[The Editors' Verdict] The Proper Response to Three-Minute Consultations

A clinic director who graduated from a Korean medical school and worked at a hospital in the United States before returning said, "The time needed per patient in the U.S. is similar to that in Korea." In other words, a patient who can be seen in 3 minutes in Korea can also be seen in 3 minutes in the U.S.

American doctors spend an average of 21.1 minutes per patient (Professor Kim Hyun-ah, Hallym University College of Medicine; British Medical Journal Open paper). In Korea, it is 6.3 minutes. In reality, it is just over 6 minutes, but in everyday terms, it is symbolized by the phrase "3-minute consultation." The director explained the time difference between Korea and the U.S. by saying that in the U.S., the paperwork submitted to health insurance companies is overwhelming, so charting takes a very long time, and because medical costs are very high, doctors need to show more attention to patients.

The outpatient initial visit fee for Medicare and Medicaid, the federal health insurance for elderly and low-income groups in the U.S., is $43 (about 58,000 KRW) for consultations under 10 minutes and $134 (about 180,000 KRW) for over 10 minutes. Private insurance for the general public is much more expensive. In Korea, the fee is 17,610 KRW regardless of time for all citizens, with a personal copayment of 5,200 KRW. His impression of running a clinic in Korea was that doctors just quickly provide the necessary treatment and send the patient out to call the next one.

A major reason public opinion supports government medical reform is dissatisfaction with 3-minute consultations. This is largely an emotional issue. Patients complain, "I made an appointment 3 months ago, waited 3 hours, and was only seen for 3 minutes!"

Patients commonly complain that doctors do not make eye contact and keep their noses buried in the monitor. Doctors argue that they have no time to look away from the monitor because they have to quickly examine and enter chart information. In the U.S., doctors can employ medical scribes who enter charts on their behalf while they kindly examine patients, making eye contact and holding hands. This increases medical fees.

After the medical crisis, waiting times at university hospitals have lengthened and consultation times have shortened (data from Park Hee-seung, Democratic Party lawmaker, National Assembly audit). The government says it will resolve the problem by restructuring tertiary hospitals starting this month. To eradicate 3-minute consultations, the National Health Insurance, modeled after Japan’s low-cost universal coverage, will inevitably have to be partially converted into a U.S.-style private insurance system. According to the aforementioned paper, Taiwan, which adopted a Japanese-style health insurance system like Korea, has an average consultation time of 5 minutes, and Japan itself is 6.1 minutes, both shorter than Korea.

Three-minute consultations have the advantage of allowing more patients to receive affordable treatment. Is it right to change a medical environment where 100 patients are seen for 3 minutes each day, spending 17,610 KRW each, to one where 30 patients receive similar consultations for 10 minutes each and pay nearly 60,000 KRW (based on the U.S. example)?

The government’s plan for restructuring tertiary hospitals is to focus on critically ill patients and reduce the number of mild cases. In reality, visits by mild patients will not decrease, and 3-minute consultations will worsen to 1-minute consultations. Sick people will find a way to visit famous doctors at large hospitals. The patient concentration began when the government abolished regulations in 1998 that restricted patients to visiting hospitals and clinics only in their residential city or county. It is now impossible to prevent patients from going to large hospitals.

The government should not forcibly reduce patients at tertiary hospitals but should instead expand excellent medical institutions so that "any sick person can receive high-level care in a timely and adequate manner." This is the proper policy to address 3-minute consultations.