[The Editors' Verdict] The Second Half of the Medical Crisis Will End Only When the Public's Paychecks Are Tapped

The radius of the Daechi-dong academy district is expanding further. Contrary to President Yoon Seok-yeol’s declaration a year ago to curb private education by eliminating killer questions, a mega academy, considered the main culprit of killer private education, is expanding its influence, increasingly dominating the area from Lotte Department Store Gangnam Branch to the Eunma Apartment intersection. This is because top-tier entrance exam students flock to the so-called “semi-killer” questions that caused last year’s unexpectedly difficult CSAT instead of killer questions. As a result, small and medium-sized academies are being pushed into nearby buildings where there were no academies before, and the traffic congestion during school commute hours is worsening. The predictions of entrance exam experts?that half-hearted interference with the CSAT would actually intensify private education?have proven correct. This is the operation according to the principles of the entrance exam market.

The increase in medical school admissions has further fueled the momentum of mega academies. A local real estate agent in the area reported that even the rent prices for one-room short-term leases (monthly rent) targeting medical school applicants who leave for regional talent selection study abroad but return to Daechi-dong on weekends and vacations are already fluctuating.

Medical experts predict that the ‘increased doctors’ produced this way will not spread nationwide into low-fee “core subjects” (mandatory subjects) as President Yoon and the government hope, but rather will concentrate in popular specialties that are already saturated. When the market for non-reimbursed medical departments becomes saturated, the pharmaceutical industry develops new products to sustain them. This is the operation according to the principles of the medical market. For example, as artificial joint surgeries became saturated, stem cell knee injections emerged as a new medical technology, causing a surge in orthopedic outpatient insurance claims. In dermatology, ophthalmology, and plastic surgery, whenever competition intensified over existing procedures in the past 30 years, more expensive new technologies always appeared.

As the number of doctors increases, the volume of medical care also increases (the 2,000 additional doctors were added to increase the medical care volume expected to be insufficient by 2035). The government’s health insurance expenditures to doctors also rise, but the current health insurance premium rate, which is already at its limit, cannot handle this. The government is aware of this. In February, the Ministry of Health and Welfare hinted at revising the Health Insurance Act to raise the legal ceiling on health insurance premium rates collected from salaries or income in the four essential medical care packages it announced. However, the government, facing the next presidential election in three years, is unlikely to actually amend the law. Instead, the medical community claims that the government has introduced measures that reduce income while increasing the number of doctors, such as licensing restrictions, medical appropriateness verification, value-based payment systems, and bans on mixed treatments. This is where the current “battle for survival” originated.

Both the government and the medical community have long agreed on the need to reform the “low burden (citizens) · low fee (doctors) · high volume (medical accessibility)” health insurance system designed during times when everyone was poor and unable to visit hospitals. The two sides have clashed fiercely over the reform methods and priorities, but the government chose a reform led by increasing the number of doctors. When the medical community strongly opposed this, follow-up incentives such as raising fees for essential medical services, accepting residents’ resignation letters, and improving working conditions were introduced. Still, the medical community remains steadfast, insisting that re-examining the increase in doctors and realistically adjusting medical fees?which have been in deficit for nearly 50 years?are the starting points for reform. This is why the Korean Medical Association demanded a 10% fee increase in negotiations with the National Health Insurance Service and mentioned a total strike.

Both the government’s measures and the medical community’s demands share the “prerequisite” of significantly increasing medical finance, including health insurance. However, neither side dares to say “the public must pay more.” The government does not want to dampen favorable public opinion, and the medical community has no reason to oppose expanding medical finance. This medical crisis will end only when both sides compromise somewhere in the middle. Depending on where that point is, it will determine how much more will be taken from the public’s monthly paychecks. This is the key point to watch in the latter half of the medical crisis.