‘Healthcare reform to save essential care will lead to commercializing medical system’

The government’s policies to resolve medical crises will only lead to commercializing the healthcare system, threatening the sustainability of health insurance, experts pointed out recently.

Such arguments were made at a discussion on “Sustainable Health Insurance and Challenges to Overcome the Healthcare Crisis” organized by the Special Committee on Healthcare Crisis of the opposition Democratic Party of Korea at the National Assembly on Monday.

“I am convinced that the purpose of the government’s healthcare reform is more to target the financial sustainability of state health insurance than to revive essential care. To achieve this goal, medical commercialization will follow,” said Kim Chan-gyu, a third-year emergency medicine resident at Wonkwang University Hospital but resigned. Kim works as a general practitioner in the emergency department of a local secondary hospital and is the head of a medical consumer organization.

Kim cited as an example the government's policy of raising the co-payment for medical expenses to 90 percent to limit the use of emergency rooms for mild cases.

“I agree that it needs to be improved from the perspective of healthcare costs and financial sustainability and that the threshold of emergency rooms should be raised to prioritize severe patients,” he said.

However, Kim noted that it would be difficult to control healthcare consumers' “medical service-using inertia.”

“Patients who come to the ER often say, 'I came here because I could no longer endure the pain,'” Kim said. “Very few doctors can tell them to endure further because they are mildly ill.”

Kim continued, “Using a co-payment hurdle to raise (the threshold) to ERs will lead to the commercialization of healthcare commercialization from the bottom up, driven by consumer desire.”

People who can afford a 90 percent co-payment or those with insurance that covers the co-pay will continue to use the ER as before. However, Kim explained that those who cannot afford it will face an invisible hurdle because they cannot determine whether their condition is mild or severe and cannot visit ERs even though they are feeling unwell.

He said the government's policy was the first step toward changing the payment system, calling for policymakers to provide opportunities for healthcare consumers to have a voice in shaping desirable healthcare policies.

“The government says it wants to revive essential and community care, but at the same time, it seeks to lower the barriers to medical access by increasing the number of medical school students,” Kim said. “However, the real purpose is ensuring healthcare finances are healthy and laying the cornerstone for implementing payment system changes.”

He continued, “The protagonists of healthcare reform are neither the government nor the medical community but healthcare consumers. Without understanding their habits in using healthcare services and ensuring a direction to address their needs, reforms aimed solely at healthcare financing will have unpredictable side effects. It will lead to de facto commercialization of healthcare services.”

Some experts noted that policy design is needed to maintain sustainable health insurance.

“Although national health insurance covers all essential medical expenses and only a small portion is covered by the private accidental loss insurance, people reject the increase in health insurance premiums. On the other hand, the same people are trying to get accidental loss insurance by all means,” said Chang Seong-in, head of the Health Insurance Research Institute under the National Health Insurance Service (NHIS).

In the future, Chang said, the national healthcare system must design policies that make people want to pay more for health insurance and think it is in their interest to do so, just as they pay for accidental loss insurance. It also should not overlook the system and structure that ensures efficiency with limited resources.

“We need options to gain people's practical consent for the new system and to build a social consensus for the system to be sustainable,” Chang said. “To become a national system that protects people's health, options should be created, and people should be able to choose, which is important for the next generation health insurance system.”

He also suggested creating a research environment for designing future health insurance policies.

“Someone has to do the work of creating real (health insurance) options. Suppose the R&D center is operated through our institute. In that case, it is necessary to create conditions for researchers to design the next-generation healthcare system with support,” he said. “If that is difficult, I hope the institute will create conditions for health insurance reform research.”