The government and the medical community are moving to the verge of a head-on collision.
Two weeks from now, many of the nation’s neighborhood clinics are likely to go on a strike in protest against what they call the “four evils” of the Moon Jae-in administration’s medical policy.
Since he took office about three years ago, President Moon has tried to ease people’s financial burdens by turning more of the previously uninsured medical services into insured ones. The so-called Moon Jae-in care, or “Mooncare,” reduces patients’ medical bills but erodes physicians’ income.
That angered many of about 130,000 practicing physicians. The doctors needed someone to lead their fight against the Moon administration’s medical policy. So they elected Choi Dae-zip as the president of the Korean Medical Association (KMA) in March 2018. Korean doctors, in general, are ideological right-wingers, but the new KMA head was categorized as an ultra-rightist.
Choi’s campaign pledge was to “shatter the Mooncare.” Ironically, however, it was also “Mooncare” that made him lead the interest group made up of members engaged in one of the nation’s most coveted and revered professions. Physicians and surgeons concerned about plunging revenue as a result of the new medical policy picked Choi, who had led some radical organizations both within and outside the medical community.
The foremost task ahead of Choi and KMA is to thwart the four medical policies pushed by the Moon administration. They are: Running a pilot program to allow packaged herb medicines to get insurance benefits, introducing non-contact treatment, increasing the medical college admission quotas, and setting up a public medical school. Most patients would find few, if any, problems with them. However, for KMA under Choi, these are “evil medical policies,” revealing a vast gap between medical service suppliers and consumers.
That also shows why KMA is often criticized as a group that only adheres to doctors' vested interests. In Korea, the best and brightest students used to major in either law or medicine. These days, some students who graduate top engineering colleges even reenter medical colleges to become doctors. The “worth” of doctors as a profession rose further over the past few years while that of lawyers fell in relative terms after the latter group’s number sharply increased with the introduction of law schools. To outsiders’ eyes, doctors appear determined not to follow the footstep of the legal profession.
According to data, Korean doctors earned about six times more than urban workers on average in 2017, two to three times wider than the comparable gap in other member countries of the Organization for Economic Cooperation and Development. In contrast, the number of doctors per 1,000 people stood at 2.3 here in the same year, even including Oriental doctors, far lower than the OECD average of 3.4. The shortage of medical workforce increases their labor intensity while making it difficult for patients to expect quality treatment. Are Korean doctors exchanging excessive workload with higher income and going to do so in the future, then?
That question must be insulting for most doctors taught to put patients’ lives and health ahead of all else. Many members of KMA are especially enraged because the government is implementing the four policies while the medical community is still struggling with the Covid-19 pandemic, saying it’s little better than “repaying good with evil,” as a medical resident put it. However, most people would think that’s precisely why the government is pushing to turn out more doctors and set up a public medical school. Against the backdrop of this seemingly unbridgeable gulf between doctors and the general public, Korea Medical Review recently met with KMA President Choi to hear his diagnosis of “four major evils” and possible remedies.
The interview was held at Choi’s office in Yongsan, Seoul.
|Korean Medical Association President Choi Dae-zip talks about why the group opposes the government’s healthcare policy and how it would fight against them, during a recent interview with Korea Biomedical Review at his office in Yongsan, Seoul.|
Question: Why does KMA oppose giving insurance benefits to herbal medicines?
Answer: Medical herbs in packages are derived from traditional Oriental medicine, which uses acupuncture and crude drugs.
Korea is adopting a state health insurance system aimed to provide benefits for all citizens. However, the stability of herb medicines falls short of meeting the standards set by modern medicine. That is, Koreans recognize those drugs just because people have long used them without appropriate testing. To get insurance coverage, medications have to prove their safety, efficacy, and cost-effectiveness. Herb medicines have demonstrated none of them through objective, scientific tests.
I believe giving insurance benefits to herb medicines also runs counter to the government’s reimbursement principle of medicinal products. It doesn’t make any sense if the government tries to verify the efficacy of untested drugs by using them on patients.
Q: In reality, there are oriental medical departments at universities, producing herb doctors every year. If the nation is to retain them, wouldn’t it be better to draw them into the modern medical system by making them more scientific?
A: There are 12 oriental medicine colleges that turn out more than 700 herb doctors a year in Korea. The KMA’s position is to do away with the oriental doctor system. I am not saying we should abolish oriental medicine itself. Instead, doctors who studied modern medicine could learn part of oriental medicine and apply it to their treatment service, as is the case in Japan.
The nation can recognize the licenses of existing oriental medical doctors for life but not produce new herb doctors and merge the oriental medicine departments into medical colleges by establishing integrated courses.
Q: The social atmosphere seems ripe to introduce non-contact treatment or telemedicine. What do you think?
A: Face-to-face care is the principle. Non-face-to-face care should be allowed only when face-to-face care is not possible. Such exceptional cases may occur when patients are aboard deep-sea fishing vessels, when they have to travel five hours or more to go to hospitals, or when the nation faces a pandemic like the ongoing coronavirus.
Telemedicine could pose a serious danger. If the government allows all medical institutions to provide remote medical services for all patients, it can collapse the nation’s healthcare system.
Most Koreans prefer to receive treatments at large hospitals. The best way to manage diseases most efficiently is to go to nearby hospitals and receive care from doctors. However, the government is “indiscreetly” pushing for telemedicine, a form of indirect treatment.
Primary care providers are very densely located in this country, allowing patients to visit neighborhood clinics at any time. Why is this government pushing for a new treatment method that is not more efficient than the existing system?
Moreover, the government is pushing ahead with this system without having any consultation with KMA. Successive governments have taken different positions concerning telemedicine. The governing Democratic Party rejected the system when it was an opposition party, thinking it could lead to for-profit medical service.
Q: What about the situations in other countries?
A: Most countries are permitting telemedicine. However, most of them have set a condition that doctors at primary care providers can reach their patients within half an hour after talking over the phone. This is because doctors should be in a stone’s throw away from patients if there is an emergency on the latter.
Q: Words have it that KMA thinks there are already so many doctors that the nation should freeze their number. The general public doesn’t seem to agree, however. What do you think?
A: If the government wants to say Korea is short of doctors, it should offer objective proof to be persuasive. If the nation suffers from the shortage of doctors, the number of outpatient services should fall. However, Korea tops the world in that category. And I don’t think the OECD data (on the number of doctors per population) are necessarily right.
Also, there is the factor of imbalance among different specialties. Doctors tend to avoid some departments, including ob-gyn, thoracic surgery and neurosurgery, where medical fees are low and legal protection is weak if things go awry.
Another imbalance is being found among different lines of services. Currently, there are too many private practicing physicians, some 80 percent of whom are specialists. As individual doctors open and run their clinics, it is difficult for hospitals to recruit doctors.
Lastly, there is an imbalance among regions. Doctors are concentrated in large cities, particularly in the Seoul metro region. I think the government should offer incentives to induce more of them to go to smaller towns and provinces.
Q: The Korea Hospital Association (KHA) supports the increase in the number of doctors. Why the difference?
A: KMA and KHA approach the issue from different viewpoints. The members of KHA run hospitals as corporate executives manage businesses. As I said earlier, hospitals are finding it hard to find specialists in specific departments. So they agree with the government’s policy.
Q: Korea needs a public medical school, doesn’t it?
A: The purpose of this system is to turn out medical doctors as government employees. The question is whether it would be effective. If they produce about 70 doctors a year for a decade, the total will remain at 700. It will also take at least 10 to 15 years to foster these talents. I doubt whether the government will attain its goal by having them fulfill various duties at national and public medical institutions.
Q: How do you assess the government’s response to Covid-19? What have the public health authorities done right and wrong?
A: The government did an excellent job of establishing regional preventive networks. The central and local governments cooperated closely in testing and tracking suspected patients and propagating and enforcing guidelines to the public. People’s positive responses also helped to reduce the spread of the virus in Korea compared with other countries.
The problem is the government still does not block the inflows of infection from overseas. The new virus cases continue to grow abroad even now. Like other countries that have prohibited entries from regions where Covid-19 is raging, Korea should have blocked suspected foreigners’ entrance when the nation confirmed initial positive cases.
Q: The Moon administration appeared to take care of both the pandemic and its impact on the economy. As a result, Korea is one of the least affected nations among OECD members economically. Shouldn’t we look at both sides?
A: KMA’s official position on this matter can hardly be based on economic considerations. Once a pandemic occurred in a foreign country, the first thing to do is block entry from there. The same can be said about infected diseases at home. If anthrax happens in one region, we should shut the rest of the country from the area.
KMA thought Covid-19 would develop into a dire situation like now that it has continued to call for a cutoff of the source. The entry of foreigners who test positive does not end up as just additional confirmed cases. and it requires enormous efforts of medical workers to cure them.
Another problem is that the health authorities are sitting on their hands to set up an efficient healthcare system amid Covid-19. The pandemic keeps medical professionals from treating other patients, another group of victims suffering from snowballing damages.
Q: What does KMA aim to achieve through its fight against the four medical policies?
A: Any progress in Korea’s healthcare can be made through the cooperation of many experts in various areas. In a country like Korea, where people regard healthcare as their fundamental right, the government should take responsibility for nurturing medical professionals.
This is possible when the government reduces interventions, such as various regulations and reckless conversion of uninsured services into insured ones while providing extensive financial and administrative supports, as the U.S. does now. I agree with establishing an agency that will manage and supervise whether such supports are used appropriately. Currently, we have requested financial support of about 300 billion won ($250 million), although KMA estimates 1.5 trillion won is needed.
As health insurance has limited financial resources, we cannot give insurance benefits to all medicinal products. I think it right to leave the matter to the market unless they are essential drugs. The Moon administration has promised to provide insurance coverage to as many medicines as possible. Still, it forces patients to shoulder 80 percent of drug prices due to the lack of funds. This is fake insurance.
|KMA President Choi Dae-zip went on an indefinite hunger strike in July 2019, calling for the withdrawal of President Moon Jae-in’s healthcare policy and declaring a general strike of doctors.|
Q: Why don’t you talk with the government first? And what are the chances of success if KMA stage a strike?
A: We tried to talk with the health authorities in 2018, thinking it necessary to reveal the medical community's problems and discuss them with the government. Last year, I went on a hunger strike for more than a week. All those struggles failed, however.
Q: Critics doubt whether you can represent 130,000 doctors, pointing out that you were elected with the support of slightly more than 6,000 members. What would you say?
A: The current election system of KMA has limitations, and it cannot elect a president if we argue about the representation issue. Only members who pay fees for three consecutive years can vote. Currently, about 45,000 doctors have voting rights. In March 2018, some 25,000 of them cast ballots, and I won support from 30 percent of valid votes, by far the most.
The current KMA executives, including me, are not struggling to maximize doctors’ profits. We are pursuing the agenda agreed on by most members to protect our minimal rights and interests.
Q: Since the nation produced more lawyers, the public has enjoyed better legal service. Shouldn’t the same thing happen in the healthcare scene?
A: The most important goal for any medical association is how to secure excellent doctors. As doctors have to deal with human life, I don’t think it proper to produce a larger number of “optimal-quality” doctors. Such talk does not make sense according to doctors’ work ethic.
Q: What made you become a doctor?
A: My mother had a heart problem since I was very young. I witnessed my mother suffer from cardiac arrest twice. She had to undergo operations to replace three heart valves with artificial ones. Those experiences drove me to this profession.
Q: Your profile says you are a politician and a medical doctor. If you were so interested in politics, why didn’t you major in law or politics?
A: When I was a student, I was not interested in politics. However, after becoming a doctor, I found problems in the healthcare field and took part in a social movement.
Q: You are a supporter of the ousted former President Park Geun-hye. Doesn’t it run counter to the sentiments of the majority of the people?
A: I think impeaching a sitting president should not be decided by public opinion or emotion. To oust a president, we need factual evidence that she or he committed too grave a crime to take the top job. Strictly speaking, however, I am not such an enthusiastic supporter of the former president.
Q: Who are the politicians you admire most?
A: I respect two former presidents – Syngman Rhee and Park Chung-hee. President Rhee, in particular, made historical accomplishments of establishing the Republic of Korea and made the country as a free, capitalist state. He also laid the foundation for nurturing 700,000 troops through an alliance with the United States.
Since my childhood, I have also respected Ahn Jung-geun, who was martyred for this country.
Q: It’s interesting that you respect historical figures of conflicting characters -- pro-Japanese politicians and an independence fighter.
A: Former President Rhee was not a pro-Japanese collaborator.
Q: Some say you also admired former President Kim Dae-jung, who hailed from your hometown of Mokpo, South Jeolla Province, but later turned away from him because of Kim’s medical policy to separate prescribing and dispensing drugs. Is that true?
A: Actually, I had little more than a moderate degree of a favorable impression of former President Kim. However, I was very disappointed with his signing a June 15 Joint Declaration with the then North Korean leader Kim Jong-il.
Q: What’s wrong with pursuing inter-Korean reconciliation?
A: In the inter-Korean relationship, South Korea is always deceived by the North. The communist regime will never change no matter what it says ostensibly.
Q: You can seek reelection according to the association’s articles. Will you do so?
A: No, I won’t.
Q: What will you do after leaving the office, then?
A: I have not thought about it much. Maybe I’ll have to take a rest at least for a year.
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