concentrated on the eligible population, the digital divide transforms into a health risk gap. If usability and risk levels cannot be assessed together within two to three years, it will be difficult to distinguish between the effects of automation and the effects of exclusion.  Currently, opportunity is judged by the time available to verify the accuracy of face-to-face versus non-face-to-face allocation, rather than the number of digital services.

Care AX Runtime

Population, Disease, Living Function → Risk Assessment → Integrated Service Combination → On-site Arrival → Change in Status → Re-hospitalization, Institutional Admission, Home Living → Cost, Equity → District/County Relocation → Reassessment

Critical Demand Growth + Fragmented Care Risk

The demand for medical and care services for the super-elderly in Busan is already present.

The scope of the system has reached the entire city of Busan.

The connection between target population pathways, field personnel, regional disparities, costs, and health outcomes has not yet been completed.

The period from 2026 to 2028 is a time when a structure in which the speed of judgment lags behind the increase in demand becomes entrenched.

The final assessment is Critical Demand Growth + Fragmented Care Risk.

1. Total population aged 65 and over in Busan and growth rate
2. Late elderly population aged 75 and 85 or older
3. Aging rate by district/county
4. Proportion of elderly people living alone by district/county
5. High-risk group for multiple diseases, frailty, and dementia
6. Long-term care approval application rate and approval rate
7. Waiting periods by long-term care grade
8. Utilization rates of home care and institutional care
9. Medical expenses per elderly person in the Busan region
10. Emergency room utilization rate among the elderly
11. 30-day and 90-day re-admission rates
12. First care service arrival time after discharge
13. Integrated care application approval rate
14. Actual service reach rate compared to judgment
15. Service dropout and reapplication rates
16. Unmet medical and care needs
17. Period of maintaining home living for integrated care recipients
18. Delay or reduction rate of facility admission
19. Home Medical Care & Home Nursing Availability
20. Caregiver and social worker turnover rate
21. Unclosed cases per person
22. Travel time by district/county
23. False positive and false negative rates of smart alarms
24. Time from alarm issuance to on-site closure
25. Total of medical expenses, long-term care expenses, regional care expenses, and family time costs

Data GAP: In the publicly available evidence, the Busan medical and care runtime—linking health risk → hospitalization → discharge → long-term care assessment → home care services → functional change → readmission/facility admission → total cost to the same subject on a timeline—cannot be confirmed.

Runtime Chain

Super-aging → Complex health risks → Integrated assessment → Medical care, nursing, and support → On-site arrival → Daily living functions → Re-hospitalization/Institutional admission → Duration of home living → Total cost/Equity → Next assessment

Source · Verification

• National Data Center, 2025 Elderly Statistics
• Busan Metropolitan City, May 2025 Population Policy Briefing
• Busan Big Data Wave, 2024 Busan Population and Aging Statistics
• Busan Metropolitan City, Integrated Community Care Support System Including Medical and Long-term Care
• Busan Metropolitan City, Busan-style Integrated Care Common Services
• Busan Metropolitan City, Busan-style Integrated Care Specialized Service
• Busan Metropolitan City, dedicated integrated care organizations in 16 districts and counties
• Busan Metropolitan City Demonstration of Integrated Care Smart Care Service
• Busan Metropolitan City, Advancement of Busan-style Integrated Care by 2026
• National Data Center, Future Population Projections by Province/City 2022–2052

Structural insights remaining from this analysis

The limitations of a super-aged city are not determined by the simple sum of hospital beds, nursing facilities, and welfare services. The moment the same citizen is separated into a patient in a hospital, an approved caregiver in long-term care, a case management subject in welfare services, and a single-person household in housing, the city's carrying capacity appears larger than it actually is. It is a structure where each institution provides services, but a person's life does not come to an end.

Fragmentation in medical and care services reveals gaps later than overlap. Even when hospitals complete discharges, administrations register referrals, and agencies schedule visits, the life risks experienced during the few days in between are not recorded as a failure of any system. As super-aging intensifies, this brief gap is amplified into falls, emergency transports, readmissions, and family burnout.

Therefore, the unit determining Busan's capacity is not the number of medical institutions or care services. The time taken from the moment a warning signal is issued until actual on-site intervention and a return to daily life is the city's actual carrying capacity. If this timeline is not connected, capacity cannot be assessed even if supply is increased.

Golden Time Thesis — The structural risk of super-aged Busan does not lie in the scarcity of care services. It lies in the fact that we are entering an era where the elderly population exceeds 30% by 2030 without measuring the time lost between a person's deterioration and the intervention of multiple agencies. The evaluation unit for Busan Medical & Care AX is not the number of service cases, but the time taken from the occurrence of a risk → arrival at the scene → recovery to daily life.