[EDITORIALS]More rumbling at hospitals

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[EDITORIALS]More rumbling at hospitals

At a seminar organized by the Health Insurance Review Agency, a Ministry of Health and Welfare arm, medical practitioners voiced their unhappiness with the proposal to cut the medical fees paid by the National Health Insurance Fund. Their dissatisfaction is understandable; this was the first such debate on medical fees since medical insurance was introduced in 1978.

Reduced national insurance payments will affect not only the finances of medical institutions, but also opens the question of whether doctors would be able to provide proper medical care. For example, if fees to treat an ulcer are covered only if the ulcer is over 1 centimeter in diameter, "Do I treat the condition after I let it grow worse?" sounds like a natural question.

Several cases of such unreasonable standards were presented in each medical field. The standards for payment reviews are ambiguous and inconsistent and because they do not reflect advanced medical techniques, patients are seldom given proper medical care. Unreasonable standards can also trigger competition to hire doctors with higher qualification. This will put more financial pressure on the medical insurance.

The National Medical Insurance Corporation must contain costs, of course. Considering the insurance fund's expected deficit of over 780 billion won ($610 million) this year, expenditures must be controlled reasonably. That was also the reason that the Health Insurance Review Agency refused to pay hospitals for medical services they provided to patients who had almost no hope of recovery. There are suspicions of excessive medical treatment and inflated bills. Last year, the review agency cut 1.3 percent, 247 billion won, out of bills presented by hospitals.

At a seminar sponsored by the National Cancer Center, participants complained that the government limits treatment by imposing strict controls on expensive cancer treatments because the insurance system is in dire straits. One expert even confessed that he had no choice but to treat 90 percent of his patients illegally. Medical circles and the government must work out reasonable solutions. Standardized medical care guidelines could be one of them.
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