[Outlook]Fast forward from 1977

National Health Insurance was introduced in 1977 when Korea was about to overcome poverty by achieving a per capita income of $1,000. It has now entered its 30th year.
In 1989, only 12 years after the introduction of medical insurance, Korea had achieved its target of providing health insurance benefits to all Koreans and boasted of it to the world as a record-breaking achievement, something equivalent to Korea’s rapid economic growth.
In July 2000, the regional insurance societies and employee insurance societies were integrated into a single insurer, the National Health Insurance Corporation.
If we take a deeper look at the health insurance system, however, we will realize that it is not that easy to boast about the nation’s health insurance coverage.
Many people agree that Koreans pay fewer medical fees and lower health insurance premiums compared to advanced countries. But if we compare the situation at hospitals and medical clinics in Korea with advanced countries, the story becomes a totally different one.
In Korea, patients do not get proper explanations of the health problem they have or the results of diagnoses. They do not have confidence in the medical personnel who diagnose them.
Therefore, patients who are not satisfied with their first medical treatment often visit other hospitals or doctors, and this practice of visiting different hospitals is spreading widely among Korean patients.
As a result of this, the number of visits Korean patients make to doctors in a year has exceeded two times that of American or British patients.
Since Korean patients pay low medical fees, Korean hospitals and clinics can make ends meet financially if a doctor accepts over 80 patients per day, not 30 to 40 as doctors in advanced countries do. This, in turn, makes it difficult for the doctors to give enough explanation to patients.
After integrating the national health insurance societies into one, the financial burden on the national health insurance system has increased rapidly.
Accordingly, the health insurance premiums people pay have also been raised annually. Moreover, the burden on employee policy holders gets bigger than that of regional policy holders due to incorrect premium calculation methods.
One of the reasons behind the rapid increase in the cost of insurance is partly the increase in wages for employees at the insurance corporation. But it also lies in the absence of standards for the management of medical fees after integration and in the bureaucratization of the corporation.
The fundamental reason for the problem lies in the fact that the basic framework that operates the health insurance and medical system is locked in the paradigm of 1977. The paradigm of 1977 is the framework that was provided to facilitate the basic medical service for the whole population at a time when our per capita income was $1,000.
In order to facilitate the expansion of medical insurance coverage to local residents whose income was difficult to calculate, there was no other way but to lower the medical insurance premium. Also, the egalitarianism that allows all people to use the medical services provided by medical insurance was the ultimate virtue. In order to achieve this goal, it was necessary to integrate the finances of different medical insurance societies. The government forcibly integrated them without unifying the methods of calculating insurance premiums.
The paradigm of 1977 was formed at a time when we were busy satisfying basic medical needs. Our medical service was standardized downward, and the health insurance system has becomeunsatisfactory for both patients and service providers.
In the era of a $20,000 per capita income, people will welcome a new system if a new framework equivalent to the time is provided.
First of all, we have to get rid of the medical service’s blind point by providing free medical service, instead of health insurance coverage, to people one class above those who are protected under the Medical Protection Law.
On the basis of this, we must enhance the efficiency of health insurance by introducing the principle of free competition.
People’s right to choose medical services from institutions outside of the health insurance network should be guaranteed. And a new system that will allow the use of private health insurance should be provided. We have to now get rid of the old practice of providing cheap medical services to a large number of patients.
At the same time, we have to develop a view that medical service, which is both a technology-and labor-intensive industry, should play the role of a new industrial growth engine that will lead Korea in the 21st century, instead of being held hostage to stubborn egalitarianism.

*The writer is a professor of health administration at Yonsei University. Translation by the JoongAng Daily staff.

by Lee Kyu-sik