Reducing 'Big 5 Concentration'... Korean Prime Minister: "Specialized Hospitals Should Receive Fees Comparable to Tertiary Hospitals"

Directive for Nationwide Public Campaign to Transfer Patients to Specialized and Small-Scale Hospitals
Request to Share Information and Provide Training on Specialized Hospitals to 119 and Others

Prime Minister Han Duck-soo instructed on the 12th to review the establishment of a system that ensures specialized hospitals, which treat severe patients with expertise comparable to tertiary general hospitals, receive appropriate compensation. The aim is to reduce the avoidance of essential medical fields through support for specialized hospitals and to lower the patient concentration at the so-called Big 5 hospitals (Seoul National University Hospital, Severance Hospital, Seoul Asan Hospital, Samsung Seoul Hospital, and Seoul St. Mary’s Hospital).

The day before, to respond to the collective action of doctors, Prime Minister Han visited Myongji St. Mary’s Hospital, a cerebrovascular specialty hospital, received suggestions from the hospital and on-site medical staff, and instructed related ministries including the Ministry of Health and Welfare, saying, "We must resolve the contradiction where essential and regional medical care is collapsing and all citizens go to the Big 5 hospitals, so that anyone can trust and visit their 'local Big 5'."

Accordingly, the Ministry of Health and Welfare plans to review support measures based on expertise and performance so that specialized hospitals, which treat severe patients with expertise comparable to tertiary general hospitals, receive appropriate compensation regardless of hospital size. Currently, fee support is applied based on hospital size, with tertiary general hospitals receiving a 15% additional rate, general hospitals 10%, hospitals 5%, and clinics 0%. Because of this, specialized hospitals have been criticized as unfairly receiving lower fees than tertiary general hospitals despite providing the same treatment and high medical expertise.

[Image source=Yonhap News]

Furthermore, Prime Minister Han instructed the Ministry of Culture, Sports and Tourism to promote to the public so that patients are more frequently transferred to specialized hospitals and strong small hospitals with outstanding medical performance. He also ordered the Fire Agency to ensure information sharing and education about specialized hospitals and strong small hospitals by region and disease to frontline paramedics and 119 emergency call centers, and to ensure that essential field specialized hospitals designated by the Ministry of Health and Welfare are considered during patient transfers between regions.

This is interpreted as a measure taken in consideration of the increasing harm to the public, such as surgery schedules being postponed at Big 5 hospitals, as collective action by doctors has expanded from residents to specialists and medical school professors. The Emergency Committee of the Seoul National University Medical School Professors’ Association held a general meeting the day before and announced, "If the government does not actively come up with reasonable solutions to resolve the situation, we have decided to voluntarily submit resignation letters starting from the 18th." The government has proposed various measures to respond to the doctors’ collective action, including deploying military doctors and public health doctors, pilot projects for physician assistant (PA) nurses, and incentives for residents in essential medical departments.

A government official emphasized, "For medical reform to succeed, a rational medical delivery system connecting local clinics (primary care), small and specialized hospitals (secondary care), and tertiary general hospitals (tertiary care) must be established, and for that, discovering and fostering specialized hospitals and strong small hospitals is important."