Three high school students were found dead and seven unconscious at a pension in Gangwon Province Tuesday because of what is assumed to be carbon monoxide intoxication. One consolation in sadness was that the accident took place in the northeastern province, which has two of the medical institutions – GangNeung Asan Hospital and Wonju Severance Christian Hospital – that can provide best hyperbaric oxygen (HBO) treatments in Korea.
Even if similar mishaps had happened in Seoul and its vicinity where almost half of South Koreans live, medical workers should have sent the patients to Gangwon Province. This is because there are no hospitals in the capital area equipped with a multi-person HBO chamber. In severe cases of CO poisoning, medical workers should enter the HBO chamber together with the patients and treat them.
Experts cite the current reimbursement system, in which the more patients hospitals treat, the larger the losses they incur, as the reason for the scarcity of HBO chambers.
|This is hyperbaric oxygen chamber at Wonju Severance Christian Hospital, one of the few institutions that run the facility. (Credit: Wonju Severance Christian Hospital)|
No HBO chambers in the capital and surrounding Gyeonggi Province
Korea has 26 medical institutions equipped with HBO chambers as of Tuesday, according to the Korea Society of Undersea and Hyperbaric Medicine (KSUHM) and the Ministry of Health and Welfare. Only 12 of them have multi-person HBO chambers that can treat critical, unconscious patients. However, those attached to Air Force and Navy can be used only for soldiers and police officers while the facility at the New Segyero Hospital in South Gyeongsang Province cannot be operated due to lack of responsible medical staffs. That means the nation has only nine hospitals that operate multi-person HBO chambers.
Notably, the most densely populated capital area has no multi-person HBO chambers at all. Five institutions – Seoul Asan Hospital, Hallym University Guro Sacred Heart Hospital, Hanyang University Hospital, Inha University Hospital and Soon Chun Hyang University Hospital Bucheon – are operating HBO chambers but all of them are single-person facilities making it difficult to treat critical patients.
“If patients are unconscious or have respiratory failures as are the cases with the accident at a Gangneung pension, medical workers should enter into the HBO chambers to watch the conditions of patients under treatment,” said Park Sang-hyeon, director of the Emergency Medicine Department at Seoul Medical Center. “As single-person chambers can only accommodate patients, it is impossible to treat critical patients who require several other devices there.”
That explains why experts said it was a happy feature of misfortune that the accident took place in Gangneung.
“This was an accident not supposed to happen at all, but it was a relief the mishap happened in Gangneung. If similar incidents had happened in Seoul or Gyeonggi Province, they should have sent the patients to GangNeung Asan Hospital or Wonju Severance Christian Hospital, which must have taken far more time,” an expert said. “Even if President Moon Jae-in gets CO poisoning, Cheong Wa Dae staffs will have to send him to Gangneung or Wonju for treatment.”
HBO chambers incurring losses due to small insurance payment
Behind the relative scarcity of medical institutions with HBO chambers is the structure, which makes it “impossible for operators to earn money” with it. As the reimbursement is low for the treatment of HBO therapy and the number of diseases for which it is efficacious is limited, hospitals find it difficult to generate revenue even if they install them and treat patients.
According to KSUHM, installing a single-person HBO chamber costs 200 million won ($178,000) and that for a 10-person HBO amounts to 1 billion won. And their maintenance expenses are seldom negligible, given it requires the operation of a doctor, a nurse and an equipment operator in each team for 24 hours a day.
The insurance payment stands at 100,000 won per patient, and the state underwriters recognize only one treatment a day even if hospitals provide multiple cares. Considering it takes an average of two-and-a-half hours to treat one patient, the “quick-sales-at-small-profits” structure is unthinkable from the start.
“HBO treatment is effective not just for CO poisoning but other diseases, including diabetic foot ulcer, but the latter is not even included in the reimbursement category,” said Professor Park In-cheol at the Emergency Medicine Department of Severance Hospital. “The reimbursement amount is also too low. To generate profits under low reimbursement, we should treat many patients, but that is difficult because it takes more than an hour to treat one patient.”
Because hospitals have to spend lots of money to install HBO chambers but find it difficult to make money due to low reimbursement, they are reluctant to introduce related equipment,” Park added.
To the relief of related medical circles, the per-patient insurance payment will go up to 170,000 won next year, at the persistent request from KSUHM. The restriction on the number of treatments will also be lifted, and applicable diseases will expand to affect not just CO poisoning and decompression sickness but diabetic foot ulcer and chronic incurable osteomyelitis.
‘Every region should run at least one CBO chamber’
The nation has still a long way to go, however, according to the society.
“Until as recently as the 1980s when CO poisoning was quite frequent, Korea was one of the countries that have most HBO chambers. Since then, however, coal briquette burning has drastically fallen, pulling down the number of HBO chambers with it,” said Kim Ki-un, a professor at Emergency Medicine Department at Soon Chun Hyang Hospital Bucheon, who also serves as an executive for policy at KSUHM.
HBO chambers are needed to treat not only people who attempt suicide using coal briquettes but dermal necrosis occurring after radiation therapy, but hospitals would seldom install them because of low cost-effectiveness, he added.
“Because of our society’s persistent requests, reimbursements will go up by 50 percent, and the scope of applicable diseases will be expanded to the U.S. levels,” Kim said. “The situation is still unsatisfactory but will gradually improve, I hope.”
The head of KSUHM also emphasized every region should be able to operate at least one multi-person HBO chamber.
“The government should not leave HBO chambers to the market force. It should provide financial support so that each region can run at least one HBO chamber,” said Huh Tak, chairman of KSUHM and a professor of Emergency Medicine Department at Jeonnam University Hospital. “It takes lots of expenses not just to install the facilities but to maintain and operate them.”
Huh went on to say, “If the government leaves this matter to individual medical institution influenced much by bottom lines, it would inevitably result in a regional imbalance between demand and supply.
“That shows why the government ought to provide multi-person HBO chambers in consideration of needs on national and regional levels,” he added.
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