A controversy is arising over the government's decision to set a ceiling on the issuance fees of various certificates, including written diagnoses starting in September, no longer leaving it to the industry’s self-reliance.

The medical community is vehemently opposing the move, saying the government’s price control itself is unfair.

The Ministry of Health and Welfare said last Tuesday it would put to public notice a new set of standards on the fees of various certificates issued by medical institutions, until July 21. The ministry will implement it from Sept. 21 after collecting people’s opinions during the period.

The Ministry of Health and Welfare announced the standards for medical certificate fees on June 27 but the medical community is vehemently opposing what it says is government’s control on even the issuing costs of written diagnoses.

There have been differences among the prices of certificates issued by different hospitals so far, resulting in lots of complaints by visitors. According to the Health Insurance Review and Assessment Service, medical certificate fees ranged from 1000 won ($0.87) to 100,000 won ($87), showing a 100 times gap depending on which hospital a patient visits.

Accordingly, the ministry has decided to control the fee by setting their ceilings. When the official notice goes into effect, fees for regular medical certificates and those on magnetic resonance imaging (MRI) and other recorded diagnostic image CDs should not exceed 10,000 won, while those on after-effect disability certificate fees should not go over 100,000 won. Also, the ceiling on prices on disability certificates, such as legal blindness, has been set at 40,000 won, and that for confirming hospitalization and discharging the hospital, at 1000 won. Medical institutions can set their fees below these ceilings.

The ministry has set the price caps taking into account the representative prices of the most common 30 certificates used by the medical institutions. Medical institutions must announce their prices at places where visitors can easily see them.

The medical community is reacting strongly, threatening to take legal actions. It is criticizing the government is forcing to set low fees for highly knowledge-intensive documents containing medical judgments of doctors.

“Various medical certificates, including written diagnoses, issued by medical institutions are highly knowledge-intensive documents that contain doctors’ medical decisions and treatment records, and it is inappropriate for the government to set a lower ceiling on their issuance fees,” said Choo Moo-jin, president of Korean Medical Association (KMA). “If the ministry does not modify this notice, we will not just take legal action but consider filing a constitutional petition.”

He went on to say, “The problems of causing excessive burden on the patients should be solved by internal agreement of the medical community, not by the government’s imposition of the ceiling which infringes on the rights of doctors to treat patients.”

Former KMA head Noh-Hwan-gyu agreed. “The latest government notice is a grave incident, which demonstrated the government’s intention to control the non-treatment, uninsured areas, using laws,” he said, Noh cited the example of the Seoul Medical Association (SMA) receiving punishment for similar moves in 2005. SMA tried to enforce similar price caps on medical certificates at the time, but the Fair Trade Commission filed a complaint against it and imposed 500 million won in penalties. The court sentenced SMS to a fine of 301 million won.

“At the time, the Fair Trade Commission and the court judged SMA’s presentation of uniform fees hurt fair competition by infringing on their rights for self-reliant decisions. But now the government has set about to force it below 10,000 won by law,” Noh said. “The government’s idea transcends the Constitution and tyranny of power.”

Not only the KMA but other medical groups are issuing critical statements. Among them are Korean Medical Practitioner Association, South Jeolla Medical Association, North Jeolla Medical Association and South Chungcheong Medical Association.

Despite the opposition of medical community, the ministry is sticking to its position that matters little. The ministry said it had made the notice through several rounds of consultations with the medical community, revised the Medical Law in ways to allow the government to set the standards, in November, securing the legal basis for its move.

An official at the ministry’s Healthcare Institution Policy Division told Korea Biomedical Review Thursday that during the official notice period, various views will come out and the ministry would carefully examine such opinions.

“We are already reexamining the case of death certificates, as doctors say the ceiling of 30,000 won is too low when travel expenses are included,” the official said. “We will examine it if KMA files a suit but an administrative suit would be inappropriate as the ministry’s move is based on laws.

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