Despite the government’s will to continue healthcare reform, major tasks stall

Even amid the impeachment proceedings against President Yoon Suk Yeol, the government has stated that it will continue to pursue the four major reform projects, including healthcare reform.

However, the healthcare reform project, promoted in earnest after the formation of the Special Committee for Healthcare Reform in April, has largely stalled except for the support project for restructuring tertiary general hospitals, on which the government exerted strong influence.

“Each cabinet minister should responsibly pursue reform tasks with full authority,” Acting President and Prime Minister Han Duck-soo said in a speech at the cabinet meeting on Tuesday. Han instructed ministers to push ahead with healthcare reform and other projects even in the face of impeachment proceedings against President Yoon Suk Yeol.

On Aug. 30, four months after its launch in April, the Special Committee for Healthcare Reform, under the direct jurisdiction of the president, announced the “First Action Plan,” which included four reform tasks -- replenishing competent medical personnel, rebuilding the innovative healthcare delivery system and regional medical care, establishing a fair and sufficient compensation system for strengthening essential medical care and creating a medical accident safety net.

However, the medical community's non-participation in the healthcare reform discussion, which was premised on increasing the number of medical students by 2,000, has caused most, if not all, tasks to fail to gain speed and have yet to reach a conclusion.

Panel to estimate optimal medical workforce will unlikely start business this year

The “Expert Committee for Estimating Medical Workforce Supply and Demand,” designed to replenish competent medical personnel, aimed to finish its composition this year, but the lack of participation from the medical community has made it difficult to organize it this year.

The Healthcare Policy Review Committee will decide once each medical occupation's committee and advisory committees are formed. The government decided to establish a committee for each profession, starting with doctors and nurses, but there was no news of the formation of either occupation.

Since the plan's announcement, the government has repeatedly asked the Korean Medical Association, the Korean Intern Resident Association, and the Korean Academy of Medical Sciences to nominate members for the committee, but they have refused to do so, and it is unclear whether the plan will be implemented.

Improving the training environment for trainee doctors ‘who no longer are present’

The support of 80 million won ($55,680) per year per teaching physician, which is the key to improving the training environment for trainee doctors, is also an unprecedented policy. However, it is uncertain whether the program will work normally next year.

The subsidy is provided because teaching physicians cannot treat patients as much as they devote to training. However, the subsidy has become meaningless as junior doctors who left the field to oppose the medical school enrollment quota increase are unlikely to return next year.

The plan to conduct a pilot project to reduce continuous training from 36 hours to 24 hours and weekly training from 80 hours to 72 hours from 2025 and to phase down the weekly training time to 60 hours by 2031 will also make it difficult to be properly implemented due to the lack of trainee doctors.

It is necessary to evaluate the impact of reducing the actual training time through the pilot project in the medical field, but it is impossible to implement it if the junior doctors do not return.

The introduction of a multi-institutional collaborative training system for trainee doctors also received attention when the government announced it. Some raised concerns about the practice of training junior doctors at neighborhood clinics, but no concrete details have emerged since then.

Despite the start of restructuring tertiary hospitals, they remain restless

The “Tertiary Hospital Restructuring Support Project,” a three-year pilot project to establish the functions of primary and secondary medical institutions and create a win-win structure in which medical institutions cooperate, began the earliest and in the most concrete ways.

After five rounds of recruiting applicants, 44 out of 47 tertiary hospitals participate in the restructuring project. These institutions will also reduce a total of 3,277 general beds to participate in the restructuring.

The Ministry of Health and Welfare plans to normalize the medical delivery system by strengthening the medical treatment capabilities of advanced general hospitals by focusing on severe, emergency, and rare diseases, establishing a strong cooperation system with secondary hospitals and other medical partners, and providing intensive training for trainee doctors.

However, as the future of the regime is unclear due to President Yoon's impeachment, anxiety is growing in the hospital community. Initially, most hospitals participated in the restructuring support project because they were told that if they did not, they would be disadvantaged in their next designation.

This means that hospitals participated in the project because they had no choice but to follow the government's policy rather than out of necessity. It is unclear whether the project will continue if President Yoon leaves office and the next administration takes over. Since it is a pilot project, there is a high possibility of interruption.

Therefore, there are already voices in the field saying, “We should consider the situation of the project’s interruption,” showing signs of losing momentum.

Will the government announce plans to improve uncovered treatment and actual cost insurance system?

The core of healthcare reform's plan to improve uncovered treatment and the actual cost insurance system is expected to include a ban on mixed treatment and a reference price system for uncovered treatments, given the government's “Second National Health Insurance Comprehensive Plan” (Draft) and the “First Practical Plan.”

Notably, mixed treatments are likely limited to those the government has classified as “non-reimbursement with obvious excessive concerns,” including hydrotherapy and cataract surgery.

In this regard, the government announced a public hearing on Thursday on how to improve the non-payment management and loss insurance system, which has yet to be canceled amid the impeachment crisis. Some have pointed out that the government is trying to improve the non-payment and loss insurance system without consulting the medical community.

If the government exploits the chaos of the presidential impeachment to push through policies by, for instance, banning mixed medical treatment, it could further exacerbate the already dire situation of medical-political conflict.

'Judicial risk mitigation' plan to help doctors also flounders

The medical community's favorite healthcare reform initiative, a malpractice safety net for patients and providers, is also in limbo.

The government said it would build a comprehensive medical accident safety net from the initial incident to the final dispute resolution to move away from medical error dispute resolution that relies on civil and criminal lawsuits, which has been burdensome for patients and medical staff.

However, while the plan for patients has been concretized, the plan for medical staff is only an idea, not a concrete plan.

For patients, to improve the fairness of the Medical Dispute Mediation System, an adversarial dispute resolution system will be introduced, a new patient advocate will be established and piloted in 2025 to assist patients, and a “national ombudsman” will be introduced.

In addition, to ensure the objectivity of appraisals, critical cases, including deaths, will be cross-verified by assigning multiple medical appraisers, and the pool of appraisers, which is only 300, will be expanded to more than 1,000 for specialized appraisals.

On the other hand, for medical professionals, the government is promoting the establishment of the “(tentative) Medical Institution Safety Mutual Aid Society” to provide prompt and sufficient compensation for essential doctors and specialists with a high risk of medical accidents by supporting part of their insurance premiums from 2025, activating liability and comprehensive insurance, and establishing and expanding deductibles.

However, it also remains unclear when and how this will be done.

Regarding the judicial risk mitigation plan, which is strongly advocated by the specialty medical community, the government said, “We will further discuss special criminal legislation to protect the best medical treatment and prepare adjustment and mediation plans for special application, requirements, and scope, and announce them within the year.”

However, there is still no follow-up news.

In addition, the “Establishment of a Beauty Market Management System” to create classification standards for beauty services to clearly distinguish between beauty medical care performed by doctors and beauty services not performed by doctors and to improve the classification of medical devices and beauty devices according to the standards, was also effectively suspended as it requires the collection of opinions from the medical community.

Besides, it is unknown when and how the “Second Implementation Plan,” which was scheduled to be announced at the end of the year and contains the main content of the payment system reorganization plan, will be announced. As the reorganization of the payment system is closely related to essential medical care and fair compensation, it is difficult to discuss the expansion of essential medical care without reaching a conclusion to the issue.

Can Health and Welfare Minister Cho Kyoo-hong fulfill his normal ministerial duties?

Minister of Health and Welfare Cho Kyoo-hong's personal risk related to his behaviors during the short-lived martial law will also likely make it difficult for him to push for healthcare reform.

At an emergency executive meeting on Monday, Minister Cho emphasized that the measures to strengthen regional and essential medical care already announced should be implemented consistently and faithfully according to the promises made to the people. He especially vowed to steadily pursue the pilot project for restructuring tertiary hospitals, launched in October.

However, Cho is currently under investigation for attending a cabinet meeting held before President Yoon declared martial law on Dec. 3 and is being investigated by the prosecution.

As a result, Minister Cho may be investigated further if the prosecution and police investigations related to martial law are in full swing as the impeachment proceedings against President Yoon continue.

Minister Cho attended a plenary session of the National Assembly's Health and Welfare Committee on Dec. 5 and stated that he “attended the cabinet meeting but expressed an opposing opinion.” However, he will likely face significant pressure because he attended the pre-martial law cabinet meeting.

Moreover, Minister Cho did not attend the cabinet meeting to lift martial law and gave a somewhat incomprehensible explanation for why he did not attend, saying, “I received a text (to attend the second cabinet meeting), but I was watching TV and was thinking about what to do in the future, so I did not recognize it.” That is likely to be a problem in the future.

If Cho was intentionally absent from the cabinet meeting to lift martial law, he should be held accountable. “If there is any responsibility (for not attending the meeting) in the future, I will take responsibility,” Cho said.

This makes it unclear whether Cho can take responsibility for major healthcare policies while facing the risk of an investigation related to the state of emergency. An in-depth discussion will be necessary to determine whether the public and the medical community can agree on the projects promoted with Cho's approval.