Elective care leaves some in the red

The 19-month-old daughter of Kim Sung-eun, a housewife who lives in Incheon, was born with two damaged heart valves.

The baby, Ha-won, has gone through 13 surgical operations, costing Kim and her husband 70 million won ($62,989) so far in medical fees.

The couple received some financial assistance from their parents, about 20 million won, and are now looking for a smaller, cheaper house to help pay for Ha-won’s upcoming medical fees.

Kim’s family is a typical “medical poor family” as defined by the National Health Insurance Corporation.

Under the definition by the state-run institution, a household which spends 10 percent or more of its income on medical bills is categorized as medical poor.

A study conducted in 2011 shows 20.6 percent, or 2.27 million, of households in the country fall into that group.

Experts point to health care not covered by National Health Insurance as one of the main factors contributing to the considerable number of medical poor families in the country.

Of the total costs incurred by uninsured medical fees in 2010, 26.1 percent, or 2.17 trillion won, came from elective medical service, according to the state-run body.

Elective medical care enables patients or their guardians to opt for a particular doctor based on the doctor’s level of experience, at least 10 years or more in one’s medical field, in exchange for paying 20 to 100 percent in additional medical fees.

If these elected doctors perform medical procedures, surgery or anesthesia, patients are charged 100 percent under the elective care system.

For Ha-won’s parents, of the 22.43 million won the couple paid in the first six months last year for uninsured medical treatments, 56.5 percent of the bill came from the elective medical service.

The main point of criticism against the elective medical program, which was initiated to widen medical options for patients, is that it is now mainly used by medical service providers as a means to generate more profit.

After analyzing medical bills for seven patients with heart disease or cancer who received surgeries in major university hospitals in Seoul, the portion of payment for elective medical care comprised half or more of the medical costs.

A 65-year-old heart disease patient surnamed Yun, who received surgery early this month in a Seoul hospital, was charged 3.93 million won for the elective care, more than half, or 55.4 percent, of his total medical fees.

As hospitals have realized that providing the elective service results in more revenue as medical items under the program are uninsured, major medical institutions are presenting their doctors as qualified for the elective care.

At Hanyang University Medical Center in Seoul, eight in 10 doctors there are designated in this category.

Under law, a medical institution can designate up to 80 percent of its doctors as qualified for the uninsured medical care.

For hospitals, limiting the scale of elective care to ease the financial burden for patients means an increased financial burden for themselves.

For Seoul National University Hospital, profits generated from the doctor-appointment system amounted to 59.1 billion won in 2011, accounting for 9.1 percent of the total medical revenue that year.

“The elective care payment was introduced with the intention to make up for the low-paying medical payment systems [because of the national insurance coverage] for medical service providers,” said the head of a university hospital in an interview with the JoongAng Ilbo, who requested anonymity.

“If we were to end the elective program, a raise in general medical fees would be inevitable.”

Shin Young-suk, vice president of the Korea Institute for Health and Social Affairs, proposes an introduction of a deferred payment system in the medical industry.

“The focus should be placed on the quality of medical treatments. Current systems, in which patients pay prior to receiving elective service treatments, have many flaws,” says Shin.

“Doctors who are proved to treat patients better than others following the objective treatment evaluation should get paid more through the deferred payment system.”

By Special Reporting Team [jkkang2@joongang.co.kr]