[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 noteWe are now in an era where, instead of standing in long lines in hospital waiting rooms, patients can meet doctors on their smartphone screens. After being temporarily allowed during the COVID-19 pandemic and amid conflict between the government and the medical community, and then tested through pilot programs, telemedicine is slated to be fully implemented at the end of this year. Alongside the convenience of filling medical gaps for residents in remote areas and vulnerable groups, concerns persist about usage limits stemming from the ban on drug delivery and the potential misuse and overuse of medications. Sharp differences in perspective also remain between the medical community, platform companies, and patient groups. Standing before a major shift that will upend the paradigm of the healthcare industry, The Asia Business Daily has closely examined how telemedicine is changing the reality of medical practice in Korea and analyzed in depth the key issues that must be resolved for it to move forward as a genuine innovation.

The full-scale rollout of telemedicine is expected to be a critical turning point that not only changes how medical services are delivered, but also transforms the very concept and value of medicine, with direct implications for public health. However, for telemedicine to become a true pillar of the healthcare system, rather than merely a tool for "patient convenience," many issues still need to be addressed. The Asia Business Daily spoke with Kwon Yongjin, Professor at the Center for Public Medical Services at Seoul National University Hospital, Kim Chungki, Policy Director at the Korean Medical Association, Jung Hyungjun, Chair of the Policy Committee at the Korean Federation of Health and Medical Organizations, and Seon Jaewon, CEO of Namanuidakteo, to hear their views on the core issues that must be resolved for telemedicine to take root within the institutional framework.

130% fee add-on: compensation or waste?

The policy of applying a fee that is 130% of the in-person consultation rate for telemedicine has been a focal point of controversy since its introduction. Fees should be set in proportion to the difficulty of the medical act, the time required, and the amount of resources投入, but the current 130% rate is turning telemedicine into nothing more than a "highly profitable business." The government explains that it took into account the additional administrative burden on medical professionals and the cost of building systems, but experts unanimously argue that the essence of the medical act itself must be examined.

On the 3rd, Professor Kwon said, "Initially, the idea behind higher fees for telemedicine was that it would take more time to carefully listen to patients' symptoms and to observe their condition via video," adding, "If consultations are simply about issuing prescriptions over the phone, as is often the case now, there is no reason to pay higher fees." Conversely, Kwon argues that if telemedicine is conducted properly, with the physician visually checking the patient and dedicating even more time than for in-person care, then it deserves appropriate compensation.

Kwon Yongjin, Professor, Center for Public Medical Services, Seoul National University Hospital

Excessive fees could also threaten the financial soundness of the National Health Insurance. Jung pointed out, "To quell opposition from the medical and pharmacy communities, the government is effectively handing out 'carrots' funded by health insurance contributions paid by the public," and criticized that "health insurance premiums are now being used as business capital to activate telemedicine platforms."

Kim added, "Within the Korean Medical Association, we have also concluded that it is inappropriate to boost the appeal of telemedicine through excessive incentives."

Can the 30% cap rule prevent concentration at certain hospitals?

To prevent telemedicine services from becoming overly concentrated at specific medical institutions, the government has introduced guidelines that cap telemedicine at 30% of the total number of consultations at each hospital or clinic. This is because, just like in-person care, telemedicine could become concentrated on specific high-profile doctors or on hospitals known for prescribing particular medications.

However, such a cap may also restrict patients' freedom to choose their doctors. For example, a patient who regularly receives telemedicine care from a particular doctor for chronic disease management may be forced to find another doctor if that physician has already reached the monthly telemedicine limit and can no longer see patients remotely that month. From the patient's perspective, being unable to choose the doctor they have been seeing breaks the continuity of care.

CEO Seon said, "To prevent medical institutions from focusing exclusively on telemedicine, there does need to be a limit on designated telemedicine-only institutions," but added, "At the same time, rapport (trust) between patient and doctor is just as important in telemedicine, so there should be a system that links in-person and remote consultations, such as seeing the same doctor in person once a year and via telemedicine every couple of months at the same hospital the patient usually visits."

Kim Chungki, Policy Director at the Korean Medical Association

Kim commented, "More important than the specific percentage used to cap telemedicine is ensuring that professional organizations have the capacity and authority to directly examine whether abnormal prescribing or treatment patterns are occurring at particular institutions," and stressed, "We need a system that allows for actual field investigations and for recommendations on whether administrative sanctions or additional training are necessary."

The limits of telemedicine: defensive medicine by doctors without immunity from liability

The biggest burden doctors feel when providing telemedicine is the diagnostic outcome for a "patient they cannot see." When the physical examination that involves directly observing and palpating the patient is omitted, it becomes difficult to determine liability if misdiagnosis or an adverse event occurs.

Kim emphasized that patients must clearly recognize in advance and consent to the fact that telemedicine may have inherent limitations in diagnostic accuracy compared to in-person care. He argued, "We need a principle that any harm resulting from a patient miscommunicating or lying about their symptoms should be borne by the patient," and continued, "If a doctor recommends an in-person visit but the patient refuses to follow that advice, or if the patient provides inaccurate information and an adverse outcome occurs, the doctor should be exempt from liability." Without such safeguards, doctors will feel compelled to tell patients with even slightly ambiguous symptoms to "come in for an in-person consultation first," which in turn undermines the efficiency of telemedicine.

Jung Hyungjun, Chair of the Policy Committee at the Korean Federation of Health and Medical Organizations

Jung, on the other hand, took a different view: "Currently, telemedicine is largely focused on prescribing medications for conditions like acne and hair loss, where the risk of misdiagnosis is extremely low and treatment is driven mainly by personal preference, so the likelihood of serious liability issues actually arising is small," he said. "Even if acne treatments carry concerns such as potential hepatotoxicity, these are relatively minor conditions where doctors can be exempt from liability as long as they fulfill their duty to warn patients, so debates over liability are somewhat misplaced."

On this point, CEO Seon proposed a technical solution. "Platforms record the entire consultation process as data," he explained. "They keep track 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 in in-person care."

How to prevent over-commercialization of platforms

Platform advertisements that encourage overprescribing non-reimbursable drugs such as hair loss and acne treatments, along with malicious star-rating attacks, are being criticized as major threats to the public nature of healthcare. Professor Kwon said, "Under the current telemedicine system, medications such as hair loss treatments, cold medicines, and gastrointestinal drugs are often prescribed based solely on a telephone interview," and advised, "For drugs that are not especially risky, it would be more appropriate to reclassify them as over-the-counter medications so that patients can choose and purchase them directly at pharmacies."

Seon Jaewon, CEO of Namanuidakteo

The ownership and security of medical data generated in the course of telemedicine are also issues that must be resolved. In particular, there is growing criticism of the current situation in which telemedicine is conducted exclusively through private platforms.

Jung argued, "Our national health insurance is a public asset of about 100 trillion won, funded by contributions from the public, so it is logically inconsistent that the services mediating these consultations are operated solely by for-profit companies," and insisted, "It would be more appropriate to build a public platform operated by the Ministry of Health and Welfare or the National Health Insurance Service, so that platforms cannot extract profits in the middle or privatize the data."

CEO Seon countered, "Public platforms will find it difficult to keep up with private-sector innovation in terms of user experience (UX)," and added, "It is more in line with the public interest to allow private platforms that have already been tested in the market to compete in a healthy manner while complying with security regulations."

Participants also noted that, in the future, "remote monitoring"-in which patients measure not only blood sugar and blood pressure but even electrocardiograms at home and send the data to their doctors-will become the core of telemedicine. As such, they argued, the system must move beyond simply issuing prescriptions and strengthen functions that genuinely serve patients who need telemedicine. Professor Kwon stressed, "For the current telemedicine system to evolve beyond video consultations and lead to broader activation of telehealth services such as remote monitoring, we must address technical challenges including platform stabilization, data integration, and enhanced safety and security."

This content was produced with the assistance of AI translation services.