Whenever I visit a university hospital outpatient clinic, a question strikes me – who this separation of dispensary from medical service is for.
Each day up to 10 thousand patients receive their diagnoses at university hospitals and head to a nearby pharmacy to receive their prescribed meds. That is because, under the current system, patients should pick up their drugs outside of the hospital although there are druggists inside.
A quarter of these outpatients are senior citizens of 65 or older. Hospitals cannot even provide a means of transportation to the pharmacy for these elderly patients, and shuttles are only allowed up to subway stations.
It is a 15-minute walk from Asan Medical Center (AMC) to a nearby pharmacy and about five to 10 minutes for the Severance Hospital. You can walk outside AMC to see a line of cars employed by the stores, waiting outside the building to give rides to the “pharmacy patients.”
Patients are not allowed to have drugs delivered to their homes, as doing so without face-to-face medication counseling from the pharmacist is illegal. Even drugs repeatedly prescribed over a given time span are not exempt from the law, nor can they be prescribed over the phone.
University hospitals and neighborhood pharmacies do not have any appropriately shared infrastructure for prescribed drugs. In Japan, patients can choose stores by paying a little more. In Korea, however, patients must go to pharmacies beside the hospitals, rain or shine, old or young, and weak or strong. That is why critics point out the problems of the current system, calling for policymakers to allow people aged 75 or older or those with reduced mobility to use the hospital pharmacy.
Cancer or stroke patients released from university hospitals can receive home care, as hospitals send a nurse to their homes. Health insurance covers the home nursing system. Even when doctors visit the homes of patients and treat them, however, they can only receive the standard outpatient medical cost for doing so. All they can charge are the round-trip transportation fees, uncovered by insurance. It is a small surprise then doctors find little incentives to make these visits.
Nor is there any compensation for visiting elderly patients, whose treatments take two to three times more time because of communication problems. The more doctors visit elderly patients, the bigger their losses grow.
About 3.5 percent of Koreans aged 65 or older have received hospital treatment due to stroke and other cerebrovascular troubles, suffering from various physical disabilities as their aftereffects. However impaired their mobility is, these aged patients must go to hospitals to receive treatments, though. In contrast, Japan, which has a large number of aged patients, has reinvigorated home medical care by making health insurance cover the costs to a sufficient extent.
Spain, which has experienced population aging ahead of Korea, demonstrates what public healthcare system should do in an aging society.
Gerontology specialists affiliated with municipal hospitals visit aged patients who have difficulty moving around, in teams of two – a gerontology specialist and a resident doctor who wants to specialize in it. One municipal hospital operates four or five such teams. They visit elderly patients’ homes once a month and make a round of 10 homes a day to check the taking of medicines and the improvement of walking.
Public hospitals have opened a department for fall-related medical care and are running a fall prevention program along with local health community center, equivalent to our health centers here. While Korea has nearly 150,000 more fall-induced fractures each year, Spain has almost none.
Aged society is just around the corner, and the number of elderly patients is rising steeply, but medical environment can’t be further from reflecting such reality. Ours is health care system and environment that harass senior citizens rather than comfort them. This is a structure in which hospitals should avoid elderly patients for routine operation. Nor does this country have a system for geriatricians.
It is important public and private medical systems collaborate to create an efficient healthcare system for the elderly, in a proper division of labor -- before health insurance finance falters in the face of snowballing costs for elderly care.
It’s time to move from the treatment of the aged to treatment for the aged.
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