Korean NHI has been unable to control health care expenditures.2,3 The Korean government on the one hand, has assumed exclusive control over medical care financing without including the medical profession in the policymaking process. Organized medicine has complained that only 65% of customary medical care costs are reimbursed by current health insurance. Korean physicians blame the government, claiming that it has developed a universal health insurance system at the expense of their professional incomes and autonomy.4
Korean medical professionals, on the other hand, have practiced without any public accountability. Government has never tried to intervene in the clinical autonomy of medical doctors. These laissez-faire practices have resulted in some appalling health care statistics-excessive overuse of antibiotics, more magnetic resonance imaging machines per million population than anywhere else in the world, and cesarean delivery rates of about 40% of live births.
While the Korean government has begun to show interest in controlling health insurance costs, it has done little public monitoring and regulating of health care services provided by doctors and pharmacists. As a resuit of this unbalanced governmental approach, the Korean people have been exposed to excessive and sometimes harmful health services.
This structural problem derives from 3 interrelated weaknesses in the Korean health care system. First medical specialists make up more than 80% of practicing medical doctors in Korea. In addition, one fourth of Korean medical doctors have 2 or more specialties. In most Western industrialized countries, medical specialists constitute no more than 50% of all practicing physicians. Korean medical care costs have escalated because medical specialists generate hightech, expensive tests and treatments in highly commercialized university hospitals. This, in turn, has exacerbated the financial deficit of NHI. The Korean government has developed no policy tools with which to discourage Korean medical doctors from becoming specialists.
Second, the private medical care sector currently consumes about 90% of total health care resources, particularly in terms of hospital beds. Korean governments have had little interest in expanding the public health care delivery sector, except for community public health centers known as Bogeunso. The other publicly owned institutions are the National Medical Center, built by the US Army during the Korean War in 1950, and provincial medical centers built by Japanese colonizers. These public institutions provide only 10% of total health care services. Almost all the rest of Korean health care facilities are for-profit. This private sector-dominated health care system is another stimulus for the increased use of highly expensive medical care.As in the case of the oversupply of medical specialists, the Korean government has not been able to formulate any policy alternatives to the private sector-dominated delivery system.
Third, pharmaceutical expenditures have consumed about 30% of total health expenditures. Before the policy of separating medical care reimbursement from pharmaceutical reimbursement was implemented in July 2000, Korean pharmacists were free to sell antibiotics and other potent biomedical drugs to customers without a doctor's prescription. Government has never prevented pharmacists from serving as primary health care practitioners. This factor has contributed to NHI's financial crisis. To make matters worse, shortly after the separation policy was implemented, pharmaceutical expenditures began to rise rapidly because of the intense lobbying by multinational pharmaceutical companies to allow marketing of high-cost drugs. When the minister of health and welfare was replaced in July 2002, he blamed the government for playing into the hands of the multinational pharmaceutical industry.
Korean NHI has been unable to control health care expenditures.2,3 The Korean government on the one hand, has assumed exclusive control over medical care financing without including the medical profession in the policymaking process. Organized medicine has complained that only 65% of customary medical care costs are reimbursed by current health insurance. Korean physicians blame the government, claiming that it has developed a universal health insurance system at the expense of their professional incomes and autonomy.4Korean medical professionals, on the other hand, have practiced without any public accountability. Government has never tried to intervene in the clinical autonomy of medical doctors. These laissez-faire practices have resulted in some appalling health care statistics-excessive overuse of antibiotics, more magnetic resonance imaging machines per million population than anywhere else in the world, and cesarean delivery rates of about 40% of live births.While the Korean government has begun to show interest in controlling health insurance costs, it has done little public monitoring and regulating of health care services provided by doctors and pharmacists. As a resuit of this unbalanced governmental approach, the Korean people have been exposed to excessive and sometimes harmful health services.This structural problem derives from 3 interrelated weaknesses in the Korean health care system. First medical specialists make up more than 80% of practicing medical doctors in Korea. In addition, one fourth of Korean medical doctors have 2 or more specialties. In most Western industrialized countries, medical specialists constitute no more than 50% of all practicing physicians. Korean medical care costs have escalated because medical specialists generate hightech, expensive tests and treatments in highly commercialized university hospitals. This, in turn, has exacerbated the financial deficit of NHI. The Korean government has developed no policy tools with which to discourage Korean medical doctors from becoming specialists.Second, the private medical care sector currently consumes about 90% of total health care resources, particularly in terms of hospital beds. Korean governments have had little interest in expanding the public health care delivery sector, except for community public health centers known as Bogeunso. The other publicly owned institutions are the National Medical Center, built by the US Army during the Korean War in 1950, and provincial medical centers built by Japanese colonizers. These public institutions provide only 10% of total health care services. Almost all the rest of Korean health care facilities are for-profit. This private sector-dominated health care system is another stimulus for the increased use of highly expensive medical care.As in the case of the oversupply of medical specialists, the Korean government has not been able to formulate any policy alternatives to the private sector-dominated delivery system.
Third, pharmaceutical expenditures have consumed about 30% of total health expenditures. Before the policy of separating medical care reimbursement from pharmaceutical reimbursement was implemented in July 2000, Korean pharmacists were free to sell antibiotics and other potent biomedical drugs to customers without a doctor's prescription. Government has never prevented pharmacists from serving as primary health care practitioners. This factor has contributed to NHI's financial crisis. To make matters worse, shortly after the separation policy was implemented, pharmaceutical expenditures began to rise rapidly because of the intense lobbying by multinational pharmaceutical companies to allow marketing of high-cost drugs. When the minister of health and welfare was replaced in July 2002, he blamed the government for playing into the hands of the multinational pharmaceutical industry.
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