[In-Depth Analysis] Four Experts Discuss the "Great Transformation of the Medical Ecosystem" [The Future of Telemedicine ⑥]

'Patient Convenience' Should Be the Top Priority...
Patient Choice Must Not Be Restricted
Telemedicine Should Go Beyond Video Consultations
and Lay the Foundation for Expanding Remote Healthcare

Editor's Note
An era has arrived where, instead of waiting in long lines at hospital waiting rooms, patients can meet doctors on their smartphone screens. Telemedicine, which was temporarily allowed and piloted during the COVID-19 pandemic and periods of conflict between the medical community and the government, is set to be officially implemented at the end of this year. While it offers convenience by filling medical gaps for remote areas and vulnerable groups, there are also limitations due to the ban on medication delivery and concerns about the misuse of pharmaceuticals. Differences in perspective among the medical community, platform companies, and patient organizations remain stark. In the face of this monumental shift that could upend the paradigm of the healthcare industry, The Asia Business Daily has closely examined how telemedicine will transform Korea's medical field and analyzed the challenges that must be addressed to achieve genuine innovation.

The full-scale implementation of telemedicine is expected to become a critical turning point that will not only change medical services but also transform the very concept and value of healthcare, directly impacting public health. However, for telemedicine to become an integral part of the healthcare system, rather than simply a matter of 'patient convenience,' many issues still need to be resolved. The Asia Business Daily interviewed Yongjin Kwon, Professor at Seoul National University Hospital Public Medical Center, Chungki Kim, Policy Director at the Korean Medical Association, Jung Hyungjun, Policy Chief of the Federation of Health and Medical Organizations, and Sunjewon, CEO of My Doctor, to hear their views on the core issues that must be addressed for telemedicine to be established within the institutional framework.

130% Reimbursement Rate: Compensation or Waste?

The policy of applying a 130% reimbursement rate for telemedicine compared to in-person consultations has been at the center of controversy since its introduction. Reimbursement rates should be determined in proportion to the complexity, time, and resources required for medical procedures, but the current 130% rate is turning telemedicine into a 'highly profitable business.' The government explains that this rate takes into account the additional administrative burden and system setup costs for medical professionals, but experts agree that the essence of the medical act itself must be considered.

On February 3, Professor Yongjin Kwon pointed out, "The original idea was to provide a higher reimbursement rate for telemedicine because it was expected to take more time to listen to the patient's symptoms in detail and assess their condition via video. However, if telemedicine simply involves issuing a prescription over the phone, there is no reason to pay more." Conversely, Kwon argues that if telemedicine involves properly examining the patient visually and spending more time than in-person consultations, appropriate compensation is necessary.

Yongjin Kwon, Professor at Seoul National University Hospital Public Healthcare Center

Excessive reimbursement rates could even threaten the financial stability of the national health insurance system. Policy Chief Jung Hyungjun stated, "The government is using health insurance premiums paid by the public as a 'carrot' to appease opposition from the medical and pharmaceutical communities. Health insurance funds are being used as business capital to activate telemedicine platforms."

Director Chungki Kim added, "Even within the Korean Medical Association, we have concluded that increasing incentives excessively to promote telemedicine is not appropriate."

30% Limitation Rule: Can It Prevent Hospital Concentration?

The government has also introduced guidelines to prevent telemedicine from being concentrated in specific medical institutions, limiting telemedicine to no more than 30% of all consultations at each hospital or clinic. This is because, like in-person care, telemedicine could become concentrated among certain well-known doctors or hospitals that prescribe specific medications.

However, such restrictions may also limit patients' freedom to choose their doctors. For example, if a patient regularly receives telemedicine consultations for chronic disease management from a particular doctor, but that doctor has reached the maximum number of telemedicine consultations for the month, the patient would be forced to find another doctor. This could disrupt the continuity of care for patients who can no longer see their regular physician.

CEO Sunjewon explained, "It is necessary to limit institutions dedicated solely to telemedicine to prevent medical providers from focusing exclusively on remote care. However, since rapport (trust) between patient and doctor is also important in telemedicine, there needs to be a system where patients can receive in-person care at their regular hospital once a year and telemedicine every few months, ensuring a connection between in-person and remote care."

Chungki Kim, Policy Director at the Korean Medical Association

Director Chungki Kim commented, "More important than limiting the proportion of telemedicine is giving professional organizations the authority and capacity to directly monitor whether abnormal prescriptions or medical practices are occurring at specific institutions. There must be a system in place to conduct investigations and provide recommendations for administrative action or education if necessary."

The Limits of Telemedicine: Defensive Medicine Without Exemption from Liability

The greatest burden doctors feel during telemedicine is the diagnostic outcome for 'invisible patients.' Since the process of directly observing and physically examining the patient is omitted, it is difficult to determine responsibility in the event of misdiagnosis or accidents.

Director Chungki Kim emphasized that patients must be clearly informed in advance and agree that telemedicine may have limitations in accurate diagnosis compared to in-person care. He argued, "If a patient provides incorrect information about their symptoms or lies, the patient should be held responsible. If a doctor recommends an in-person consultation but the patient refuses, or if the patient provides inaccurate information, the doctor should be exempt from liability." Without such safeguards, doctors are likely to recommend in-person visits for any ambiguous symptoms, which undermines the efficiency of telemedicine.

Jung Hyungjun, Policy Chief of the Federation of Health and Medical Organizations, is giving an interview to The Asia Business Daily. Photo by Dongju Yoon

On the other hand, Policy Chief Jung Hyungjun pointed out, "Currently, telemedicine is focused on prescriptions for conditions like acne and hair loss, where there is almost no risk of misdiagnosis, so the issue of liability rarely arises. Even if there are concerns about liver toxicity with acne medications, as long as the doctor fulfills their duty to warn, liability is not an issue since these are minor conditions."

In this regard, CEO Sunjewon presented a technical solution: "Platforms record the entire process of the consultation. There is a record of what information the patient provided and what questions the doctor asked, so in the event of a dispute, it is actually possible to provide more objective evidence than with in-person care."

How to Prevent the Commercialization of Platforms

Platform advertisements and rating attacks that encourage excessive prescriptions of non-insurance medications such as hair loss and acne treatments are cited as major threats to the public nature of healthcare. Professor Yongjin Kwon advised, "Currently, telemedicine is used to prescribe medications like hair loss treatments, cold medicine, and digestive aids through phone consultations. For drugs that are not particularly dangerous, it would be more appropriate to reclassify them as over-the-counter medications so that patients can choose and purchase them directly at pharmacies."

Sunjewon, CEO of My Doctor

Issues of ownership and security of medical data generated during telemedicine must also be resolved. There is growing criticism that telemedicine is currently only available through private platforms.

Policy Chief Jung Hyungjun argued, "Korea's health insurance system is a public asset worth 100 trillion won, funded by premiums paid by the public. It is not logical for services that mediate these consultations to be operated solely by for-profit companies. It would be better for the Ministry of Health and Welfare or the National Health Insurance Service to operate a public platform so that platforms cannot profit as intermediaries or privatize data."

In contrast, CEO Sunjewon countered, "Public platforms cannot match the user experience (UX) innovation of the private sector. It is more beneficial for the public if private platforms that have already been proven in the market compete healthily while complying with security regulations."

Looking ahead, as remote monitoring-where patients can measure not only blood sugar and blood pressure but also electrocardiograms at home and send the data to their doctors-becomes the core of telemedicine, there is a growing call to move beyond simple prescription issuance and strengthen functions for patients who truly need telemedicine. Professor Yongjin Kwon emphasized, "For current telemedicine to evolve beyond video consultations into active remote healthcare, it is necessary to address technical challenges such as platform stabilization, data integration, and enhanced safety and security."