The Jigsaw Puzzle of Medical System Reform

The jigsaw puzzle originated in Great Britain in the 18th century. The puzzles were then used as educational aids to teach geography. Maps were drawn on wooden boards and cut into irregular pieces that formed a picture when placed together. In order to cut the curved shapes, a jigsaw, a special saw with a narrow, vertically mounted blade, was needed. Leaders of the second generation of the British Empire were taught to manage and govern their colonies by fitting together a jigsaw puzzle of the world.

When one piece is not placed in the right spot, the big picture, consisting of innumerable pieces, is not completed satisfactorily. Completeness is the exquisite beauty and the difficulty of the jigsaw puzzle. When all the pieces find their proper places and fit optimally together, the picture is complete.

The endless dispute between doctors, pharmacists and the government calls to mind an incomplete jigsaw puzzle endeavor. Everyone is struggling with the pieces to put together a new big picture for the medical system based on the separation and distinction between medical and pharmaceutical practices. The puzzle cannot be easily solved, however. Everyone is making their best efforts to complete the puzzle, but in vain. It seems like a puzzle designed to never be completed.

The idea to make a new picture by changing a few pieces of the puzzle is baffling from the start. If the modified pieces are forced to fit together, the picture is not really complete and the image is distorted.

In order to complete a puzzle with a new picture you must go back to the drawing board and sketch the design from the beginning. That is why reform is invariably difficult and perplexing.

France is considered to have one of the best medical and national healthcare systems in the world. The separation between medical and pharmaceutical practices is consistent and thorough. The expense, however, is considerable. The basic foundation of the French medical system is a social agreement that the employers, i.e. the owners of the companies, would foot the healthcare bill.

For an employee whose monthly salary is one million won ($900), the employer must pay 128,000 won ($112) in medical insurance fees in addition to the salary. The employee pays only 7,500 won in medical insurance fees.

France’s costly medical system has been successfully maintained in this way. Doctors are guaranteed high incomes, which is agreed upon as a social standard. Doctors earn about 6.4 million won ($5,800) per month on average. Patients are refunded 70 percent of their examination fees, 65 to 100 percent of medicine costs, and 80 percent of hospitalization bills.

If we truly shared the will to realize a separation of medical and pharmaceutical practices, we shoud have started from the groundwork of a functional medical insurance system. It is unavoidable that the public will pay the substantially increased costs of medical insurance. The government tries to force the puzzle finished after pushing through a separation of medical and pharmaceutical sectors, without a national consensus to determine who will pick up the tab.

The hospitalized and the sick are only suffering more because of the ill-effects of this slovenly reform.

by Bae Myong-bok