Why Is Innovation in the Care Business So Difficult in Korea? [Part 2] How Do Care Companies Innovate Their Business Models? Lessons from Korea and Abroad

This is the second of four articles in the series “Why Is Innovation in the Care Business So Difficult in Korea?”

Korea’s care market is growing rapidly. But as the market expands, are new care businesses becoming equally diverse? This four-part series explores that question.

Part 1 examines the supply structure of Korea’s care market; Part 2 explores business model innovation among care companies in Korea and abroad; Part 3 examines the characteristics of demand in Korea’s care market; and Part 4 considers how entrepreneurs can start small and enter the market.

Part 1 compared the different ways care markets operate in the United States, United Kingdom, Netherlands, Japan, and Korea, and characterized Korea as an “institutionally regulated quasi-market.”

How, then, do actual care companies innovate their business models within these different market structures?

Rather than recounting the success stories of well-known care companies, this article asks which customers, institutional conditions, and organizational and operational capabilities make each business model work. It focuses in particular on how differences in the location and scope of provider discretion shape business models. Here, discretion means the scope providers have, within a given market structure, to decide for themselves on prices, service configurations, staffing, and organizational arrangements. The wider that scope, the more room providers have to try new business models.

For Part 2, I selected one company from each of the five national market structures identified in Part 1. In the United States, Visiting Angels expanded franchise-based home care around private-pay customers. In the United Kingdom, Helping Hands connected demand from self-funders to directly employed staff and a local branch network. In the Netherlands, Buurtzorg developed a model of self-managing teams by using professional and organizational discretion within publicly funded community nursing. In Japan, Duskin Life Care turned everyday needs outside long-term care insurance into paid services. In Korea, Caring began as a platform within the institutionally regulated long-term care market and expanded into directly operated services, IT, institutional operations, and care delivery network integration. The questions are what business model each company uses, what conditions and capabilities make it viable, and what these cases suggest for Korea’s care market.

Care Business Model Innovation: Cases from the United States, United Kingdom, Netherlands, Japan, and Korea

Country	Company	Market structure	What the case illustrates
United States	Visiting Angels	Coexistence of private-pay and publicly funded purchasing markets	Replicating a delivery model for private-pay customers
United Kingdom	Helping Hands	Coexistence of a public-purchasing quasi-market and a private-pay market	Expanding services and a care delivery network for self-funders
Netherlands	Buurtzorg	Professional- and organizational-discretion quasi-market (community nursing only)	Using organizational and professional discretion within a public market
Japan	Duskin Life Care	Coexistence of an insurance-based quasi-market and a non-insurance market	Commercializing daily living needs outside insurance
Korea	Caring	Institutionally regulated quasi-market	Delivery innovation through operations, IT, direct management, and scaling

Source: Compiled for this article from official company and institutional materials [1]–[7].

1. United States—Visiting Angels: Replicating a Private-Pay Care Delivery Model Through Franchising

The U.S. care market combines private-pay and publicly funded purchasing markets. Public programs such as Medicaid support long-term care for people with low incomes, while older adults and their families purchase a substantial share of non-medical home care with their own money. In the private-pay segment, providers can design different business models by combining service hours, delivery arrangements, and prices.

Visiting Angels has made use of the discretion to set prices and configure services in the private-pay market. Its principal customers are older adults and families purchasing non-medical home care directly, and most customers pay out of pocket.[1]

Its business model standardizes non-medical home care services and operating methods so they can be replicated through franchises. It has more than 600 franchises in the United States. Company materials report median gross revenue per franchise of US$2.3 million in 2024.[1]

For this model to work, a company must attract private-pay customers, standardize local service operations, and reproduce those operations across a franchise network. The ability to turn services for private-pay customers into a repeatable care delivery model becomes a business model in its own right.

2. United Kingdom—Helping Hands: Expanding Services and a Care Delivery Network for Self-Funders

The UK care market combines a public-purchasing quasi-market with a private-pay market. Local authorities provide care support following assessments of assets and income, while older adults and families whose assets exceed the eligibility threshold pay for care themselves. In the United Kingdom, people who pay the full cost of care without public support are called “self-funders.” Private and nonprofit providers participate in both markets and can design business models in different ways.

Helping Hands is a private home care company serving primarily self-funders in this market, where public and private funding coexist. Most of its family customers pay for care themselves.[2]

The company configures services around each customer’s circumstances: how many hours of visiting care they need, whether live-in care is required, and what assistance with daily living they want. It delivers those services through directly employed care workers and local branches. In 2025, it served more than 10,600 people each week, directly employed over 6,100 care workers, and provided more than five million hours of care annually. It had approximately 155 local branches.[2]

Where Visiting Angels replicated its delivery model through franchises, Helping Hands expanded its own care delivery network through direct employment and local branches. This requires not only the ability to configure services around paying customers’ needs but also the capacity to employ care workers and run a local delivery network. Private-pay demand alone cannot sustain the business model without the operational capacity to manage staff and local branches.

3. Netherlands—Buurtzorg: Using Organizational and Professional Discretion Within a Publicly Funded Market

Dutch community nursing operates as a professional- and organizational-discretion quasi-market. Funding comes from public insurance, but nurses working in provider organizations contracted by insurers have comparatively broad scope to decide how services are configured, how staff are deployed, and how care is organized.

Buurtzorg used this discretion within a publicly funded market to develop an organizational model built around nurse-led, self-managing teams.

Buurtzorg created teams of no more than 12 nurses who coordinate the care their clients need and manage team operations themselves. By 2022, it had grown to approximately 900 teams and more than 10,000 nurses in the Netherlands. Its distinctive business model lies less in pricing or new products than in organizational design. Nurses’ professional judgment, the autonomy of small teams, and the organizational capacity to support them underpin the model.[3]

Payment arrangements for community nursing have also improved, giving nurses greater scope to decide how care is provided in practice. Payment rules determine what providers can do and how much they can do. When care is reimbursed by individual activity in five-minute units, nurses must work to specified time slots and categories. More comprehensive payment arrangements give them greater scope to judge what care is needed on the ground. According to the Nederlandse Zorgautoriteit (NZa), alternatives to five-minute billing, including integrated rates and weekly or monthly payments, have been tested over the past decade. Nearly 95 percent of community nursing providers now use integrated rates. Policy has also sought to strengthen professional initiative and trust while reducing administrative burdens.[4] These payment reforms did not, however, give rise to Buurtzorg, which was founded in 2006.[3]

The Dutch experience shows that even in a publicly funded market, organizational models themselves can become a site of innovation when professionals and provider organizations have discretion over how care is organized.

4. Japan—Duskin Life Care: Turning Unmet Daily Living Needs into Paid Services

Japan’s care market combines an insurance-based quasi-market with a market for services outside insurance. Services covered by long-term care insurance have standardized content and prices, but outside insurance, older adults and families can buy services with their own money. Businesses can design and sell a variety of daily living support and care services.

Duskin Life Care used its discretion over prices and service configurations in the market outside long-term care insurance to serve older adults and families whose daily living needs were not met by insurance-covered services.

Its services are paid for privately and are not covered by public long-term care insurance. The company combines housekeeping, accompaniment on outings, companionship, daily living assistance, and care according to each client’s needs and sells them with set hours and prices. The company has operated this business since 2000. According to materials released in January 2026, it had 95 locations nationwide as of the end of March 2025. Regular-use services in the Tokyo and Kanagawa areas started at ¥5,500 per hour.[5]

For this model to work, a company needs customers willing to purchase non-insurance services directly, as well as the capability to package everyday needs into services and connect them to prices, hours, and local operations. Applied to Korea, the question is whether unmet needs outside public insurance can be converted into distinct paid offerings. Doing so requires defining customers outside the insurance system and designing services as concrete units of exchange.

5. Korea—Caring: Where Does a Platform Go in a Market with Limited Discretion?

Korea’s care market is an “institutionally regulated quasi-market.” Private providers are numerous, but purchasing power is concentrated in long-term care insurance and other government-supported social service programs. Regulations set core service conditions, including prices, covered benefits, hours, staffing, and records. Providers have relatively little discretion to design business models in different ways.

Caring began by using IT and a platform to connect fragmented care provision within this structure, then substantially expanded direct service provision and directly operated institutions. Because prices and service configurations are institutionally defined, it sought opportunities in the discretion that remained over organizational arrangements, particularly operational efficiency through IT.

Under Korea’s long-term care insurance system, however, a platform cannot freely design the essential terms of transactions. Regulations specify covered benefits and how their costs are calculated, and providers must comply with individual care plans, documentation requirements, and staffing standards. Unlike a conventional platform, it cannot freely set transaction prices or commissions; increasing transaction volume therefore does not automatically generate platform revenue.[6]

As a result, Caring’s model now looks less like platform intermediation than like a business that directly runs care institutions and integrates workforce management, IT, institutional operations, and care delivery networks. The company describes its model as 100 percent directly operated. In 2025, it had 61 care institutions nationwide and had provided direct care to approximately 16,152 older people cumulatively. Annual revenue reached KRW 165.8 billion (about US$125 million) in 2025, and it secured KRW 40 billion (about US$30 million) in Series C investment in 2026 (at roughly KRW 1,330 per US dollar, October 2026).[7]

Scaling up in this way does not remove the economic constraints of the long-term care market. Growth through directly operated institutions entails expanding the management of institutions and staff. It is a different growth path from that of a conventional platform that scales primarily by increasing transactions.

More recently, Caring has expanded into residential offerings, including stays and residences, which the company presents as part of its integrated care and senior lifestyle business.[7] A company that began as a care platform now also directly operates housing-related services.

In an institutionally regulated quasi-market such as Korea’s, providers have little freedom to design transaction prices, commissions, or covered services. A conventional platform model is therefore difficult to sustain, while the capacity to operate institutions, staff, IT, and care delivery networks directly becomes a condition for business model innovation.

Conclusion: What Do the Five Cases Reveal?

All five companies discussed here began with the care needs of older adults and their families. But who pays for care, and what providers can design for themselves, differ across countries. Their business models—and the conditions that make those models work—therefore differ as well.

The table below compares the five companies’ business models, operating conditions, and implications for Korea.

Care Business Models, Operating Conditions, and Implications: A Five-Country Comparison

Country	Company	Business model	Operating conditions and capabilities	Implications for Korea	Indicative figures
United States	Visiting Angels	Standardized non-medical home care replicated through franchising	Private-pay customers; standardized operations; franchise management	A care delivery model itself can be replicated as a business when customers pay directly	600+ franchises; median franchise gross revenue US$2.3m (2024)
United Kingdom	Helping Hands	Visiting and live-in care for self-funders; directly employed local network	Paying customers; service design; workforce and local network management	Connecting private-pay demand to tailored services and a proprietary delivery network is crucial	10,600+ weekly clients; 6,100+ directly employed carers (2025)
Netherlands	Buurtzorg	Community nursing through small self-managing teams	Professional judgment; team autonomy; organizational support	Organizational innovation is possible within public funding when professional and organizational discretion exists	Approx. 900 teams; 10,000+ nurses (2022)
Japan	Duskin Life Care	Privately paid daily living support outside insurance	Private-pay customers; service, time and price design; local operations	The capability to turn needs outside insurance into specific paid services matters	95 locations (March 2025)
Korea	Caring	From platform to direct operations, IT, institutional management, and network integration	Regulatory compliance; staff and institution management; IT integration; direct operations	Conventional platform models face constraints; direct operating capabilities may matter more	61 institutions; revenue KRW 165.8bn (2025)

Source: Reconst

First, the five cases show that companies that find opportunities in market structures offering greater provider discretion (whether in insurance or private markets) develop more innovative business models. In the United States, where the private-pay market is substantial, Visiting Angels replicated standardized home care through franchising. In the United Kingdom, where publicly supported and self-funded care coexist, Helping Hands configured services for self-funders and operated a directly employed local workforce. In the Netherlands, where organizational discretion is relatively broad even within public insurance, Buurtzorg developed small self-managing teams. In Japan, where a market exists outside insurance, Duskin Life Care turned daily living needs into paid services. In Korea’s institutionally regulated quasi-market, Caring began as a platform but has increased its direct operation of institutions, IT, staff, and care delivery networks.

Second, each business model requires different capabilities. Visiting Angels needs the capacity to standardize operations and replicate them across a franchise network. Helping Hands needs to attract self-funders and operate a local care delivery network. Buurtzorg needs to translate nurses’ independent professional judgment into organizational practice. Duskin Life Care needs to turn daily living needs into paid offerings. Caring needs to manage multiple directly operated institutions and care workers through a unified IT system while complying with institutional requirements.

Caring’s trajectory shows that even a company starting as a platform in Korea’s institutionally regulated quasi-market ultimately needs direct operational capabilities. To build an innovative care business in Korea, entrepreneurs should not simply import overseas models. They need to consider where provider discretion lies, which business models fit that discretion, and whether they can develop the organizational capabilities required to implement those models. For example, hospital accompaniment, housekeeping, and daily living support paid for directly by older adults and their families outside long-term care benefits are areas where providers can design services and prices. In these areas, as with Duskin Life Care, the key capability is turning everyday needs into paid services.

In my view, innovation in the care business comes less from a good idea alone than from finding a market where providers have discretion and developing the organizational capabilities suited to that market.

[About the Author]

Kim Sung-Kee, Ph.D. in Social Welfare

Director, The Care Biz Lab

Chair, SE Empower Social Cooperative

Email: skkwelfare@gmail.com

References

[1] Visiting Angels. “Senior Care Franchise” (figures for 2024). https://franchise.visitingangels.com/ ; Visiting Angels. “Home Care Costs.” https://www.visitingangels.com/costs

[2] Helping Hands (2026). “Helping Hands Impact Report 2025.” https://www.helpinghandshomecare.co.uk/wp-content/uploads/2026/03/Helping-Hands-Impact-Report-2025.pdf

[3] Buurtzorg (2022). “Buurtzorg Case.” https://www.buurtzorg.com/wp-content/uploads/2022/11/Buurtzorg-Case-Final.pdf

[4] Nederlandse Zorgautoriteit (2024). “Verder werken aan invoering cliëntprofielen en nieuwe bekostiging wijkverpleging is noodzakelijk” (in Dutch; Mar. 26, 2024). https://www.nza.nl/actueel/nieuws/2024/03/26/verder-werken-aan-invoering-clientprofielen-en-nieuwe-bekostiging-wijkverpleging-is-noodzakelijk

[5] Duskin (2026). “ダスキン ライフケア『100年人生サポート認証（生活支援サービス分野）』を取得” [Duskin Life Care Receives ‘100-Year Life Support Certification (Daily Living Support Services)’] (in Japanese; Jan. 27, 2026). https://www.duskin.co.jp/news/2026/pdf/260127_01.pdf

[6] National Health Insurance Service. “Notice on Standards for the Provision of Long-Term Care Benefits and Calculation of Benefit Costs” (in Korean). https://www.nhis.or.kr/lm/lmxsrv/law/lawDetail.do?LAWGROUP=2&SEQ=1637

[7] Caring. “Caring Recruitment Website” (in Korean). https://recruit.caring.co.kr/ ; Byline Network (2026). “Caring Reports KRW 165.8 Billion in Revenue Last Year Amid Nationwide Expansion of Care Infrastructure” (in Korean; May 8, 2026). https://byline.network/2026/05/08_12093874/