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Doctor Lee’s struggle shows downside of medical service in KoreaRegional trauma centers suffer mounting losses despite rising patients
  • By Song Soo-youn
  • Approval 2017.11.28 15:06
  • comments 0

As a gunshot-wounded North Korean soldier drew the world’s attention for making a dramatic dash through the Joint Security Area to flee to the South, trauma surgeon Lee Cook-jong at Ajou University Hospital was also under the big spotlight of the media for saving the defector’s life.

The Washington Post called Lee “the McDreamy,” a nickname of fictional character Doctor Shepherd from the U.S. medical drama “Grey’s Anatomy” who is perfect in every aspect.

However, Lee’s life is far from that of the McDreamy in reality of Korean medical service.

After graduating from Ajou University’s College of Medicine and receiving the medical training at Ajou University Hospital’s surgery department, Lee chose trauma medicine as his field, which almost no one else chose. He also received training for trauma surgery at the UC San Diego School of Medicine in the U.S. and the Royal London Hospital in the U.K.

Department of surgery is such an unpopular medical career choice in Korea. For years, medical schools have suffered shortfalls in applicants. According to the Ministry of Health and Welfare, departments of surgery across the nation opened 195 attending positions in 2016 but only 179, or 91.8 percent, were filled. This year, only 172, or 90.1 percent of the 191 positions, were filled in the surgery departments. Even in the medical community, trauma surgery is unpopular.

While pursuing the silent and unrecognized life of a trauma surgeon, Lee was thrust into the spotlight in 2011 when he saved the life of a ship captain who had been shot by Somali pirates in the Gulf of Aden. Then, the Korean public called Seok “the hero of the Aden Bay,” for surviving six critical gunshots while in hostage during the South Korean naval force’s operation to rescue crew members of the Samho Jewelry.

After saving Seok’s life, Lee drew the media’s attention, just like he did in recent weeks, and pointed out the problems of the local medical system in treating trauma patients. He called for the government to increase support for trauma centers. Lee’s appeals moved the public opinion and led the National Assembly to pass the so-called “Lee Cook-jong Act,” or a revised Emergency Medical Service Act, in May 2012. The revised law offered legal grounds to establish regional trauma centers with the government’s help. Accordingly, the Health and Welfare Ministry in August that year announced that it would spend 200 billion won ($183.4 million) of emergency medical service fund to build 17 regional trauma centers by 2016 and nurture trauma surgeons to fill vacant positions.

At that time, the ministry vowed to lower preventable trauma death rates in Korea from 35.2 percent in 2010 to below 20 percent by 2020. With both the government and politicians promising aggressive support, the goal seemed feasible.

Lee Cook-jong, trauma surgeon at Ajou University Hospital, talks with a trauma patient who recovered from surgery.

About five years have since passed, but Korea is left with the same problem. Regional trauma centers have been just established without much funding. The South Gyeongsang region has no regional trauma center yet because no hospitals there are willing to provide related care.

Regional trauma centers are still in a shortage of trauma surgeons to treat patients. According to the Korean Society of Traumatology (KST), Korean medical schools have nurtured 228 trauma doctors, but only half of them are working as trauma surgeons. One regional trauma center needs 23 trauma doctors. That translates into the minimum number of 391 trauma surgeons needed at 17 regional trauma centers, according to the KST. However, none of the nine regional trauma centers currently in operation has met the legal minimum employment number of 20 trauma surgeons.

The worse problem lies in the medical care system where the more patients trauma centers treat, the larger losses they have to suffer. On a newsletter of Ajou University in September, Lee wrote that he “became a monster who was to blame for the school’s annual loss of 1 billion won.”

Trauma patients need multiple operations due to complex intestinal damage and stay hospitalized longer than other patients. However, the reimbursement system to cover the medical costs is weak in reality. Under the national health insurance system, reimbursement for surgeries is categorized only for head, limbs, torso, and abdomen. Operations of multiple parts of the body due to complex intestinal damage and reimbursement requests for individual body part operation are likely to end up with reduced reimbursement.

Heo Yun-jung, a professor at Ajou University, said Korean emergency rooms could be paid only up to 68 percent of the medical cost on average and the reimbursement rate is worse at trauma centers, in her report, “How to improve reimbursement system for regional trauma centers,” in October 2014. A regional trauma center suffered a 32.83 percent annual loss in its 2013 profit and loss statement, losing 2.52 million won per patient.

“Operation costs cannot be fully reimbursed. Under the current insurance system, hospitals should raise the number of outpatients, while discouraging hospitalization, to make profits. But to treat trauma patients who are hospitalized for a long time, trauma centers are in a loss-making structure,” Heo said.

As trauma surgeon Lee saved the life of the North Korean defector and appealed for more funding for trauma centers, the Korean public once again moved to support him. As of Monday, more than 230,000 Koreans have signed the online petition for more support for trauma centers on the presidential office of Cheong Wa Dae.

Apparently pushed by the Korean public’s move, the government said it would come up with measures to support regional trauma centers.

“I ordered ministry officials to find out what kind of issues regional trauma centers have. The ministry will thoroughly review all of the aspects, including medical charges, reimbursement criteria, and evaluation criteria,” Vice Minister of Health and Welfare Kwon Deok-cheol said.

However, some raise concerns that the attention on regional trauma centers might be short-lived. With the spotlight fading, Ajou University Hospital could not receive 200 million won medical cost for treating captain Seok. The hospital was even asked to urgently pay for using the air medical service that moved Seok to the hospital. The Korea Shipowners’ Association, where Seok’s Samho Jewelry had a membership, later paid for the air ambulance.

soo331@docdocdoc.co.kr

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