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±âŸ±Û(All except pediatric cardiology)

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Is ¡°free medical care¡± going to be possible?

Free medical care is one of the hot issues in Korea lately. However, from a practical point of view, ¡°completely free medical care¡± is impossible. National health insurance corperation(NHIC) had reported a huge deficit up to 1.3 trillion Korean won last year alone, which is the largest deficit during the past 10 years. It appears clear that NHIC will go bankruptcy unless drastic measures are taken soon.

There are many reasons why expenditure from NHIC is skyrocketing : ¨çDrug overuse is one of the largest component of NHIC expenditure, ¨èCost of developing a new drug or a device is very expensive, reaching more than 500 million dollars, ¨éRapidly increasing geriatric population and survivors of cancer or other chronic illness requiring a life-long and costly medical care, ¨êNHIC coverage for new and expensive diagnostic tests and drugs and coverage for neonates and infants, rare disease, disabilities and cancer is rapidly increasing ¨ëSpending for diagnosis and treatment of chronic disease, particularly cancer and metabolic disease is increasing rapidly as occurrence of these disease is increasing due to an environmental pollution and changes in life style, most importantly, dietary factors. ¨ìOccurrence of infectious disease by new organisms, sometimes reaching an epidemic or pandemic level, ¨íIncreasing expectations from people equipped with state-of-the-art information, demanding more expensive tests or treatment, ¨îWasting of resource due to unnecessary ¡°shopping for hospitals and doctors¡± due to unrestricted access to medical facilities, ¨ïToo many doctors(3200 graduates every year) resulting in a bigger market and a bigger expenditure, ¨ðWasting of medical and financial resources due to a moral hazard on the part of patients, medical professionals, industries and government, ¨ñAnother absurd wasting of resources due a duplication and harmful counteraction between ¡°modern, Western ¡± medicine and ¡°Oriental medicine¡±.

Then what should we do to provide ¡°a partially free medical care?¡± (1) The most urgent intervention is to reduce the expenditure on drugs. It can be done by reducing non-essential drug use as much as possible, by eradicating ¡°rebate¡±, and by reducing drug price if possible. (2) Increasing national health insurance premium appears unavoidable. At present insurance premium that Korean people are paying to NHIC is very low as compared to OECD countries, particularly developed countries. Also it is essential to introduce a concept of a ¡°health tax¡±, which means that healthy people with a high income should pay more while sick people or people with a low income pay less. (3)It is necessary to expand the scope of public health care. It includes expanding public hospitals and service, providing vaccinations, regular health surveillance program, education on health promotion, diet and healthy life style for the entire population. These programs will prevent or detect a disease in early stage and therefore will ultimately reduce the expenditure in a long run. (4) Private health insurance is another option and many people are already buying it. However, their policy is not always favorable to the customers and therefore they should be monitored. (5) Lastly and most importantly, the society has to be changed to a more ethical, morally mature and more transparent society, because eradicating a moral hazard is mandatory to provide a partially free medical care.

Conclusion : Welfare is not an option but is a mandatory requirement in developed countries. Korea is rapidly changing and is entering an era of a developed country and as a result it is unavoidable to foster a welfare program, such as medical care. However, it should be done very carefully and gradually by making a fair system, which will allow maximal utilization of resources while avoiding moral hazard and wasting.

 

In-Sook Park, MD.

Professor, Department of Pediatric Cardiology

University of Ulsan College of Medicine

Asan Medical Center, Seoul, Korea

E mail : ispark@amc.seoul.kr

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