'Formation of the "Severe Classification System Innovation TF (tentative)" Underway
Includes Medical Cooperation Between Regional and Higher-Level General Hospitals'
The government will invest 3.3 trillion KRW annually, totaling 10 trillion KRW over three years, of health insurance funds into the pilot project for restructuring tertiary general hospitals. Applications will be accepted starting from the 2nd of next month, and medical institutions that apply can participate in the pilot project after a simple screening process.
The Presidential Commission on Medical Reform announced the 'Plan for Promoting the Support Project for Restructuring Tertiary General Hospitals' on the morning of the 27th at the Government Seoul Office in Jongno-gu, Seoul.
The government will first transform the medical care structure so that tertiary general hospitals focus on severe, emergency, and rare diseases, gradually increasing the proportion of severe care from the current 50% to 70%.
However, considering that the current proportion of severe cases varies among tertiary general hospitals, the goal is to raise it to 70%, but hospitals with a lower proportion of severe cases will receive incentives if they achieve a certain level of increase in the proportion of severe patients, even if they do not reach 70%.
In this process, to prevent disadvantages caused by the current classification criteria that may classify patients who should be treated at tertiary general hospitals as non-severe, an exception criterion considering such cases as severe will be newly established in the restructuring support project. Patients referred from secondary-level cooperative hospitals, patients admitted through the emergency room in a severe emergency state, and severe pediatric patients will be regarded as severe even if they are not classified as such under the current classification system.
To this end, a 'Severe Classification System Innovation Task Force (TF, tentative name)' will be formed promptly to focus on discussing improvement measures.
Jung Kyung-sil, Director of the Medical Reform Promotion Team, said, "We will carefully monitor the proportion of patients by department to ensure that the balance among medical departments does not change abruptly during the transition of tertiary general hospitals to focus on severe patients, and we will achieve the goals within that scope."
Cooperation between tertiary general hospitals and cooperative medical institutions will also be strengthened. Tertiary general hospitals will participate in the pilot project in connection with cooperative hospitals, and support levels will be expanded as regional medical cooperation is strengthened.
Additionally, the existing formal referral and return system will be significantly improved and converted into a specialized referral and return system. The 'specialized referral system' will be established and reinforced to enable patients to receive fast-track treatment by sharing patient information such as medical records based on professional opinions of doctors between cooperative hospitals within the region.
Director Jung explained, "While strengthening medical cooperation within regions, we will also support inter-regional cooperation between tertiary general hospitals, considering situations where patients are transferred from Seoul to non-metropolitan areas."
Tertiary general hospitals will shift their focus from excessive bed and treatment volume expansion to improving medical quality, reducing the number of single beds by 5-15% depending on the region and bed level.
However, pediatric beds, emergency beds, and other essential beds will not be reduced, and while mild care will be decreased, essential medical functions will be maintained.
The workforce structure of tertiary general hospitals will also be adjusted to be suitable for treating severe and emergency patients. The overall treatment scale will be reduced, focusing on severe and emergency care, maintaining current employment levels without workforce reduction, and improving workforce efficiency through team treatment involving specialists and nurses.
The direction of restructuring tertiary general hospitals also aims to improve the training environment so that residents can receive meaningful training as trainees.
Director Jung stated, "This is not about reducing the number of residents as some fear. We will establish and gradually apply a multi-institution cooperative training model so that residents can gain diverse experiences, including surgeries of moderate severity or less." Through this, tertiary general hospitals will reduce their dependence on resident labor, operate centered on skilled personnel, and residents will solidify their status as trainees.
The government will invest 3.3 trillion KRW annually, totaling 10 trillion KRW over three years, of health insurance finances to ensure this restructuring is carried out stably.
For intensive care units, which had low compensation relative to workforce input, an additional daily fee of 300,000 KRW, about 50% of the current fee, and an additional daily hospitalization fee of 75,000 KRW for rooms from double to quadruple occupancy, also about 50% of the current fee, will be added, investing a total of 670 billion KRW.
To raise the undervalued fees for severe surgeries, 910 surgical fees mainly performed at tertiary general hospitals and anesthesia fees associated with these surgeries will be increased by about 50%, investing a total of 350 billion KRW.
Emergency room specialist consultation fee additions, additional fees for severe and emergency surgeries within 24 hours after visiting emergency medical centers (150 billion KRW), 24-hour treatment support (730 billion KRW), and management fees for intensive care units and inpatient care by dedicated specialists (300 billion KRW) will be reflected as support fees for the restructuring of tertiary general hospitals and institutionalized in the future.
Of the 3.3 trillion KRW scale, 30%, equivalent to 1 trillion KRW, will be paid differentially based on performance considering bed reduction achievements, the proportion of patients treated for appropriate diseases, and medical cooperation results.
Fee support will be provided after confirming bed reduction, and support based on performance indicators will be prepared this year, evaluated for results from January to December next year, and paid in 2026.
Director Jung said, "This restructuring support project for tertiary general hospitals is the first step and an intermediate process to correct the distorted medical supply and utilization system and innovate it into a desirable medical delivery system, triggered by the implementation of the emergency medical system. We will ensure that the restructuring of tertiary general hospitals serves as a catalyst for the normalization of the overall medical delivery system, including general hospitals and regional clinics, without any setbacks."
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