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Why do doctors oppose Mooncare?
  • By Marian Chu
  • Published 2018.05.25 14:08
  • Updated 2018.05.25 14:08
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Members of the KMA march towards the Blue House as part of the anti Mooncare rally held in central Seoul Sunday.

More than 10,000 doctors took the streets of Seoul Sunday to protest the new healthcare policy of President Moon Jae-in, dubbed the “Mooncare,” and called for an overhaul of the healthcare system.

The objective of the Mooncare is to lower financial burden for citizens in need of medical care. It aims to do so by providing coverage for an additional 3,800 medical services – raising the share of care covered from 63 percent to 70 percent.

The government announced last year that it would spend 30.6 trillion won ($28.1 billion) over the next five years to cover all medical treatments eventually, excluding beauty and cosmetic care.

However, doctors have been protesting against Mooncare fiercely since its announcement, with a medical association ramping up cries of opposition this weekend. The anti-Mooncare rallies came ahead of the negotiations to take place between the health authorities and physician groups Friday.

Against this backdrop, Korea Biomedical Review uncovered why members of the Korea Medical Association are opposing Mooncare.

Existing reimbursement system leaves doctors in the red

President of the Korean Medical Association Choi Dae-zip

KMA President Choi Dae-zip, who led the anti-Mooncare rally in central Seoul, called for an end to the healthcare policy, protesting additional coverage for medical services.

“We are holding this rally to relay the doctors’ opinion to the rest of society, the National Assembly, and the government. We are calling for stopping reimbursing all uncovered medical care, abolishing the system of limited reimbursement, normalizing treatment costs, and reestablishing unreasonable examination systems” Choi said.

The main complaint against Mooncare is based on the problems of the current reimbursement system where physicians lose money treating patients. Physicians are arguing that more reimbursement will mean bigger losses.

“The amount of coverage is about to get greatly strengthened with the implementation of Mooncare. Now the medical community stresses - as it has always stressed - the appropriate price for medical services,” said Im Young-jin, president of the Korean Hospital Association, at a meeting with officials from the National Health Insurance Service earlier this month

“Doctors point to low medical bills as the problem, but this is not because they want their hospital to make more money. It’s because they can at least keep their hospitals running and provide quality care in a safe situation,” he added.

Doctors claim they barely keep their hospitals going because of an “incorrect” price set for medical services.

Under the current policy, the government and the patient split the medical bill. If the medical service costs 100 won, the patient pays around 25 won, and the government pays the remaining 75 won.

Physicians opposing Mooncare argue that 100 won is not enough to cover the actual cost of medical service because of additional overhead, human resources, and material costs.

According to a 2012 report submitted by the Korea Institute for Health and Social Affairs to the Health Insurance Review and Assessment Service, the “cost conservation rate” was 85 percent for clinics and 75 percent for medical fees. The numbers indicate that hospitals get only 75 percent return on investment for treating a patient.

“It’s quite absurd because doctors invest 100 percent into treatment but only get around 75 percent of their investment back. This might lead to bankruptcy for the doctor,” said a university hospital professor who claimed anonymity. “It also forces doctors to find a way to compensate for their losses.”

Doctors say they have relied on quantity over quality regarding medical care, treating a large number of patients a day to stay afloat.

“Hopefully this year, we will determine the appropriate medical fee for every medical department, and we hope for a [successful] negotiation that can be applied to the field,” Im said.

Despite the willingness to talk, physicians are largely distrustful of the government given how the current reimbursement system was set up. Physicians at the rally also claimed Mooncare would deplete national health insurance funds, raising health insurance premiums for all citizens.

'Mooncare drives doctors into a corner'

Under the current system, physicians say they had little choice but to turn to uninsured medical services to keep their hospitals going.

Members of the Korean Medical Association protest Moon Jae-in Care at a rally held at Deoksugung in central Seoul Sunday.

Many Korean physicians and hospitals claim they turned to expensive, uncovered medical services such as MRIs and robotic surgeries to make up for the losses they incur by treating patients.

However, Mooncare aims to cover all treatments. As a result, physicians have fewer medical services to turn to for profit.

“By expanding coverage, doctors face greater difficulties in compensating for the losses. They’re worried that it will lead to heavier financial losses from treating patients,” an expert said.

Kim Yong-ik, chief of the National Health Insurance Service and the drafter of Mooncare, noted on the problem in a radio program Kim Uh-joon News Factory last Thursday.

“Hospitals could stay afloat because of the so-called uninsured [medical services] that acted as a source of income even if the government set a low medical charge. Now, with the insurance coverage, hospitals need to live off only the health insurance. Putting the medical charge amount too low could lead to the annihilation of hospitals so we can’t do that,” Kim said.

Government 'infringes' on the right to diagnosis and treatment

The KMA also claims the government infringes on the right to diagnosis and treatment.

Under the present system, the government reviews the doctor’s medical service. It then decides on whether to reimburse the activity.

“If the government considers the medical activity unnecessary, it notifies the patient by telling them, ‘You were treated inappropriately and should get money back from the doctor,’” said an industry insider. “This greatly influences the doctor-patient relationship and works to infringe on doctors’ rights.”

Physicians also say the government wields power over the treatment method used and may lead to doctors refraining from using advanced, often expensive, treatment.

Doctors have also criticized an unspecialized review board that does not have the expertise to decide on the appropriateness of the treatment used.

“In principle, from the perspective of the government, Mooncare would be ideal because the government can control all treatment and diagnosis done by doctors. However, from the physicians’ side, doctors want to correct the reimbursement amount for medical services and stop the government’s infringement on the physician’s right to treat and diagnose patients,” an industry source said.


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