Expanding the medical school enrollment quota emerged as a key issue in Wednesday’s parliament audits of the National Health Insurance Service (NHIS) and the Health Insurance Review and Assessment Service (HIRA).
Asked how much medical school students should be increased, the heads of both organizations remained reticent.
However, NHIS President Jung Ki-suck said an increased medical school quota's "trickle-down effect" on allocating more doctors to essential care and non-Seoul areas would be “minimal.”
During the National Assembly's inspection of the two government agencies, Rep. Shin Hyun-young of the opposition Democratic Party of Korea (DPK) asked the heads of the two organizations, both former doctors of essential medical care, whether they supported expanding the number of medical school students and inquired about the appropriate size of the increase.
NHIS President Jung is a respiratory physician, and HIRA President Kang Jung-gu is a surgeon.
Both were hesitant to take a stand. "I understand that the demand is quite high," Jung said. “I used to provide essential care, but I don’t know whether it is appropriate to express a position on the size of the quota increase,” Kang said.
Rep. Shin was tenacious in her questioning. "Please give me a simple answer on how many students should be added to the medical school," Shin said. "The media cited 350, 500, 1,000, 2,000, 3,000 more students. How many should the government add yearly?”
Again, there were no definite answers. "I don't have a personal opinion," Jung said. Kang said, “I can't say how many because I haven't considered it. It's difficult to discuss the exact number."
However, when asked about the trickle-down effect of expanding the number of medical school students on expanding doctors in essential medical fields, Jung said, "It should be seen as minimal," adding that the concentration of doctors in dermatology and cosmetic surgery is “very natural.”
On the condition of personal opinion, Jung said more medical school students will lead to more health care spending.
"It's clear that demand creates supply. In the U.S., there was a shortage of doctors, so they imported them, and unnecessary tests increased. As the number of doctors increases, each has to generate revenue to make ends meet," he said. “And the state health insurance spending is bound to be much bigger than that."
Rep. Shin pointed out that expanding the number of medical school students should not be a political issue.
"I think it is a bad example of the ruling party pulling out that card to make up for the failure of a district mayoral by-election," she said. “Before increasing the number of medical schools, it is necessary to establish a medical expert committee to estimate the number of doctors based on scientific evidence.”
Shin had also introduced a bill, “Partial Amendment to the Healthcare Manpower Support Act," to establish such a committee.
"If an integrated information system related to healthcare worker licensing is established at the NHIS, it will provide data that can be objectively studied to estimate the supply and demand of medical personnel. In countries like the United States, Japan, and Australia, there are organizations dedicated to the supply and demand of doctors. Through monitoring various trends, the government can prepare long-term plans and make policy judgments on how to increase the number of doctors more stably instead of turning it into partisan battles."
"The number of doctors in Korea should not be politicized," she said. “The ultimate goal of the policy should be to strengthen medical care in essential areas, not to expand the number of medical school students."
Ruling and opposition parties spar over 'Moon Jae-in Care'
At the audit, the ruling and opposition parties fought over the Moon Jae-in administration's policy to strengthen health insurance coverage. The ruling People Power Party (PPP) criticized “Mooncare” as a populist policy that caused health insurance finances to collapse, while the opposition DPK said the PPP lacked evidence to prove it.
"The only thing (in the NHIS report) that I could find noteworthy was the objective fact that the expansion of coverage for brain MRI scans has increased the early detection of ischemic stroke, which is a positive effect," said Rep. Kim Min-seok, a DPK lawmaker. "There's not much else to find a problem with. Shouldn't Mooncare have a positive effect?"
Rep. Jeon Hye-sook of DPK also said, "HIRA monitors (MRIs and ultrasounds) under the pretext of preventing their excessive use. The decline in their use was due to HIRA’s cuts in reimbursement” she said.
No government in the past has called the positive function of enhancing coverage “populism or waste,” Rep. Jeon said. “The Lee Myung-bak and Park Geun-hye administrations also expanded coverage. Are theirs good, and the Mooncare is bad? The politicized belittling of Mooncare is wrong.”
In contrast, Rep. Lee Jong-sung of PPP pointed to the NHIS’s “performance management goal” among the evaluation indicators of the MRI and ultrasound guarantee expansion support project among the detailed projects last year, countering that the indicator shows that Mooncare was a populist policy.
"I'll show you the evidence of populism. The performance targets for the coverage expansion support subproject are to achieve the number of beneficiaries and targeted benefit expenditures due to the expansion of health insurance coverage. How can the goal be simply increasing the number of beneficiaries? These are populist policies."
Lee said, “How much money was spent on how many people cannot be a policy indicator. Instead, evaluating whether precious public money was spent on the right people who need it should be the key criterion.”
‘70 percent of health insurance policy panel members don’t know the field’
Another lawmaker pointed out that the composition of the Health Insurance Policy Review Committee, which decides most of Korea's health insurance policies, should be changed, pointing out that most members do not know the medical field and cannot reflect the reality of policies.
"We need to change the composition of the health insurance policy review committee," said Rep. Cho Myung-hee, a PPP legislator. "Last year, I asked the Ministry of Health and Welfare and the NHIS to raise the price of essential medical care, but it didn't proceed well. The committee does not collect opinions properly."
"Of the 25 committee members, only six know the medical field. The other 70 percent don't know the field," she said. “If a new government wants to push new policies, it must change the committee."
Cho also called for an increase in the fees for essential medical treatments.
"If the price of essential medical care had been raised last year, there would have been no controversy over the enrollment quota increase," she said, "I called for raising the fee at the last audit. However, there is no point in conducting the parliamentary inspection if requests are not accepted. I hope this will not be repeated."
In response to a request to change the health insurance policy deliberation panel's composition, NHIS head Jung replied positively, saying, "We will do so."
Regarding the upward adjustment of the fees for essential medical care, he said, "While adjusting the relative prices this year, there is a lot of support for essential medical treatments. Next year, we invest about 80-90 billion won ($60-70 million) in additional finances in the essential care."
‘Blocking 6,000 new beds in Seoul metro region will save 12 trillion won’
There were also calls for a plan to revoke the permission to open branches of university hospitals in the Seoul metropolitan area. Citing the example of Kyung Hee University Medical Center, which canceled its branching out plan due to disagreements with the local government, some lawmakers called for the government to devise measures to prevent the expansion of beds.
"If 6,000 beds are to be built in the Seoul metropolitan area, how many patients and doctors will be needed to fill them," said Rep. Kim Won-soo of DPK. "There will be excessive competition for hospitalization. The waste of health insurance funds is also obvious. The NHIS should have a clear stance on the 6,000-bed plan, and the health and welfare ministry must curb it."
"Kyung Hee University Medical Center wanted to build a 600-bed branch in Hanam, Gyeonggi Province but canceled it due to disagreements with the local government. Like this, the local government, the health-welfare ministry, and NHIS can jointly revoke a branching out plan in the metro region if they work together."
"We have come this far because local governments wanted to attract hospitals," Jung said. "It is true that ‘social hospitalization’ occurs due to an excess of beds, which is a problem for health insurance finances. We are conducting long-term research on how to make such hospitals die naturally."
Calls were made to address drug shortages
Other lawmakers pointed out that HIRA should actively utilize the Korea Pharmaceutical Information Service (KPIS) to eliminate "pharmacy pilgrimage” due to the unstable supply of medicines. They noted that it would have been possible to grasp the unstable supply and demand of medicines and take preemptive measures had they used data from the KPIS.
"There are 21 primary drugs with 11 ingredients that experience unstable supply problems; one-third of them were those without generic drugs. In June, the Korea Children's Hospital Association reported 141 essential drugs and nine drugs for severe diseases had been sold out." DPK lawmaker Seo Young-seok said.
Although the authorities can fully know this through KPIS, they stopped dealing with the situation as just civil complaints, Seo noted.
"Pediatric and adolescent drugs can have problems from the production stage due to low birthrate. If we don't especially manage the supply and distribution, it will be disastrous," he added.
Urged to develop an indicator of supply and demand instability and establish a system to manage it from the production stage, HIRA President Kang replied, “We will take care of it closely and carefully."