Increase in Staff is Irreversible, Key Points are Fee Hikes and Strengthening the Medical Accident Special Act [Urgent Review of Medical-Political Conflict] (Part 2)

Essential Medical Fee Increase Funding
Limitations of Health Insurance Reserve Coverage
Medical Accident Special Act Faces Difficulties
Due to Patient and Opposition Party Opposition
Need for Solid Financial Planning and Legislation

Editor's NoteThe conflict between the government and medical professionals has entered its fourth month, escalating into a prolonged standoff as medical students, residents, and now professors join collective strikes. The Korean Medical Association (KMA) is taking a hardline stance demanding a complete reconsideration of the medical school quota increase, while politicians fiercely criticize doctors as a 'vested elite group protecting their professional interests.' Public concern over a healthcare disaster is growing. In this context, at the point when the 2025 medical school quota increase of 1,500 students has been confirmed, this article urgently examines the remaining critical issues in healthcare reform. As the conflict approaches a crisis, we analyze the essence and core of healthcare reform, current challenges, priorities, and future alternatives.

On the 18th, the Korean Medical Association's decision to stage a collective strike has intensified the government-medical community conflict into a head-on confrontation. However, behind the scenes in the medical field, voices are emerging that since the 2025 medical school quota increase has already been decided, the priority should be on raising fees for emergency care, childbirth, severe diseases, and pediatrics, as well as strengthening the Medical Accident Special Act. The medical community needs to unite efforts to open the way for a practical 'trickle-down effect' so that the increased number of doctors will flow into essential medical services that save lives, rather than cosmetic or plastic surgery.

Health Insurance Reserves Still Available but Future is Uncertain... Steady Investment in Essential Medical Services Must Be Guaranteed

The source of funding for raising fees in essential medical services is health insurance premiums. Currently, health insurance reserves amount to 25.2 trillion won (as of 2023), so investing 10 trillion won over the next five years (5 trillion for severe diseases, 3 trillion for pediatrics and childbirth, 2 trillion for building essential medical networks) is generally considered feasible. If fees for essential medical services increase, doctors' workload in emergency and severe disease fields will decrease, and large hospitals will be able to hire more essential medical doctors.

An emergency medicine professor said, "There has been inadequate compensation for the 'standby state' when emergency patients may appear at any time. Moreover, fee-for-service compensation has been insufficient, and with the risk of criminal punishment, no one wanted to take on this work."

The problem is sustainability. In addition to raising fees for essential medical services, the decision to cover nursing care expenses in long-term care hospitals will require an annual budget of 15 trillion won, and the depletion of health insurance finances is becoming apparent. Due to low birth rates and aging population, the number of people paying premiums is rapidly decreasing while the number of beneficiaries is significantly increasing. In fact, health insurance reserves are at risk of depletion even without additional expenditures. According to the National Assembly Budget Office, the 25.2 trillion won reserve as of last year is expected to be completely exhausted by 2028. Ultimately, health insurance premiums will need to be raised for essential medical service funding, but social consensus is difficult due to tax resistance.

A professor participating in the government's Medical Reform Special Committee stated, "Our country's budget structure is too rigid, and the government is stingy in investing resources in public healthcare." Inside and outside the medical community cite the failure of local medical center projects in Ulsan and Gwangju last year due to the Ministry of Economy and Finance's re-examination of preliminary feasibility studies as an example of the government's reluctance to invest in healthcare finances.

Medical Accident Special Act... Protecting Essential Medical Services VS Doctor Privilege Law, Calls for Strengthening Mediation Functions

The enactment of the Medical Accident Special Act is even more challenging. It is difficult to reach consensus due to opposition from patient groups and opposition parties. The Medical Accident Special Act aims to ease the burden of criminal punishment by making prosecution difficult through 'special provisions' when medical personnel are enrolled in liability insurance or mutual aid associations. It also includes provisions allowing sentence reductions in cases of death during essential medical acts performed by insured medical personnel. This was included in the 'essential medical package' based on the judgment that reducing the risk of criminal punishment and compensation liability could increase applicants for essential medical services.

A university hospital doctor mentioned, "In pediatrics, it is common to perform multiple surgeries over several years to save patients with congenital malformations. However, if the patient dies during this process, the doctor is exposed to civil and criminal lawsuits."

However, the opposing argument is also strong. Kim Seong-ju, head of the Korea Severe Disease Alliance, said, "Patients bear the burden of proof in medical accidents, which is already difficult, and I worry that the Special Act will further increase this burden on patients." He added, "Using the Special Act as a means to resolve the government-medical conflict is inappropriate, and other incentives are needed to alleviate avoidance of essential medical services."

For this reason, some suggest strengthening the role of the Medical Dispute Mediation and Arbitration Committee. This committee, composed of legal professionals unrelated to the medical community, can mediate disputes between patients and doctors at the pre-litigation stage. Professor Park Eun-cheol of Yonsei University's Department of Preventive Medicine said, "Patients often lack medical knowledge and have blocked communication channels with doctors, so they resort to lawsuits to clarify causes. It is necessary to minimize provisions in the Medical Accident Special Act that disadvantage patients while enhancing the role of dispute mediation and arbitration."

Series Outline

<上>The Medical School Boom, but 7,625 Students Overlapping Classes... Concerns Over Education Quality
<中>The Quota Increase is Irreversible; Fee Increase and Medical Accident Special Act Reinforcement are Key
<下>The General Strike on the 18th Unlike Those in 2000, 2014, and 2020... The Medical Community Must Engage in Dialogue with the Public