[The Editors' Verdict]Unworkable Solutions for the 'Emergency Room Merry-Go-Round'

Every day, about twenty ambulances nationwide sound their sirens toward university hospitals, cross the center line, and make U-turns while speeding. The so-called ‘emergency room merry-go-round,’ where ambulances wander the roads due to no emergency room match or re-transfer patients because the first-arrival emergency room cannot accept them, occurred 7,634 times in 2021 alone. This only counts cases where patients arrived at the emergency room alive. Those who faced tragedy while stuck in the ambulance merry-go-round are a separate matter.

Whenever the emergency room issue arises, the government plays an old tape. At the emergency medical urgent countermeasure party-government meeting on the 31st of last month, the same parroted measures were recited. These are recycled proposals that have repeatedly appeared and disappeared from the Ministry of Health and Welfare’s cabinet. They were unrealistic desk theories that could not be implemented initially and cannot be implemented this time either. This is due to the government and ruling party’s bureaucratic habit of not considering emergency medical services from the perspective of emergency patients.

The first measure that Park Dae-chul, the Policy Chairman of the People Power Party, and Ministry of Health and Welfare officials pulled out from the drawer that day was to restrict the acceptance of mild patients in emergency rooms of advanced hospitals. From the emergency patient’s perspective, what if you were rejected as mild and died, but it turned out you were severe? What about the injustice then? If the government cannot answer this question, expanding the ‘dualization of severe and mild patients’ is impossible. It has been so until now.

The second measure from the government and ruling party can be summarized as ‘if there are no vacant beds, remove one mild patient and unconditionally accept a new emergency patient.’ From the perspective of existing emergency patients, should you willingly sacrifice your bed because a more severe patient has arrived? Above all, this idea directly violates the Medical Service Act’s prohibition on refusing treatment to existing patients. This reveals how hastily the Ministry of Health and Welfare drafted the measure and sent it to the ruling party, and how the Policy Chairman simply read it as written.

Although it was not brought up at this party-government meeting, the perennial ‘spice’ that can always reappear is the ‘additional surcharge on emergency treatment fees at advanced hospitals.’ Emergency diseases or injuries require treatment to start within 30 minutes of occurrence to significantly affect survival. From the emergency patient’s perspective, can you choose a smaller emergency room after considering costs when you are in severe pain? Emergency rooms at advanced hospitals are already much more expensive than those at small and medium hospitals. Increasing the surcharge rate will only raise profits for large hospitals.

What emergency patients most need, which the government and ruling party ignore, is emergency room accessibility. If emergency rooms are nearby, mild patients disperse smoothly. However, even the existing small and medium hospital emergency rooms have been closing continuously since the Ministry of Health and Welfare implemented the Emergency Room On-Duty Act in 2012. Due to the side effects of this law, emergency room deficits worsened, and the number of emergency medical institutions decreased by more than 10%, from 458 in 2012 to 405 last year.

The government and ruling party must enable small and medium hospital emergency rooms to reopen without worrying about deficits. Just as fire station budgets are allocated even if fire trucks do not dispatch, emergency medical services should be exempted from activity-based medical fees linked to the number of visiting patients. The Health Insurance Review and Assessment Service also proposes this method (Status and Tasks of Emergency Medical Fee Improvement, 2020). Then, the government and ruling party will no longer need to threaten the public by saying, “Mild cases are prohibited from using advanced hospitals,” or push them by saying, “We will charge more surcharges, so go to smaller hospitals.”