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[메디게이트뉴스] In 2001, the following year after the division of pharmaceuticals was enforced in the summer of 2000, the total health insurance benefit cost was 17.8 trillion won. And eight years later, in 2009, it exceeded twice that number, and nine years later, in 2018, it exceeded four times that number. The total amount of health insurance benefits has been doubling in a period of less than 10 years, and finally exceeded 100 trillion won in 2022.
The increase in medical expenses in Korea is very steep. This is a very unusual case among OECD (Organization for Economic Co-operation and Development) countries, and because of this, last year’s national medical examination included a question asking what is the method of payment for medical expenses that can most effectively resolve the increasing trend of medical expenses in Korea. However, the answer, as is already known, is the ‘total contract system’.
Considering the current economic growth rate of the Republic of Korea and the increasing trend of health insurance benefits, the total contract system is likely to become the hottest issue in the health care system within the next 10 to 20 years, when the increasing medical expenses will reach an unbearable level.
The reason students take a leave of absence is partly because of the worsening teaching conditions and the decline in the quality of education, but the bigger reason is because they cannot see the future. The reason why so many 3rd and 4th year residents, who could have acquired a specialty by completing a little more training period, have joined the ranks of resignations is that the current residency training environment is poor, but a more important factor is that the future after obtaining a specialty has become uncertain.
In other words, the reason why students and residents massively resisted the 2,000-person increase in medical school seats is because this policy direction will destroy their future as doctors in 10 or 20 years. Many doctors predict that even 30% of the residents who resigned will return after the current standoff is over. The reason is that it is difficult for their future to improve unless the current situation changes dramatically.
The problem is that the purpose of increasing the number of medical school students by 2,000 is aimed at stabilizing medical care in Korea 10 to 20 years from now, and coincidentally, that period coincides with the emergence of the total contract system. As mentioned earlier, if the current trend continues, medical costs are expected to reach an unsustainable level in 10 to 20 years and eventually explode. If the government’s unreasonable increase in the number of medical school students succeeds, the rate of increase in medical costs will accelerate, bringing the explosion closer.
Therefore, the current crisis to increase the number of medical school students by 2,000 students has the character of a prelude to the crisis that will occur due to the total contract system. If the current struggle to resist the government’s medical abuse by increasing the number of medical school students and pushing ahead with the essential medical policy package ends in failure, it is highly likely that a wave of total contract systems will hit immediately afterwards.
Some argue that an increase in fees is necessary to save essential medical care. There are also rumors that the Ministry of Health and Welfare has asked doctors to bring a plan to increase the number of doctors they want. Considering the government’s behavior so far, this move appears to be aimed at ending the situation by raising the number of people slightly. However, if the government accepts the price increase while maintaining the policy framework it is trying to promote, it will result in intoxicating the sweet scent of food and eating hidden poison.
Just as the government abolished the prescription fee that was established in the 2000 agreement on the division of medicine, the money paid by the government can be taken back whenever the government wants. However, once a system is properly created, it is very difficult to eliminate or change it. Therefore, we should not be fooled by the sweet treat of a fee increase, but should strive to change the system. We must keep in mind that if the public has the perception that ‘all doctors wanted was money’, even if the government puts more unfair pressure on doctors in the future, public opinion will not stand on the doctors’ side and will instead applaud the government’s actions. .
It is true that essential medical care is collapsing because it is not properly compensated. However, simply increasing the fees for some essential medical fields is not a fundamental solution. Even though the total health insurance benefit cost, which was around 17 trillion won in 2001, exceeds 100 trillion won in 2022, essential medical care is not working properly, showing that this is not a problem that can be solved simply with money. Ultimately, the structural problems of the Korean medical system must be resolved.
Knowing that medical costs are rapidly increasing to an unsustainable level, but trying to quell complaints by raising the prices of essential medical services without solving the fundamental problem, is like a company that will soon go bankrupt making a big splash. The core of the problem is that the government is consuming the limited resource of health insurance as if it were an infinite resource, and when resource depletion is imminent, it is only planning to throw a bomb called the total contract system without developing new resources.
The state must ensure that no citizen is left out of only the most basic and high-priority medical services in maintaining public health, and leave medical services beyond the scope of financial acceptance to the function of the market. In other words, the mandatory health insurance designation system, which is unprecedented in the world and cannot be maintained for a long period of time, must be abolished and the right to choose in the provision and use of medical services must be returned to medical institutions and the public.
So far, the government has not changed the overall framework of Korea’s medical system, which includes the mandatory designation of medical institutions and a single public insurance system, and has only resorted to temporary fixes when problems arise. In the end, the problems with Korea’s medical system have festered and exploded, and medical costs are growing to the point where people cannot afford them. So far, our doctors have made many proposals to create a sustainable health insurance system, but the government and media have disparaged the proposals as just protecting the doctors’ livelihood. However, the government must accept that it is time to stop tinkering and solve the fundamental problem.
Korea’s medical system has already become impossible to return to the way it was before, and a huge wave of change has begun. We must create a system that satisfies both doctors and the public, rather than a system that is maintained only through someone’s sacrifice. Will we live by conforming to the current system, which is no different from a slave that has to do what the government tells it to do? Or will we take a step forward to create a world where both doctors and citizens are happy? Which path to choose is now entirely up to our doctors. This must be remembered before making a choice. If we go together, we can go far.
※The column is the personal opinion of the columnist and may not be consistent with the editorial direction of this magazine.
On healthcare costs and the need for a comprehensive solution.
Guest 1: Dr. Kim Jong-ho, President of the Korean Medical Association
Guest 2: Dr. Seo Jeong-woo, Director of the Korean Institute of Medical Information and Policy.
Interviewer: Today we are here with Dr. Kim Jong-ho, President of the Korean Medical Association, and Dr. Seo Jeong-woo, Director of the Korean Institute of Medical Information and Policy. We would like to discuss the recent health insurance crisis in Korea, the ongoing dispute between the government and doctors over the increase in medical school seats, and the potential impact of the total contract system on healthcare in Korea. Firstly, Dr. Kim, can you explain your perspective on the current situation and why doctors are opposing the proposed increase in medical school seats?
Dr. Kim Jong-ho: Of course. The issue at hand is not just about the number of medical school seats but rather the government’s attempt to impose an unreasonable increase without addressing the fundamental problems plaguing the healthcare system. The current system is unsustainable, with increasing medical costs and worsening working conditions for doctors. The total contract system, which we believe the government is preparing to implement, will only exacerbate these issues. Instead of addressing these concerns, the government is seeking to alleviate tensions by raising fees for essential services, which is a short-sighted solution. The proposed increase in medical school seats is part of this larger strategy and will only lead to a further increase in healthcare costs and an eventual collapse of the system.
Interviewer: Dr. Seo, what is your perspective on this issue? Do you believe that increasing medical school seats is necessary to stabilize the healthcare system in Korea?
Dr. Seo Jeong-woo: I believe that increasing the number of medical school seats is indeed necessary, but only as part of a larger reform package. The current crisis is a symptom of deeper issues within the Korean healthcare system, and addressing it solely by increasing the number of doctors is not enough. We need to look at ways to improve working conditions for doctors, reduce unnecessary tests and procedures, and find ways to incentivize preventative care. However, I also understand the concerns raised by Dr. Kim about the potential impact
