[NOTEBOOK]Health Care Standards For Better Care

What would happen if you went shopping for television sets and found that the quality of sets of the same make differed at every sales outlet you visited? It goes without saying that the manufacturer would have to explain itself and compensate customers.

Can such equalization of quality be achieved in the medical sector?

Dr. Earnest Codman, a U.S. surgeon in the early 20th century, tracked his patients and analyzed the effectiveness and side effects arising from his surgical methods. After conducting the study, Dr. Codman in 1910 made public his treatment record and proposed that the medical community set standards for medical care.

His proposal was neglected by the medical community for more than 40 years until the U.S. Joint Commission on Accreditation of Healthcare Organizations came into being in 1951.

The independent, non-profit organization evaluates and accredits nearly 80 percent of health care organizations and programs in the United States. Hospitals undergo the evaluation voluntarily and shoulder the expense because the certification they get from the evaluator serves as a standard for customers in deciding which hospital to select.

But even in the United States, which has such a thorough appraisal system for medical institutions, 40,000 to 98,000 people die every year from bad medical care. This figure, released by the U.S. National Academies' Institute of Medicine, only takes into account deaths attributed to preventable medical mistakes such as doctors' misjudgments or negligence.

If deaths that resulted simply from patients not receiving top-quality care were added, the number would be far greater.

What is the situation in Korea? Korean people still have a great penchant for "doctor-shopping," looking for excellent doctors. That is a legacy of traditional Oriental medicine, where doctors pride themselves on their "secret formulas." Why are Koreans sticking to the old habit when they are looking for doctors of modern medicine educated in exactly the same science?

The reasons can be summarized in two points. One is that the quality and effectiveness of care vary among doctors and hospitals. In other words, the fate of a patient depends on which medical institution or doctor he chooses because medical care is not standardized or equalized.

The other reason is that hospitals and doctors do not make public their track records. Patients are running about in confusion, looking for a false image of an "excellent doctor" because they do not have access to information about doctors and hospitals.

Industrial countries have been developing guidance for clinical treatment since the 1980s, trying to assess whether doctors' treatment is effective (efficacy of clinical treatment), whether there is any gap in the standard of treatment offered by doctors and hospitals (standardization of treatment) and whether treatment is cost-effective (economy of medical care).

Let's compare the United States, which has established clinical guidelines, with Japan, which has not. For operations on patients with myocardial infarction, Japan shows a success ratio of 90 percent, with an average hospitalization of 25 days, while the United States recorded a 98 percent success ratio with one week of hospitalization. Clinical standards contribute absolutely to saving expenses as well as enhancing the quality of medical care.

I regret that government measures to save on medical costs seem to focus solely on detecting false or illegal medical bills claimed by doctors. Such measures may help reduce leakage in the finances of the medical insurance system. But how can the government bridge the chasm of distrust between doctors and patients?

Isn't it more urgent that the government sets standards for evaluating proper care to ensure economy and efficiency before pointing the finger at doctors?

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The writer is deputy information & science news editor of the JoongAng Ilbo.

by Ko Jong-kwan