The carbon monoxide poisoning accident, which took the lives of three high-school students last week, exposed the reality of the nation’s hyperbaric oxygen (HBO) treatment.
In treating unconscious patients as are the victims of this accident, multi-person HBO chambers are a must because medical workers, along with auxiliary equipment, have to go into the chamber to monitor the patients. For this and other reasons, even a 10-person HBO chamber can treat only two to three unconscious patients.
According to the Ministry of Health and Welfare, there are 26 medical institutions that have HBO chambers in Korea. Multi-person HBO chambers, however, are in only six provinces and large cities – Gangwon Province, Busan, Daegu, South Chungcheong Province, South Gyeongsang Province and Jeju Province. There are no hospitals with multi-person HBO chambers in Seoul, Gyeonggi Province and Incheon where almost half of the population is concentrated. Ulsan does not have even a single-person HBO chamber.
|A single-person HBO chamber at Soon Chun Hyang Hospital Bucheon (above) and a multi-person HBO chamber at Jeju Medical Center (Credit: Korea Society of Undersea and Hyperbaric Medicine)|
There had been more than 300 hospitals with HBO chambers until the 1980s when Koreans used coal briquettes for warming and cooking. The rapid decrease in the number of patients poisoned with coal briquette gas has also sharply reduced the number of HBO chambers.
On the other hand, the United States has more than 1,000 medical institutions that have HBO chambers. Japan also has more than 500 hospitals with HBO chambers. This is not because the U.S. and Japan have far greater numbers of coal briquettes gas poisoning patients, but because these countries use HBO treatment to deal with not just CO poisoning and decompression sickness but various other diseases, including diabetic foot ulcer. The U.S. and Japanese hospitals are just following the market theory.
According to the Korea Society of Undersea and Hyperbaric Medicine (KSUHM), the U.S. pays about $300 (338,000 won) as reimbursement per patient who receives HBO treatment. The diseases to which they apply HBO treatment are also varied ranging from -- besides CO poisoning and decompression sickness – air embolism and crush injury to severe anemia, abscess inside the skull, difficulty in hearing and gas gangrene. All this explains why the U.S. has about 1,200 HBO centers. These facilities have either a multi-person HBO or about six single-person HBO chamber.
In Japan, the reimbursement for HBO treatment is about 500,000 won per patient. Japanese hospitals also apply HBO therapy to diverse diseases, such as incurable ulcer, radiation hazard, hypoxic encephalopathy, sudden deafness, intestinal obstruction and acute coronary syndrome. There are about 500 hospitals that have HBO chambers.
In Korea, however, HBO treatment is about to wither away instead of expanding, because of low reimbursement, experts say.
Last year, the per-patient reimbursement for HBO treatment was 100,000 won at most in Korea, with underwriters recognizing repeated cares on the same day as just one treatment. Its applications are also limited to CO intoxication and diver’s disease. KSUHM has persistently brought up the problem, managing to lift the restriction on repeated treatments and expanding applications to also include diabetic foot ulcer, abscess inside the skull and chronic incurable osteomyelitis, starting in next January.
To create infrastructure for treating patients on time when accidents like the one at the Gangneung pension occur, however, the government needs to raise reimbursement and provide other supports, the society emphasized. The health and welfare ministry should help to finance the installation of multi-person HBO chambers at regional emergency medical centers and raise insurance payment to apply HBO treatment to more varied diseases, it said.
“In the United States, the federal government is supporting regional medical institutions install HBO centers, in part to prepare for fire and other disasters,” said Kim Ki-un, a KSUHM executive for policymaking who is also a professor at the Emergency Medicine Department of Soon Chun Hyang Hospital. “They pay 300,000 won per patients and allow its application to various diseases so that many hospitals are operating HBO treatment facilities.”
Kim said Korea also should call for the installation of HBO chambers at regional medical centers with the financial and other support from the central government, as part of preparations for disasters. The health and welfare ministry also ought to increase insurance payment so that hospitals not incur losses, let alone generate profits, from the HBO treatment, he stressed.
“Also, other countries are applying HBO treatment to various diseases but we are not. We need to step up public awareness campaign about HBO treatment,” Kim added.
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