[EDITORIAL] Reforming Medical Reform

Thanks to the government and ruling party's hasty policy decisions, the national medical insurance system is on the verge of financial collapse. Estimates of how much money would be needed were wrong, and every time the problem of reforming the medical system to separate treatment from the dispensing of pharmaceuticals came to a head, the administration avoided facing the core issues and based its decisions on political considerations, resulting in today's financial fiasco. Before the medical system reform was carried out, the administration and ruling party kept insisting that the reform would not result in greater insurance expenditures, but just a month before the reform plan was to take effect, the government changed its tune, saying that an additional 1.5 trillion won ($1.2 billion) would be needed. But according to a report issued Friday by the Ministry of Health and Welfare, the insurance system will go 4 trillion won in the red this year, of which 3.7 trillion is accounted for by expenditures incurred as a result of the reforms.

Last July, when the reform was put into effect, the ministry announced that there would be no change in the amount a patient pays himself for treatment and medication. In other words, for a doctor™s visit that cost 12,000 won or less, the patient would continue to pay only 3,200 won directly. Then in December, legislation was proposed that would raise those figures to 23,000 won and 4,000 won, respectively. This met with opposition on the part of the Millennium Democratic Party, and the out-of-pocket payment was changed back to 3,200 won, but now on bills of up to 25,000 won. It is estimated that this will cost the insurance system an additional 800 billion won per year. Payments have continued to increase as high-priced items such as CAT scans were included in the coverage and 180-day-per-year limit convalescence allowances was dropped. It is apparent that the administration has used the insurance system as a political tool, showing generosity to the electorate while ignoring the financial problems.

In the meantime, payments to doctors have also been raised to assuage their dissatisfaction with the loss of the right to dispense drugs. There have been three such raises since the reform took effect, for a total increase of 22.7 percent. Last year, insurance payments to pharmacies were 13 times greater than in the previous year, and payments to clinics were 52.2 percent higher. In view of the fact that the reformed system was in place for only the last six months of last year, it is obvious that this year's totals will be far higher still.

The government now has to find a prescription for curing the ailing finances of the health insurance system. The system of reimbursing doctors and the breadth of coverage should be thoroughly analyzed to find ways to plug unnecessary leaks. And as we have pointed out before, the merger of the workplace medical insurance and the regional medical insurance systems, scheduled for January 2002, should be reconsidered. Though it was originally believed that the merger would lead to lower premiums and more stable finances, since then the workplace system has also reached a state of crisis. Ways must also be found to cull out medical facilities' false or excessive claims and to collect full premium payments from all who are subject to them.

The Ministry of Health and Welfare says that early next week it will apologize to the public and announce a plan to deal with this financial crisis. An apology, however, is not enough. To avoid repetition of this problem, the lines of responsibility must be clearly drawn and all involved must be strictly held to account.