Service gaps, care transitions, and structural inequities in end-of-life care in Korea: a qualitative framework analysis

As Korea rapidly ages, the need for continuous end-of-life care across home, hospice, long-term care, and hospital settings is increasing. Specialized home hospice/palliative care and non-specialized home-based medical care both support patients near the end of life, but they differ in target populations, eligibility criteria, service scope, and reimbursement mechanisms. This study explored service gaps and care transitions between these services in Korea. A qualitative descriptive study was conducted using eight focus group sessions with 27 physicians, nurses, and social workers experienced in specialized home hospice/palliative care, consultative palliative care, or non-specialized home-based medical care. Data were collected between October and November 2025 and analyzed using framework analysis. Six themes were identified: differences in patient trajectories and care environments; complementary but non-interchangeable service roles; service selection as a constrained matching process; structural inequities constraining viable care pathways; potentially avoidable but unavoidable hospitalization; and system-level improvement strategies. Specialized hospice services were perceived as having greater capacity for specialized symptom management and terminal-phase care, whereas non-specialized home-based medical care provided broader longitudinal support for frail older adults and patients with chronic non-cancer illnesses. Service selection and transitions were shaped by medical needs, service availability, caregiving capacity, and patient and family preferences, while geographic disparities, workforce shortages, fragmented pathways, and reimbursement inequities further narrowed viable care options. When no safe and feasible community-based alternative remained, hospitalization became unavoidable in practice even though it might have been avoided had adequate alternatives been available. Participants emphasized coordinated referral pathways, gap-filling palliative care models, workforce development, and stronger support for home-based end-of-life care. Specialized home hospice/palliative care and non-specialized home-based medical care have distinct but complementary roles in community-based end-of-life care. Coordinated pathways across home, hospice, long-term care, and hospital settings are needed to support timely transitions, strengthen home-based care, and reduce hospitalization that become unavoidable because adequate alternatives are unavailable.