[How About This Book] Only 3 Minutes of Consultation Time?... Doctors Also Have a Lot to Say

Difficult to Improve Despite Patient and Doctor Complaints
Hospitals Increase Various Tests Over Consultations
Employed Doctors Face Pressure for Excessive and Over-treatment
Proper Medical Fees Must Be Set Before Increasing Number of Doctors

It is well known that South Korea's health insurance system has been established at a world-class level, and that it is relatively easier to see a doctor in South Korea compared to other advanced countries. Under strong government control, large hospitals at the general hospital level or higher are obligated to have essential medical departments regardless of profitability. However, this does not necessarily indicate that Korean healthcare is on a normal track. In hospitals where "3-minute consultations" are widespread, doctors are in a hurry to see more patients, and patients anxiously worry that the consultation time will end without receiving proper explanations.

In this difficult situation, hospitals actively utilize "tests" as a source of revenue. According to the Health Insurance Review and Assessment Service's review statistics from 2012 to 2021, the proportion of consultation fees in total medical expenses has continuously decreased, while testing fees have increased. The consultation fee proportion dropped from 23.8% in 2012 to 17.1% in 2021, whereas testing fees rose from 12.3% to 16.3%. Author Kim Hyun-ah, a professor of Rheumatology at Hallym University College of Medicine, explains, "This data supports the suspicion that consultations are becoming inadequate while tests are increasing. For example, performing one computed tomography (CT) scan generates more income than seeing eight patients."

According to the author, indiscriminate testing in South Korea's medical community amounts to a waste of resources. Comprehensive health checkups have been packaged to include all kinds of tests, leading to misdiagnoses and excessive diagnoses that cause unnecessary social costs. Although there is a preventive aspect to these screenings, the author points out that among patients who visit after abnormal findings in health checkups, less than 10% are actually diagnosed with rheumatoid arthritis. Rather, while suspected patients flood in, true patients find it difficult to receive proper care.

There is a structural problem behind this. Looking at hospitals' pursuit of profit, domestic hospitals are basically premised on being "non-profit hospitals." Profits from medical activities cannot be used for personal purposes. However, the author sharply criticizes, "I wonder how many hospitals in South Korea truly adhere to this." He points out, "After the two major conglomerates, Hyundai and Samsung, built mega hospitals and decorated their floors with marble, all hospitals had to follow this appearance."

One of the problems the author identifies is the low medical fee. In fact, domestic medical fees are significantly lower than those in other advanced countries. The author notes that for laparoscopic surgery fees, even in Europe where fees are lower than in the U.S., the minimum was about $5,058 (approximately 6.76 million KRW) in 2010, but in South Korea, it was around 239,000 KRW for 11 years since 2006, which is "less than one-third of the material cost." This structure pressures doctors to see many patients in a short time or to recommend high-revenue tests.

This situation also explains the increase in robotic surgeries. Robotic surgery costs more than ten times the general laparoscopic surgery depending on the calculation method. The question is whether it is worth that much, and the author lists evidence that it is not. According to a 2018 study by Professor Kim Jung-mok's team at Hanyang University College of Medicine analyzing about 1,700 patients who underwent surgery from 1981 to 2016, robotic surgery did not outperform laparoscopic surgery in terms of operation time, complication rates, costs, and other aspects.

The author says that although doctors are regarded as high-income professionals, they are not free from the hospital's "power harassment." They constantly bear the burden of excessive or unnecessary treatments. The author criticizes the hospital's attitude that forces extended consultations at the same pay, saying, "If you want to quit, just quit; there are many people who can take your place."

This is also the underlying psychology behind doctors opposing the increase in medical school admissions. There is no guarantee that more doctors will lead to better treatment for doctors or patients. Rather, there is concern that excessive and unnecessary treatments may increase. "Even now, doctors have to see so many patients to sustain themselves; if the number of doctors increases, how much more excessive treatment will be required, and how much will income be cut?"

The author emphasizes that the perception that "Korean doctors live well" absorbs all problems like a black hole, but proper medical fee setting is necessary for patients' rights. He argues, "Only after establishing advanced country-level standards for the appropriate number of patients per doctor and nurse, strictly managing compliance, and budgeting accordingly, can standards for hospitals' excessive pursuit of profit be set and discussions on appropriate fees and wages be possible."

The Era of Medical Business | Written by Kim Hyun-ah | Dolbegae | 275 pages | 17,000 KRW